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Headand neck

Head and Neck Cancer Support Network Auckland Support Group Meeting 10 February 2020

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HEAD AND NECK CANCER
SUPPORT
AUCKL AND GROUP MEETING
10TH FEBRUARY 2020
C H A R M A I N E M C K E R N A N R M T
D R V O D D E R L Y M P H O E D E M A T H E R A P I S T A N D M A N U A L
L Y M P H A T I C O N C O L O G Y M A S S A G E T H E R A P I S T
A U S T R A L A S I A N L Y M P H O L O G Y A S S O C I A T I O N A C C R E D I T E D
L Y M P H O E D E M A P R A C T I T I O N E R
PROPOSED AGENDA
• Introduction
• Effects of surgery
• LymphoedemaTherapist,
• Background on lymphatic system
• Why is my swelling worse in the morning?
• Sleeping position
• Dry mouth
• Shoulder issues
• Manual lymphatic drainage (MLD) and
Taping
• Compression options
• Treatment Plan
• Contacts
ABOUT CHARMAINE
• I have secondary lymphoedema in my right leg as a result of surgery in 2011due to cancer
metastasizing from an earlier melanoma removal in 2008.
• I wear compression during the day and at night (optional)
– 18 / 21 nodes removed, things were very grim
– Lymphoedema occurred almost immediately but I didn’t know what it was, other than “big leg”
– Took 9 months to get an off the shelf garment due to miscommunications
– Took another 4 years before I learned about made to measure and support by Waitemata DHB
Physiotherapists Lymphoedema Outpatient Clinic
– I have had MLD regularly since 2011 and my leg is in fantastic shape but requires ongoing MLD and
compression to deal with the lymphoedema
• I retrained with over 132 hours withVodder School International to specialise in lymphatic drainage
• Opened in private practice in 2018
• Advance module from Klose training for Head and Neck in November 2019
• I work from the Sleep andWellness Centre, Ellice Road,WairauValley, North Shore
CAUTION!
• Information shared in this presentation is for self-education and is freely shared with the Head
and Neck Support Network.
• Any self manual lymphatic drainage / self taping / compression should only be done after
discussion and advice of a trained / accredited LymphoedemaTherapist (refer last slide for
contact information)
• Your body is unique and should be treated as such so do not assume what works for
someone who has had a similar cancer experience will have the same management plan
HEAD AND NECK CANCER:
MUSCLE, NERVE AND LYMPHATIC
Highly complex part of the body with muscles attaching from the shoulder to the
neck, swallowing and breathing function, major nerve junctions and has a very large
amount of lymph nodes and lymph vessels.
HEAD AND NECK CANCER:
EFFECTS OF SURGERY
• Scar adhesions
• Hyper-sensitive scars
• Nerve damage
– Spinal Accessory Nerve (SAN) -
shoulder dysfunction
– Great auricular nerve
• Facial nerves
• Swelling
• Loss of fascia, deep and superficial
• Pain
• Loss of muscle, usually at anterior neck;
sometimes posterior neck
• Sternocleidomastoid muscle (SCM)
• Omohyoid
• Tongue
• Donor site (forearm)
• Disuse (no movement)
• Trismus/TMJ
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Headand neck

  • 1. HEAD AND NECK CANCER SUPPORT AUCKL AND GROUP MEETING 10TH FEBRUARY 2020 C H A R M A I N E M C K E R N A N R M T D R V O D D E R L Y M P H O E D E M A T H E R A P I S T A N D M A N U A L L Y M P H A T I C O N C O L O G Y M A S S A G E T H E R A P I S T A U S T R A L A S I A N L Y M P H O L O G Y A S S O C I A T I O N A C C R E D I T E D L Y M P H O E D E M A P R A C T I T I O N E R
  • 2. PROPOSED AGENDA • Introduction • Effects of surgery • LymphoedemaTherapist, • Background on lymphatic system • Why is my swelling worse in the morning? • Sleeping position • Dry mouth • Shoulder issues • Manual lymphatic drainage (MLD) and Taping • Compression options • Treatment Plan • Contacts
  • 3. ABOUT CHARMAINE • I have secondary lymphoedema in my right leg as a result of surgery in 2011due to cancer metastasizing from an earlier melanoma removal in 2008. • I wear compression during the day and at night (optional) – 18 / 21 nodes removed, things were very grim – Lymphoedema occurred almost immediately but I didn’t know what it was, other than “big leg” – Took 9 months to get an off the shelf garment due to miscommunications – Took another 4 years before I learned about made to measure and support by Waitemata DHB Physiotherapists Lymphoedema Outpatient Clinic – I have had MLD regularly since 2011 and my leg is in fantastic shape but requires ongoing MLD and compression to deal with the lymphoedema • I retrained with over 132 hours withVodder School International to specialise in lymphatic drainage • Opened in private practice in 2018 • Advance module from Klose training for Head and Neck in November 2019 • I work from the Sleep andWellness Centre, Ellice Road,WairauValley, North Shore
  • 4. CAUTION! • Information shared in this presentation is for self-education and is freely shared with the Head and Neck Support Network. • Any self manual lymphatic drainage / self taping / compression should only be done after discussion and advice of a trained / accredited LymphoedemaTherapist (refer last slide for contact information) • Your body is unique and should be treated as such so do not assume what works for someone who has had a similar cancer experience will have the same management plan
  • 5. HEAD AND NECK CANCER: MUSCLE, NERVE AND LYMPHATIC Highly complex part of the body with muscles attaching from the shoulder to the neck, swallowing and breathing function, major nerve junctions and has a very large amount of lymph nodes and lymph vessels.
  • 6. HEAD AND NECK CANCER: EFFECTS OF SURGERY • Scar adhesions • Hyper-sensitive scars • Nerve damage – Spinal Accessory Nerve (SAN) - shoulder dysfunction – Great auricular nerve • Facial nerves • Swelling • Loss of fascia, deep and superficial • Pain • Loss of muscle, usually at anterior neck; sometimes posterior neck • Sternocleidomastoid muscle (SCM) • Omohyoid • Tongue • Donor site (forearm) • Disuse (no movement) • Trismus/TMJ
  • 7. WORK WITH A TEAM Core Specialists • Oncology radiologist • Medical oncologist • Plastic surgeon • Oral surgeon/prosthodontist • Specialty nurse SupportTeam • Physiotherapist • Accredited lymphoedema therapist • Speech therapist / OT • Dietician • Other specialists as needed Don’t forget about you! Everyone is different so different so swap in / out those supporting team members you need as you need it
  • 8. HOW CAN A LYMPHOEDEMA THERAPIST HELP? • After surgery (72 hours) can start treatment to help prevent adhesions, dissipate swelling and promote lymphatic pathways – Can also treat during Radiation up to and sometimes over the radiated area (with specialist signoff) • Advice on positioning while sleeping and proper posture while awake • Scar management • Manual Lymph Drainage (MLD) – Help drain the lymphatic to ease the pain and create new lymphatic pathways • Very gentle touch, should never cause pain – Help stimulate the salivary function (intra-orals) – Provide “shoulder specials” for prevention of frozen shoulder and protection of this joint during the muscle imbalance – Medical taping – Teach you how to breathe! – Teach you how to self MLD and facial exercises • Compression garment referral if not supplied by your specialist • Refer you to work alongside the physiotherapists, speech therapists, OTs
  • 9. LYMPH AND LYMPHOEDEMA • What most of us don’t realise is that we also have a second circulatory system called the lymph system. It acts as the drainage route for the body’s cells, carrying away excess fluid, waste materials, immune cells and proteins from the tissues. – The fluid that leaves the cells and enters the lymph system is called lymph, and the system itself is made up a network of lymph vessels and glands (which are sometime referred to as ‘nodes’). • Lymphoedema is a chronic condition caused by a failure in the lymph system, meaning lymph is not draining from the body. – There are many reasons (in the HNL case surgery and radiation) but the end result is generally the same: a build-up of fluid in the tissues causing chronic swelling with thickened skin
  • 10. WHY IS MY SWELLING WORSE IN THE MORNING? • Lymphoedema swelling is more severe in the morning because lying down allows the fluid to pool more easily within your head and neck, and there is also a lack of movement in your facial muscles overnight. • Everyone has a degree of swelling in their eyelids on waking, though most of us probably don’t realise it as it’s largely undetectable and the fluid drains away as soon as we have blinked a few times. • For anybody with lymphoedema involving the face or neck, using facial muscles is very important to stimulate lymph drainage. • Exercises involving facial expressions such as frowning, lifting eye- brows, blinking, squeezing eyes shut, smiling, opening mouth wide, etc. are important aspects of treatment, particularly alongside other treatments such as Medical Kinesio Taping and MLD
  • 12. PAIN POINTS – DRY MOUTH • What is XEROSTOMIA / DRY MOUTH • Radiation to the salivary and parotid glands can cause partial or permanent damage. (may resolved in 12 to 18 months, longer or never be the same before treatment) • Quantity and quality of saliva are altered • Saliva is thick, ropy, sticky • Causes difficulty swallowing • Decreases control of oral microbial growth • Causes cavities, periodontal disease, oral infections
  • 13. PAIN POINTS – DRY MOUTH WHAT TO DO • Acupuncture • Frequent water sipping • Room humidifier • Salagen tablets • MLD intra-orals (may help) • Rinses and gargle mix of 1 tsp of salt & 1 tsp. of baking soda in 1 litre of water • Sleep apnoea masks have a humidifier built in but please check with your specialist
  • 14. PAIN POINTS – SHOULDER ISSUES
  • 15. MLD TREATMENT The objective is to direct lymph flow away from congested areas of lymph to parts of the body where drainage is working more effectively. There are about 300 lymph nodes in the head and neck so we can always find a pathway! This is what to expect. You will be seated upright • Stimulate the lymph nodes in the armpits and breast / chest wall (axilla) • Work up the neck (unaffected side) then affected side • Work up the face treating from chin to cheek to nose to forehead with the appropriate redirection for lymphatic uptake • May do shoulder specials if shoulder dysfunction • Intra orals (massage inside the cheeks, mouth and tongue) • Scar work (low level laser therapy (LTU-904) and or MSTR • Medical Kinesio Taping to help the lymph • Compression • Skin care awareness • Breathing! Deep, slow belly breaths • Talk about self MLD
  • 16. CONTRAINDICATIONS MLD • Thrombosis • General oedema (heart or kidney trouble) - GP / specialist approval needed • Fever • Early stages of pregnancy Medical Lymph Taping • As above • Over skin defects • Over an area that has carcinomas or metastases • Breast feeding • Thin skin or skin integrity issues • Diabetes (caution)
  • 17. COMPRESSION! Compression may be needed to help with lymphatic flow and help break down the fibrotic tissue. Please talk with your lymphoedema therapist.
  • 19. TREATMENT PLAN? • Please remember that your current state is changeable but there will be time costs *yours and the lymphoedema therapist* and the ongoing financial burden to cover your one on one treatments. • Work out your treatment plan together with your lymphoedema therapist ensuring you are up front for what works in with what you can or cannot do (time / financial / availability / travel) • Costs can vary between Therapists, so ask for a financial cost as part of your plan • Remember!The more frequent the treatments, the sooner you will see change!
  • 20. LYMPHOEDEMA THERAPISTS • http://www.lymphoedemanz.org.nz/Lymphoedema+Therapists.html • https://www.lymphoedema.org.au/accreditation-nlpr/find-a-practitioner/ • https://www.vodderschool.com/find_a_therapist • http://www.dovehospice.org.nz – can be referred which is a free service in Glendowie • Contact Charmaine https://www.maclymph.com or email Charmaine@maclymph.com