FAQ

Why does warm weather worsen your lymphedema?

by Dr. Zsolt Zatrok 2023-06-12

If you suffer from lymphedema, you may have noticed that your symptoms get worse in spring and summer due to the warm weather. While the swelling is quite tolerable throughout the fall and winter, the situation gets worse as the warm weather arrives. Why is this so and what can you do about it?

As a starting point, please read my article titled “Why does the lymph accumulate in lymphoedema? …and why does it accumulate over and over again?”.

From this you may learn that lymph is formed every day, both in winter and summer, unstoppably. The lymphatic system is responsible for collecting the lymph and returning it to the bloodstream. If the lymphatic system is struck by any disease or is injured (in an accident or more often during surgery), it will not be able to remove all the (accumulated) lymph. This causes swelling, or in other words, lymphedema.

The relationship between lymphedema and temperature

Your blood circulation also plays a role in regulating your body temperature.

During the cold period of the year, the blood vessels in the skin constrict, which reduces heat loss. The narrower blood vessels receive less blood and therefore less lymph is formed. The lymphatic system can “cope” more easily with this amount of lymph.

If the warm weather arrives or you go to a warm heated pool or take a warm bath, the opposite process happens. The blood vessels dilate, receiving a lot of blood, which generates more lymph. At the same time, you body dissipates more heat, which cools your body. Larger amounts of lymph can already exceed the load capacity (i.e., transport capacity) of the lymphatic system. /In an undisrupted, healthy system, the transport capacity exceeds the lymphatic load (by almost 10x)/. If the lymphatic system cannot carry away the excess amount of lymphatic fluid, it appears in the form of edema.

Treatment of lymphedema

You need to treat the symptoms of lymphedema as often as necessary in order to bring the swelling back close to normal.

If the lymphatic system just fills up slowly, it means that it is less damaged. In this case, bandaging, wearing compression stockings, and performing manual or mechanical massage every few days may be sufficient.

However, if the edema returns within a few hours, the function of the lymphatic system is severely impaired. In these cases, bandaging, wearing compression stockings are the “base” (treatment modes). In addition, manual or mechanical massaging may be necessary up to several times a day. Clearly, in such serious cases, performing multiple daily manual massage therapies is not feasible. On the one hand, the masseur is not available every hour of the day, and on the other hand, it would put a significant financial burden on the patient. Therefore, purchasing a state-of-the-art compression therapy unit is essential in the home treatment of rapidly recurring edema. Your investment will pay off in a few months.

What should you do in warm weather?

As a patient suffering from lymphedema, you’ll definitely enjoy the caressing sunshine, but the warm weather “is not your friend”!

A bandage or compression garment can feel a real “prison” in warm weather. Due to the larger amount of edema, the elastic material squeezes it even more, this time of the year it feels even more uncomfortable and harder to cope with it. The unanimous recommendation of vascular specialists treating patients with lymphedema is as follows: compression clothing is needed also in the warmer months.

Some tips for enduring warm weather

Schedule the outdoor activities for the cooler early morning and evening periods! Stay in the shade in a cool place during the hottest part of the day.
Wear compression clothing despite the heat. If you follow the above mentioned recommendations, you can take it off during the hottest periods.
Your clothes need to be absorbent to absorb your sweat.
Wear light, well-ventilated clothing.
In warm weather, often rest with your edematous limb(s) elevated! Avoid dangling the limb, do not stand or sit for too long.
Cool your limb(s) often with a cold, damp towel (but do not soak the skin).
Avoid sunbathing!
If you do go out in the sun, protect your skin by applying a sunscreen.
Go swimming! But not in warm water pools. A swimming pool filled with 24/25 degree water is the best.
Instead of swimming, you can also do water gymnastics. The water in the swimming pool can be cold, 26-28-degree water is suitable for these purposes.
When swimming in a lake, river or sea, always wear protective shoes to avoid injury to your affected limb(s) (due to danger of developing erysipelas).
Protect yourself from insect bites! The bites increase the risk of infection.
Avoid using the bathtub! Choose to shower in lukewarm, or at most body-temperature water!
Avoid salty foods and minimize caffeine and alcohol consumption!
Exercise daily to stimulate lymphatic circulation.
In the cool of the day (in the coolest part of the day), walk, swim, cycle at a slow pace.

Other recommendations

If you have lymphedema, you may have noticed that after taking a sauna or a hot tub, the body area affected by lympedema gets reddened and swollen. This is due to the vasodilating effect of heat. Neither the heat of the sauna nor taking a long hot bath is good for you!

In mild to moderate lymphedema, the specialists may not prohibit them, but please, be reasonable!

Spend a maximum of 10-15 minutes in the sauna! Also shower only for a few minutes and do not set the water temperature above 38 degrees Celsius!

In severe edema, especially in complicated cases, you should completely avoid the “hot pleasures”.

And if you don’t have a compression therapy unit for home treatment yet, then you might want to consider purchasing one.

Even before the warm season arrives!

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FAQ

Electrotherapy and implants

by Dr. Zsolt Zatrok 2022-11-09

Electrotherapy treatments (e.g. TENS, EMS, FES, MENS) can now be performed at home without risk. However, many people are afraid of these treatments. They do not know whether they should be performed near or directly above implants or metallic fixtures. How scared should they be? What is the truth?

There are two types of implants

ACTIVE implants. These include pacemakers, defibrillators, insulin pumps and others. These are battery-powered devices that are “implanted” under the skin.
PASSIVE implants. Most commonly used to fix bones, such as a marrow pin, screw, plate. But they can also replace a complete joint (e.g. knee, hip)

Active implants

Active implants are electrically powered. Pacemakers and defibrillators, for example, monitor the electrical activity of the heart and intervene if they detect abnormal heart activity that could be life-threatening.

Any external electrical impulse can interfere with these devices!

So the pacemaker may not detect the slowed heartbeat and “let the patient die”. Or the defibrillator may detect the high-frequency TENS pulses as arrhythmia and deliver an electric shock when it should not.

In the case of active implants, the use of any electrotherapy treatment is always PROHIBITED. This is an absolute contraindication, no exceptions!

Passive implants

There is a long-standing prohibition on passive implants. It is based on the assumption that a metal implant can be “significantly” heated by an electric current. This could have a detrimental effect on the tissue surrounding the implant. In particular, it could damage bone marrow and periosteum.

At the time when this opinion was formed, iron and steel alloys were still mostly used and electrotherapy devices were imperfect.

In the meantime, the materials used for implants have changed completely and electrotherapy devices are much more precise.

Today, titanium and other light metal alloys react differently to electricity and magnetism. Despite this, you’ll find a prohibition in the description of every electrotherapy device in the home: don’t use over implants.

Some electrotherapy methods should not be used at home!

There are a number of treatment methods whose main effect is heating and the changes this creates that produce the healing effect.

Examples of such treatments are shortwave, microwave, TECAR, diathermy, continuous ultrasound, medical laser. Their inappropriate use could even cause harm.

These treatments, however, cannot be done at home, but only in an institute by a professional! Draper and colleagues have shown that relatively high-power, pulsed, short-wave treatment had no harmful effects on metal implants in the treated area (Draper et al., 2004). In other words, in the right hands, even otherwise harmful things can be “tamed”

Summary

Laws do not allow you to buy medical therapy equipment for your home that could be used to do harm.

Electrotherapy, ultrasound, soft laser, etc. devices that you can buy for personal use are safe to use. Of course, if you use them with the express intent to harm, disregard the instructions for use, and for a medical condition for which they are not intended, then it is a different story. But if used as intended, you can do no harm!

Follow these instructions:

If you have an active implant, the use of any electrical treatment is prohibited. Even if you really need it.

In the case of passive implants, the effects of electrical treatments (TENS, EMS, MENS, FES), even after prolonged use, will not have any harmful effects on the implant or its environment. Home electrotherapy devices can be used with or over any passive implant.

If you are still unsure about treatment, you should seek advice from a physiotherapist experienced in electrotherapy treatments.

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Multimodale Behandlung - was bedeutet das?

Multimodality treatment – what does it mean?

by Dr. Zsolt Zatrok 2022-05-07

To treat a single complaint, a doctor may usually recommend several different treatments. This may involve different modalities. For example, medication, physiotherapy treatments, possibly surgery, as well as dietary advice and exercise guidance. Each of these will have a different effect on your body and your recovery. Some are stronger, some are milder. Used together, they work better than just one of them. Multimodality treatment is given to you to ensure that the different methods work together to complement each other and produce better results.

No “gotcha”

You probably already know that as many people as there are different cases. Even between identical twins there are differences. In addition, everyone lives differently, eats differently, moves differently, etc.
Because everyone is different, there is no single “magic bullet” for treating illness. There is currently no single medical method that works in the same way for all patients and leads to a complete cure.

All patients have different needs and different symptoms.

This is why everyone needs personalised treatment. It is impossible to predict which treatment will be best for a particular individual. For example, two patients with the same complaint may respond differently to the same drug or treatment. One may get relief after the first one, while the other may get worse.

Multimodality treatment – more effective together

Today, the treatment of certain diseases is mostly multimodal. The doctor does not recommend just one method, but several at the same time. Well “mixed” treatments reinforce each other’s beneficial effects and speed up recovery.

A simple example. If you want to make a birdhouse but you only have a hammer, it will never be finished. You need a saw to cut the boards to size. You need a drill to make a hole. A hammer and nails to fasten the boards together. A hook to hang it on a branch. With these you can assemble the birdhouse. However….. you have all the tools, but you use them incorrectly – the hammer to cut, the saw to drill – the result will not be good.
The emphasis is on using the right tools in the right way and in the right order! That’s the only way to get it done.

Sickness management is the same. The point of treatment is to “mix the right tools” and methods in the light of the complaints, symptoms, co-morbidities and test results.

With no way of predicting how the patient will react, there is the potential for error! They may not find the most optimal combination for you the first time. Once a treatment has started, monitoring is very important. On the basis of experience, the doctor may suggest changing some methods or changing the dosage.

This way, the most optimal treatment “package” can be found in a few “steps”

For each condition, there may be differences in what to use first and which can be used together.

Thousands of possible combinations

Guiding treatment is a medical responsibility, but you have a role to play too. It’s not enough to just sit in your armchair and take your pills. Only you can implement the diet and exercise recommendations. If you rely only on pills or surgery and “do not do your bit”, you are less likely to succeed.

The success of multimodality treatment depends heavily on whether you do the parts that apply to you. For your own good…

Example of multimodality management

If you spend all day hunched over in front of monitor, by the end of the day your neck and back will start to burn and ache.

If you take a painkiller pill, it may have a momentary effect, but it will hurt again tomorrow. After all, symptomatic treatment does not eliminate the cause of the pain.

Your complaints are caused by poor posture throughout the day, because your back isn’t properly supported by the chair, and the monitor is in too low a position – so you sit in a hunched position for prolonged periods. Your neck, shoulders and upper back muscles are therefore constantly strained, while your pectoral muscles stiffen. This makes your neck arch forward, your back hunch and your shoulders slump. You feel a tensing pain in your muscles.

But you can be sure that painkillers won’t do much for you. The multimodality approach suggests that you need to do several things to get your symptoms to go away completely.

Replace your chair with one that supports your back.
Lift the monitor up – the centre of the monitor should be at eye level
Take a break for a few minutes every hour and move your pecs and back muscles through some exercises
Occasional massage will speed up the resolution of complaints
Use therapeutic ultrasound to relax stiff muscles
Use muscle stimulation to speed up muscle recovery
Exercise daily to strengthen your neck, back and pectoral muscles

If you don’t do it, your complaints will be constant and plague you every day. If you apply them all at once, the beneficial effects add up and together they produce a rapid – and lasting – improvement.

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FAQ

Definition and significance of dermatome

by Dr. Zsolt Zatrok 2022-05-07

The dermatome is a section of the body surface that is occupied by nerves entering and exiting a particular spinal vertebra. Based on your complaints, your doctor can identify which vertebrae are the cause of the problem.

For example, if you have pain in the back of your upper arm and in the back of your hand, index and middle finger areas, you may have a problem with an exiting/retracting nerve under the 7th (C7) vertebra in your neck. This is where to look for disc herniation, calcification, fracture, slippage, etc.

This is why, in the case of arm pain, you may have an x-ray of your neck instead of your hand.

If you are not familiar with dermatomes and how the spinal nerves “mesh” with your body in such a band, your pain may be deceiving you. One of the most common examples is sciatica. In which the pain is on the back of the buttocks or thighs. However, the treatment does not treat your thighs or buttocks, because this is where the pain “just protrudes”. The lumbar-thoracic junction is the “area of competence” of the S1 vertebra. Therefore, treatment of sciatica is directed at the lumbar spine.

Knowledge of the dermatomes is also important when using anaesthesia in the spine (epidural anaesthesia). The doctor uses the dermatome map to decide which nerve roots need to be blocked in order to achieve the anaesthetic effect in the surgical area.

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FAQ MileStone

Electricity – the basic nature of the human body

by Dr. Zsolt Zatrok 2021-09-15

If electricity didn’t exist, you wouldn’t be reading this article. Not just because your computer wouldn’t work, but because without electricity, neither would your brain! Every movement, every thought, every emotion is based on electrical signals. These are what enable, control and direct the functioning of your body.

Memories from physics class

In physics class you learned that everything is made up of atoms, which are protons, neutrons and electrons. Protons are positively charged, neutrons are neutral, and electrons are negatively charged. If they are not in balance, the atom is either positively or negatively charged. The difference in charge is what allows the electrons to flow, which creates the electric current.

Because your body has many, many atoms, together they can generate electricity. You could jokingly say that your body is an electricity plant (too).

What does the body use electricity for?

When your brain “tells your hand” to hold the cup, your brain sends “signals” through nerves to your hand muscles to contract. These are entirely electrical signals. Just like when an image you see from your eyes is sent to your brain or your thoughts are bulbous.

Every cell in your body is electrically powered, so electrons don’t travel along wires (like in machines), but the electrical charge “jumps” from one cell to another connected to it to reach its destination. For example, from one nerve cell in the brain to another in the spinal cord, and from there to the muscle. The electrons are transported by the electrical impulses from one cell to another, and from there to the muscle.

Electricity is the key to your survival!

Electrical signals are very fast and this ensures that “control” messages are transmitted extremely quickly, almost instantaneously. This allows you to jump out of the way of an unexpected emergency, pull your hand away if you get stabbed by a spike or burned. If the control for this were only chemical reactions, i.e. you had to move chemicals to issue a command in such cases, you’d die quickly (or in mild cases, you’d burn your finger badly because you couldn’t catch it in an instant on a hot surface)

Your heart is also under full electrical control. The sinus node in the right atrium of your heart regulates your heart function throughout your life. Firstly, it has an automatic mechanism that triggers the heart to contract 60-80 times a minute. On the other hand, it raises and lowers your heart rate as needed. For example, when you run, your heart rate rises because of the increasing demand for blood. When you stop, it decreases.

What causes body electricity?

When you are not transmitting a message, i.e. you are at rest, all the healthy cells in your body have a slightly negative charge.

This occurs because there is a slight imbalance of calcium and sodium ions between the inside and outside of the cell (i.e. the two sides of the cell membrane). This is the membrane potential of the cell, which is on the order of -30-50 microvolts.

In the cell, there are more potassium ions than sodium ions, while sodium ions are in the majority. Potassium ions are negative, so the inside of the cell is slightly negatively charged. Sodium ions are positive, so the outer surface of the membrane is positive. The charge difference is so small that there is no electron flow and the cell does not produce electricity.

If, however, a “message” needs to be transmitted, the “balance is upset”. This is a very complicated mechanism called a sodium-potassium gate or pump. In very simple terms, when a cell receives a pulse from the cell next to it, the gate is activated and releases ions. The negatively charged potassium ion leaves the cell because it is “attracted” to the positivity outside the membrane. Positively charged sodium ions, on the other hand, move towards the negative charge inside the cell. Therefore, the concentration of the two types of ions changes, the “flip” between positive and negative generates an electrical pulse.

This pulse triggers a similar process in the next cell, creating another charge and so on. In this way, an electrical impulse moves until it carries, for example, a pain stimulus from the toe to the brain. The same thing happens when your sinus node causes your heart to contract faster, or when the image your eyes perceive reaches your brain.

What if the control fails?

With all bodily functions relying on electrical signals, any malfunction in the body’s electrical system can lead to serious problems.

For example, a shock or lightning strike can “blow a fuse” that stops the body’s normal electrical functioning (much like a power failure in an appliance).

Of course, there are also less serious electrical problems that lead to a variety of complaints. A disease of the sinus node can cause “misfiring”, i.e. the heart “forgets” to contract, missing a beat. Or, on the other hand, the sinus node may cause a rapid heartbeat when you are in bed and should not have a high heart rate. The electrical impulse that triggers a vasospasm can cause a blood supply disturbance, which can lead to strokes or heart attacks. Mild regulatory disturbances include hypertension of unknown origin or, for example, cold palm sweating.

If electricity is so fundamental, why is it treated with medicine?

Good question! It is clear that today’s medical treatments are overwhelmingly drug-centric. Increasing numbers of people are taking some kind of drug every day. But they have little effect, because the number of patients is not decreasing, but the statistics prove that the number is increasing. If drugs were a cure, they would have to decrease! Rather the trend is not to eliminate the cause (the electrical dysfunction) but to suppress the symptoms. The consequence of this is that most of the drugs have to be taken for the rest of life because they do not cure it.

This was not always the case. Natural remedies (manual therapy, herbs), natural energies (light, ultrasound, magnetism, etc.) and electricity were almost on a par until the middle of the last century. Since then, they have been gradually supplanted by the pharmaceutical industry. And over the last 50-80 years, the pharmaceutical industry has become one of the world’s biggest businesses (after oil, energy and banking).

Some interesting facts about body electricity

Dr Harold Saxton Burr believed that “electricity is a fundamental property of all living organisms”. He demonstrated through a series of experiments that living organisms are surrounded by an invisible electric field, measurable on the microvolt scale, whose changes indicate both healthy functioning and disease states.

Dr. Robert Becker (1923-2008) conducted similar studies, successfully measuring the electrical potential of the cell membrane.

The theory of “injury current” is associated with his name. The theory is based on the theory that when tissue is injured, the electrical charge balance of the cell membranes is disrupted and tissue function stops. The energy production of diseased (injured, inflamed, damaged) cells, protein synthesis and thus regeneration and healing processes also stop. Dr. Becker found that the electrical charge in damaged areas becomes positive and then slowly returns to a balanced, zero value during the healing process.

He began studying salamanders, amphibians known to be able to regrow their lost tails and even limbs. He noticed that in these animals, the charge in the damaged tissue did not return to zero, but became negative. In a study published in 1972, he reported that he observed similar processes in experimental rats that had lost a limb after electrical stimulation as in salamanders. Despite the fact that rats in nature do not exhibit “limb-retraction”.

Radiologist Dr Björn Nordenström analysed about 7,000 chest X-rays and noticed that around the lung tumours there was a clearly defined area 2-3mm wide, which he called a corona (because it was similar to the corona phenomenon around the sun). He was able to show by targeted studies that there was a significant difference in the electrical potential at the boundary between diseased (tumour) cells and intact tissue. His best-known work is the development of an electrical treatment procedure for lung tumours. He was awarded the Nobel Prize for this method.

Recent research based on the above suggests that Becker’s lesion current can be eliminated by microcurrent treatment. This restores cell function and increases energy production by up to 5-8 times. This is the basis of healing.

This in itself could be of huge significance in the treatment and regeneration of chronic inflammation and wear and tear joint disease.

I think the above may already make my point: since your body is entirely driven by electricity, research into electricity should play a much bigger role in the development of disease and of course its treatment.

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why does lymph accumulate again and again

Diseases FAQ

Why does the lymph accumulate in lymphedema?

by Dr. Zsolt Zatrok 2021-03-30

You have lymphedema. You wear the compression stockings regularly, see your therapist every week for manual lymphatic drainage, but barely see any results …you don’t understand why the swelling doesn’t decrease, and why the lymph production does not just stop. Let me explain it.

Lymphedema is not curable today, meaning it can not be cured permanently despite all the treatment efforts. You should carry on with the treatments to prevent swelling and reduce limb circumference to a level close to normal.

The lymph is formed during each heartbeat, unstoppably as long as your heart beats!

This is absolutely normal. This is the case for all people. Those with a healthy lymphatic system do not develop swelling.

In a lymphatic disease, the collection and transport of lymph is problematic. Therefore, as soon as you stop a treatment, it will start to accumulate immediately. For some people, the accumulation process is slow, while others are less fortunate and their edema returns even within hours.

You should treat it as often as the edema recurring regularity requires.

How is lymph formed?

When your heart beats, it pumps out blood into your arteries, which deliver it all the way to your cells. Cells take up the substances from the blood that they require for their operation, and release waste materials they do not need.

Your veins collect this “used blood” and return it back to your heart. “Along the way”, your blood flows through your liver and kidneys, which filter out the toxins from it, finally with the help of your lungs, your blood gets “mixed” with fresh oxygen. From the lungs, your blood enters your heart again, which pushes it through the arteries into your body again.

Your arteries are strong and your heart is actively pumping your blood into them. However, your veins are “less efficient”. They cannot bring back all the fluid brought by the arteries. A little fluid stays between the cells (in the interstitial space), in your body after each heartbeat.

This is the “residual” lymph

Your lymphatic vessels are “responsible” for collecting the rest (residual lymphatic fluid). These above-mentioned vessels collect it, the lymph nodes filter out the pathogens from it, and eventually, get them back into your bloodstream.

In a healthy state, your veins and lymphatic vessels together collect (without leaving any residual lymphatic fluid) the amount of blood pumped through the arteries. Thus, by draining the interstitial fluid that collects in tissues, no swelling develops.

When does the lymph begin to accumulate?

Swelling (lymphedema) occurs when your lymphatic vessels do not work properly and cannot perform the “task assigned to them”. After each heartbeat, a little extra fluid remains that stays there. It accumulates slowly, multiplies, and becomes visible over time. It causes tension slowly. If the affected area/limb is very tense, it will cause you pain.

The lymphatic vessels cannot do their job if, on the one hand, they are congenitally poorly developed (you were born ill). But, on the other hand, as more often is the case, the lymphatic vessels may become damaged, destroyed, or occluded in an accident, or even more often times, during medical treatments (surgery, radiation therapy). And if there is no (vascular) channel/not enough channels, through which the lymph could be carried away, it stays in place and multiplies…

We are not yet able to “manufacture” new lymphatic vessels. Once ruined, they cannot be replaced. That is, the affected area/limb will always swell.

The balance may “break” for other reasons, too.

For example, if certain veins are removed or occluded in a limb during varicose vein surgery, then the (remaining) veins will no longer perform their function properly. This happens due to a decreasing venous capacity, thus more tasks will remain on the lymphatic vessels. But they have a certain capacity. In this case, your body cannot drain, collect the lymph and transport back to the heart due to the missing veins. The consequence is the same.

Drastic, surgical eradication of your crooked varicose veins can lead to braking the lymphatic balance and the formation of lymphedema.

What follows from this?

Because lymph production is an unstoppable process, from heartbeat to heartbeat, the development and onset of swelling is only a matter of time.

Luckily, it takes 1-2 days for you to start feeling the tension. Others are not so lucky, because in their bodies, the previous situation recur quickly, even 1-2 hours after stopping the treatment.

You should handle this situation and manage your disease in a way that you take into account the edema recurring time. If it recurs only every two days, it may be enough to treat it every two days. However, if it recurs within 2 hours, you should manage it more often, accordingly.

My advices

The accumulation of lymphedema occurs just as dirty laundry accumulates in the family. Every moment someone comes and throws a used shirt/pants/socks in the laundry. It constantly accumulates. It takes you less effort if you “throw” some of your clothes into the washing machine every day, than if you waited a month and spent an entire day washing a pile of dirty clothes.

From this, you can also understand that regarding the treatment of lymphedema, it is a big mistake to wait too long. Please, do not wait until the affected limb/area becomes tense, sore or the skin over the affected region ruptures, or becomes ulcerated! The longer you let it swell, the harder it will be to “clean it up”!

You are doing it right if you watch yourself carefully. As soon as you feel the edema, treat it by applying a short duration (20-30 minutes) and low pressure (40-60 mmHg) mechanical lymphatic massage. If needed, treat up to 2-3 times a day. This is better than carrying out a long, high-pressure treatment once a week …and a thousand times better than waiting for someone to schedule an appointment for you for a manual lymphatic massage. If your edema recurs in 2-3 hours, 1-2 massages a week is simply a waste of your money. It will not improve your condition in any way in the long run (it may help only for a 1-2 hours time period right after the massage, but no longer).

There will be two consequences if you wait too long between the treatments!

The greater the swelling, the harder it is to get rid of it. A single massage session cannot significantly reduce it.
The more you let it swell (the higher the pressure/tension), the faster your condition will worsen. Proteins start to deposit in your tissues from the lymph that “sits still in one place” for a long time. In a few years time, the area becomes so firm (fibrotic) as irreversible changes happen. Finally, your lymphedema grows to such a state that the specialists no longer consider it treatable,…only suffering remains which accompanies you. Please, accept my advices, and avoid that state.

Start treating your lymphedema as soon as possible, please, don’t wait years with it. Set the frequency of treatments to the recurring time of your edema. Don’t let it swell too long untill a painful state develops, with a large edema feeling firm due to great tension. You can treat it several times a day. It is much better if you apply more short duration, low pressure treatment sessions, rather than one long session with a high pressure. You can only do so if you own a compression therapy unit yourself! If you have only the simplest 4-chamber device at home, it’s also a thousand times better than not handling the problem at all.

You have one body and the better you treat it, the better you will feel.

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FAQ

Questions about compression therapy

by Dr. Zsolt Zatrok 2021-03-14

In this article, you will find frequently asked questions related to compression therapy and lymphatic massage related.

I have an old, one-air chamber compression device, can I use it to treat my lymphoedema?

The first-generation compression devices aimed to treat the oedema of the arm, and leg, or the leg. They inflated then deflated the cuffs (compartments of the cuff) simultaneously. For a time, they also included the device among the basic lymphoedema treatment modules. However, in a short time, they reached the conclusion that simultaneous, full inflation of the cuffs (or its chambers) creates too strong pressure. This can result in damage to the lymphatic vessels, and lymph nodes over the years in congenital lymphoedema, in some cases. Thus, the lymphatic therapists expressly forbid the use of old types of pumps. Today’s latest generation compression therapy units no longer inflate all the compartments of the cuff at the same time, rather sequentially and intermittently. We can adjust the cuff pressure very precisely and thus the treatment pressure is adaptable to the patient’s condition. Use a modern, up-to-date device!

My therapist says that it is prohibited to use mechanical lymphatic massage. Is this true?

There is no single drug, machine, treatment method that works in the same way for every patient! There have always been clinicians, therapists and patients who have not received good results with the machines and do not recommend their use. However, there is only one treatment failure in hundreds of success stories giving great results. Machine therapies are not for everyone and the treatment success depends on how precise equipment you use and what settings you apply. Improper settings can cause damage (too high pressure) or yield no results (too simple device, short operating time, etc.) THE KEY IS TO BUY A GOOD QUALITY DEVICE AND PROPERLY SET THE TREATMENT PROGRAM/UNIT!

Lymphatic massage aka Compression Therapy

[message title=”Power Q-1000 Premium compression therapy unit” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

4 compression chamber cuffs
Use it equally in oedema affecting the arms or legs.
Optimal for arm swelling, developing after breast removal surgery (mastectomy)
Eliminate the feeling of heaviness of legs, and tension pains caused by varicosity.
Relieve swelling of your feet associated with varicosity in pregnancy.

[/message]

[message title=”Power Q-1000 Plus compression therapy unit” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

Home treatment of mild to moderate lymphoedema without complications
For cardiac swelling after mastectomy, this device is usually sufficient
It is effective in relieving the heavy legs and tightness caused by varicose veins
You can also use it to reduce leg swelling in pregnancy varicose veins

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My therapist says that the machine doesn’t help initiate lymph flow and even exacerbates the oedema.

That’s actually not correct! As I mentioned above, a poorly adjusted treatment can cause complications, while treating with settings appropriate to the patient’s condition can cause no harm.I reviewed the medical literature. There is no scientifically proven data or case report that would support the fact that mechanical lymphatic drainage would exacerbate the oedema. While, on the other hand, a series of studies demonstrate the effectiveness of these machines.

There is a growing perception that we should use pneumatic compression as an alternative to bandaging and compression stockings. While, in contrast, opening of the lymphatic drainage pathways should be performed from time to time with manual lymphatic drainage. I don’t consider it appropriate, if a therapist prohibits – on the basis of false, partial information, “presumption”-, a treatment from the patient that could actually help. If your lymphoedema does not receive adequate treatment, you are the one who “pay the price” (i.e., the patient is the one who pays for the consequences).

Facts prove that an intermittent compression therapy unit provides effective assistance in reducing the symptoms. The false, incorrect information can confuse patients about treatment. Despite the contradictions, there is clinical evidence that good quality and properly adjusted mechanical lymphatic massage can help hundreds of thousands of people.

It is important to make sure that your device has proper functions and pay attention to use it correctly! It’s not complicated. In my blog, you’ll find more articles, videos on the subject.

Can we apply mechanical lymphatic drainage in children?

Experts do not recommend the use of compression therapy units for infants and children under 6 years of age. For them, general decongestive therapy is advisable (a combination of bandaging, wearing compression stockings, and manual lymphatic drainage).

How important is the pressure gradient?

Devices with adjustable pressure gradients prove to be the most suitable for reducing lymphoedema. Your device is not ineffective just because it does not provide a pressure gradient, but it is less efficient than those that have that feature.

What is compression therapy and treatment like?

Unlike the vascular system, the lymphatic system has no “built-in engine”. The heart pumps blood into the blood vessels. The lymphatic system “leans on” the muscles, their contraction keeps the lymph moving. When a muscle contracts, it presses on also the lymphatic vessels and the lymph fluid, which flows upwards. The alternating compression “mimics” this natural way of the lymphatic circulation, that is, the function of the muscle pump.

I don’t move at night. How can the lymphatic circulation still work?

Your muscles are under the control of your brain. A few percent of your muscle fibers is still active and perform delicate contractions even during your deep sleep. You don’t even feel this muscle twitching (fasciculations), it’s not visible, but it’s enough to maintain the lymph circulation and, in part, the blood circulation. Therefore, the flow does not stop even during sleep.

How do I set the correct treatment pressure?

Measuring your blood pressure can be a good guiding factor. For example, if the value is 120/80 mmHg, 120 mmHg represents the occurring pressure when your heart is just contracting, squeezing blood into your arteries. And the value of 80 mmHg represents when your heart rests between two contractions.

Thus, you SHOULD NEVER SET the treatment pressure higher than this lower value! Moreover, you should set this value at least 20-30% below that. Therefore, in case of a 120/80 mmHg blood pressure, the maximum pressure in the lower compartment should be 55-65 mmHg. The pressure values should gradually decrease with each compartment in the direction of the thigh and the upper arm.

There are therapists who consider even lower (maximum 40 mmHg) pressure on the arm to be the best.

High pressure would suddenly trigger the movement of a lot of fluids, which would overload the tissues above. So if you apply high pressure regularly, it can worsen your condition over time. So a higher pressure is not a better option.

Although, there are cases, such as fibrosis, where we may need to use higher pressures to soften the solid tissues. In the event of a severe fibrotic condition, pressure treatment (pressotherapy) should be performed exclusively under the guidance of a competent therapist.

How long should I use the machine a day?

If you only have time for one treatment a day, do it before going to bed in the evening. You may have noticed that you have significantly less oedema in the morning (during sleep, it “flows out” from your limb).

If you can, divide the treatment into two parts. Do a treatment session in the early afternoon and the other in the evening.

The duration of a treatment can range from twenty minutes to up to an hour, depending on the outcome. The lower pressure will yield a result in a longer period of time. For most of the affected people, half a day, up to two hours of treatment is usually enough. Take longer treatment sessions only when the therapist recommends that.

It is better to divide the treatment procedure to several treatment sessions, because there will be less fluctuation in swelling. If you wait too long before you treat, and you have much oedema, it could be harder to reduce it. With more frequent treatment sessions, you can achieve a state when the swelling (the fluid refill) is not so pronounced.

Each case is different and requires appropriate treatment! Change your therapy only if your lymph therapist recommends it.

Can I use the lymphatic massage machine in case of ulcers and open wounds?

The lymphatic massage machine can also be used for venous ulcers or open skin wounds if there is no infection nor signs of cellulitis. Cellulitis is the superficial inflammation of the skin. (Though a person with cellulitis can also develop fever and/or swollen lymph nodes in the area of the infection) You should treat the wound or ulcer as follows: cover it with wound dressing. You need to clean and disinfect the treatment cuff after treatment.

In case of an active skin infection, inflammation (e.g., erysipelas), you should not carry out compression massage. That is because pressure waves may carry pathogens further on the skin surface, or can cause generalised sepsis, when pumping them into the blood stream.

Signs of an active infection: local swelling, pain, redness, purulence, red streaks on the skin. If you have any of these symptoms, do not use the pump! See a doctor immediately! The infection requires antibiotic treatment.

I have lymphoedema and also leg ulcer and my doctor prohibits the use of a lymphatic massage machine. Why?

Probably, this doctor didn’t think through the conditions of this medical prohibition, or didn’t know what a compression machine is for.

Lymphoedema causes tension in the leg, which causes a severe circulatory condition. The consequence of slow circulation is that the injuries to the leg showing signs of lymphoedema are easily infected and heal very badly.

If you do not get help to reduce your tense oedema – this is what the machine would do-, you cannot expect recovery. The reason for this is that it is exactly the poor circulation, which causes your oedema.

Thus, in case of an ulcer, healing can be achieved by supporting the circulation and reducing tension – that is, by applying mechanical massage.

I have visited my beautician for lymphoedema treatment, after which my legs hardened and I feel pain. What causes that?

Beauticians are not authorized to treat lymphatic diseases, but this is only a minor part of the “spree”. The bigger problem is that if they don’t even have the proper knowledge in the field, they don’t know what they are doing. Post-treatment pain and induration indicate that they have treated you with inadequate (too high) pressure.

Although a single badly done treatment probably doesn’t cause any lasting damage. However, if you receive such “treatments” regularly, your condition may worsen rapidly and may render your oedema unmanageable in a few months.

Please, find a competent, skilled specialist!

I was at my beautician for lymphoedema treatment, after which my varicose veins became inflamed and I feel pain. What causes that?

Pain and “inflammation” of the vessels indicate that the treatment was carried out with too high pressure, and with inadequate attention. The machine thoroughly “kneads” your dilated, crooked veins (they were thoroughly worked on). Put ice on it for 2-3 days and load your leg (put weight on your injured leg) only carefully (do not go to training, but you can go for a walk). No further mechanical or manual massage can be carried out until the superficial venous inflammation heals properly.

Contact a lymphatic therapist, also known as (lymph)oedema therapist, instead of an incompetent beautician.

I got a headache during the machine treatment! What caused that?

This is due to the treatment pressure being too high or too large an area being treated at the same time (e.g., both legs and the trunk). Thus, they squeezed out the blood from your legs and even your trunk. This raised your blood pressure.

Look for a treatment centre where experts pay more attention to proper settings and handling of treatment. If you experience a headache during treatment, discontinue the session and notify the therapist immediately.

High blood pressure does not exclude mechanical treatment, but even a lower than usual pressure is needed, and the treated area should be reduced. That is, it treats only one leg at a time, then the other, and finally the trunk. This is, of course, three separate treatments, three times as much time, but in this way, it will not cause complaints.

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FAQ MileStone

What causes your disease and what promotes your recovery?

by Dr. Zsolt Zatrok 2021-02-03

What causes the disease? What triggers, promotes your recovery? What does it mean to cure? Who or what heals? The doctor? The medications she/he prescribes? The ultrasound beam? Maybe the surgical knife/scalpel? Have you ever thought about these questions? If not, now I’ll help you.

Your body is a complex system

The operation of a single cell in your body is incredibly complicated. Just think about it! It creates new cells instead of your dead cells. Your body renews your skin, nails, hair, blood cells, immune system, digestive enzymes, hormones, etc. It produces a wide variety of substances, proteins, enzymes, hormones, etc., and “spreads them” in your body to where they are actually needed most. It’s like a huge factory.
There are many things that affect the way your body works, such as the weather, the quantity and quality of your nutrition, and your physical activity level. What’s more, …your momentary emotions, sorrows, desires, fears!!! And much more.

What controls the functioning of the body?

Your brain serves as the “body control centre”. It works like a computer that controls machinery, and your nervous system enmeshes your body, brings information back and forth between your cells, organs, and your brain.

To put it very simply, the control can be divided into two main parts.

The involuntary (vegetative or autonomic) nervous system (ANS), which operates automatically, independently of your will. It controls, coordinates, regulates, and monitors the automated operation of billions of your cells using electrical impulses. This determines how many times your heart beats in one minute for a given activity, how much sweat is needed in order to cool your body down to its preferred temperature, how much insulin, trypsin, bile acid and so on, you need to be able to digest food, or how many white blood cells are required for the integrity of your immune system, etc.
You cannot influence these things with your will.

The voluntary (somatic) nervous system (SNS), which can be controlled deliberately. For example, you can determine when to perform an action. Here, you can initiate the operation/action of movement yourself, however, in this case, too, certain automatisms are controlled by the brain. For example, you think of lifting your coffee cup from the table to your mouth. However, you do not consciously control the order in which your muscles contract, or with what intensity and strength they need to contract. Based on the estimated cup weight, distance, etc., the brain calculates the necessary “settings” and “sends” a movement execution command stimulus down to the muscles.

The importance of logistics

As in every factory that works effectively, even in your body, precise logistics ensures the smooth operation. Imagine yourself in the assembly hall of a car factory. The automobile parts are in piles, the cars are also being made, however at the last station, suddenly, they run out of wheel bolts, so the wheels cannot be put in place. Due to the few missing bolts, the entire manufacturing process is stuck, because without wheels, no car can roll off the production line. The whole car plant is paralyzed.

They start investigating the case. It may turn out that there are enough screws in the warehouse, but they did not get to the assembly line in time. (However, it may have happened that they did not order the right type of bolts and something else arrived from the warehouse, …or the warehouseman made a mistake and issued something else, …or the forklift broke down and there were no means of transport to transfer them. It could also have been the case that an external shipment did not arrive on time, …because the carriers were on strike or the road was washed away by flood, etc.).

A thousand reasons could have led to the fact that the production was stopped – the process became “sick”.

How does the disease develop?

To put the process very simply: even your body can only function healthily if all the raw materials are available for renewal, and in the right amount and quality. If anything, even the slightest trace element, is missing, the function runs the wrong way and the disease can develop.

Many times, a quite simple reason, such as the lack of a mineral (calcium, magnesium, potassium, etc.), leads to the inability of your cells to function effectively, thus your body’s immune system is not able to defend itself effectively against a pathogen. Other times, an excessive intake of a substance (such as sugar) leads to problems.

But there can be thousands of other reasons why a “small grain of dust” can get into the machine, so that you would eventually get sick. Injuries, stress, overwork, accidents, malnutrition, and lack of exercise can all trigger unfavourable processes which “turn into” disease over time.

What does it mean to cure?

You may already understand that there can be millions of causes for the disease, let’s also look at how to prevent it!

Returning again to the example of the factory, the shift manager will come and find out the reason for the shutdown. As soon as the right type of bolts arrives, car production can be restarted and the products can be manufactured.

In the complex system of your body, the processes are even more complicated than in a factory, making it harder to find a cure. Healing is an action to restore a healthy condition that is performed or directed by the healer.

A healer can be anyone who can help you find the path to healing. He or she could even be the neighbour who suggests: “Put ice on it!” in case of a twisted ankle. However, anyone who suggests in the same case that you should put your ankle in warm water, is not a healer, as in this case, the heat will be more harmful (increases the bleeding and swelling).

At the medical university, one of the first admonitions for medical students is the proverb: “Medicus curat, natura sanat“. That is, the doctor cures, (but) nature heals.

Some doctors quickly forget this, walking up and down with a huge swollen ego, being extremely confident that they are the great healers. Yet in most cases, the doctor has at most contributed to the recovery! He removed the obstacle that stood in the way of healing or was just beginning to use a method that restored the self-healing processes.

In fact, your own body will heal you!

The role of the doctor, nurse, physical therapist, etc. is to guide your body on this self-healing path. In the case of appendicitis, the doctor surgically removes the inflamed appendix – without this intervention, your body really would not be able to heal. But the healing, the wound healing already depends on your body.

Isn’t that clear? I believe you!

Just think back to when you broke a bone. The doctor examines you and states the fact of bone fracture, gypsum fixation is applied right away. You don’t get any medicine, don’t even see the doctors until 3 months later and TA-DAH, your broken bone is healed!

But who the hell healed you? The doctors? The gypsum/plaster cast? NO… your body.

Another example: you cut deep into your finger with a knife. Who heals the wound? Who repairs it? You didn’t even see a doctor, did you???

Your body’s natural ability to self-heal and regenerate is enormous, these processes must be assisted in order to heal.

What is symptomatic therapy?

A method that does not cure the disease, but makes a symptom “invisible.” Your shoulder hurts, and you get a painkiller. It doesn’t help anything in the healing process, but you don’t suffer as much.

You will get an antihypertensive drug for your high blood pressure. It suppresses the blood pressure but the medication does not cure high blood pressure. This is shown by the fact that if you accidentally do not take the medicine, your blood pressure will rise.

Symptomatic therapy is just like when a toddler covers his/her eyes during the hide-and-seek game and thinks he/she is hiding. The disease is still there, destroying your body, your organs – but it just doesn’t show up because “it is masked by the received systemic medication”.

Physical therapy methods promote the healing process

It’s a fact that physical therapy methods help and are proven to work, they can only be harmful when used completely incorrectly. The use of ultrasound, soft laser, pulsed magnetic field, microcurrent or other natural methods may be beneficial for you. Of course, each one works differently and you can expect a different effect from it. If you use the right one, it will definitely help. This is a proven fact.

If you’ve gotten this far with reading this article, you already understand that it’s not the ultrasound beam, laser light, magnetic field, electric current, etc., that heals, but those physiological processes that they initiate in your body during and after treatment.

Most diseases are such conditions in which your body’s own self-healing processes stop. For example, the cells of inflamed tissues do not produce energy, the production of “self-repairing materials” stops (protein synthesis) and thus they do not heal. We need something to push them out of this frozen state.

Treatment, physical therapy, does nothing but helps initiate the beneficial processes. However, the healing itself is done by nature, that is, your body!

The right tool and the right application

However, for the adequate effect, you need to choose the right tool and apply it in the right way. Everyone and every disease is unique, that is, a specialist in this field has to tell you what you need to use. You can learn from him/her also which type of treatment to use.

Why is it important to choose the right tool?

Let’s take a kitchen example: You need pot for cooking, baking. You need different types of cookware for preparing different types of dishes e.g., when cooking a soup, baking a roast, or a cake. You use different sized pots if you cook only for yourself, for the family, or for a larger group of friends.

If you only have a cake tin, you won’t make soup for the family. Do you understand what I’m trying to explain to you?

Just because you have an ultrasound device, you may not be able to treat a particular problem with it.

Why is it important to use the device properly?

If the treatment is not carried out in an appropriate manner, for example, if you treat for too short a time, too few times or with the wrong intensity, you will not get the effect either. If you overdo it, you can even hurt yourself.

A very simple example is sunbathing. 20-30 minutes of sunbathing will warm you up pleasantly and when repeated for a few days, you’ll get a tan. If you sit in the shade in a dress, the sun will have little effect on you, you certainly won’t get a tan, although you may warm up a bit. On the other hand, if you lie down for 3 hours in the sun, you will not only get a tan, but doing so will actually destroy your skin.

How fast does physical therapy work?

Physical therapy methods are usually do not work rapidly, in most cases they may take several weeks, up to 30-40 treatments, or even more to take effect. This is precisely because it is not directly these treatments that heal, but the regenerative processes in your body – and they are this slow. Thus, a bone fracture heals in about 2-3 months, and a cut wound in 10 days. Your body can also deal with a persistent inflammation in a few weeks.

But there is certainly no miracle cure that can help in days.

You may ask why do they only give 10 treatments in the outpatient clinics and why not as many as you need for your recovery? This is simply a financial issue. That’s how many treatments are covered by the health insurance.

Home medical devices are designed to enable you to continue treatments at home until you recover. At the moment, in most of European countries, few home medical devices are covered (partially or fully) by the insurance and can be prescribed.

Please, read my article titled “What can home medical technology be used for?“.

Indication is science

Expertise is required to determine which methods will help and which are excluded from use, in case of a given diagnosis.

The doctor, the physical therapist, the physiotherapist, masseur, etc. are the specialists who, in the light of the results of the medical examination, can recommend treatment methods and help you.

Unfortunately, many of these professionals do not take the time to follow up on the latest methods and help you with treatment options beyond medication or surgery.

If you want to heal, look for a professional who is not only aware of the medications but also the use of natural energies (i.e., physical therapy methods).

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