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How much Water is too much for Lymphoedema?

The body processes, moves and stores fluid to maintain homeostasis. Homeostasis basically means keeping your body in a good balance to be able to function at an optimum level.

Lymphoedema is formed when for some reason we are out of body balance and a watery solution becomes trapped in and out of our intercellular tissue spacing. The body finds it difficult in moving and removing this watery solution.  Therefore, it stores this watery solution wherever it can.  Slowly over time the person begins to gain weight and/or notices bulk in some areas of the body.  These bulk areas can become very sensitive and painful to touch.

How can a person slow down this lymphatic dysfunction? It can take a lot of work; however early diagnoses is very helpful.

Firstly, it is best to understand the difference between water intake and fluid intake. Water intake means ‘water’.  Water is made up of two chemicals – hydrogen and oxygen. Is coffee, tea, soft drinks, cordial drinks and alcohol counted as water intake?  No, these are known as fluid intake, not water. There are more chemicals involved to create these forms of fluids.  For example; cordial is water- hydrogen and oxygen plus colouring, flavours, sugars etc.

So, how much water is too much for the lymphatic system to deal with?  If our bodies are approximately 70% water, how do we maintain this level? There are no set rules as each day changes.  What activities we do or don’t do, our body and mental health level, the weather, the environment we are in (indoors verse outdoors) going from air conditioning to the hot outdoors, there are so many variables to consider to determine how much water is the right amount.  Even the idea of having the availability of clean healthy water can be an issue for some people as they don’t have the luxury of going to the kitchen and turning on a tap to pour a glass of water.

It is suggested 1.5 to 2.5 litres of water a day is what a person requires to stay hydrated.  If 1.5 litres is all you can manage in a day, then that is a great start.  You will be the best judge for your hydration level and water availability as your days change and you begin to notice your thirst levels accordingly.

Pitting Method. You can do a self-check at the end of each day to see how you are going with your water/fluid intake level.  The Pitting Method is as simple as placing your index finger on your shin and press moderately in for the count of 20.  After lifting your finger away if there is a dimple, you are carrying extra water/fluid – your lymphatics need assistance to remove or move this water/fluid.  Aim to fit in a bit more movement into your day to help circulate this water/fluid along.

The key point is: take notice of how your body wants and uses water. If you start to gain weight, ask yourself; is it because I am eating more than usual or drinking more processed fluids – such as savory-sweet sugary fluids?  If you are not sure why you are gaining weight seek medical assistance sooner rather than later.

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Remedial Massage Therapy and Manual Lymphatic Drainage Management on an Amputee’s Arm

First Introduction:

When meeting a client for the first time it is a good practice to be very open minded, as there is a lot to cover in a short visit. This particular client presented with a long history of a number of cancers, chemotherapy and radiation therapy treatments over many years. Currently undergoing terminal chemotherapy with first stage lymphoedema developing in the left arm. Management for the lymphoedema was wearing an arm sleeve however; this became difficult to be placed on over time.

A terminal tumour was found in the junction site of the left arm and chest. Movement in the left arm was restricted due to chemotherapy treatments and thick scar tissuing. The left arm itself was heavy, cumbersome and “just hung there”. Lifting the left arm required the aide of the right arm. Overall, the left arm had become redundant and burdensome.

Treatment Program:

An agreement was made to work on improving circulation in the left arm with Remedial Massage Therapy and Manual Lymphatic Drainage. The client was very aware that full range of movement in the left arm might not be possible to achieve due to the amount of scar tissuing and chemotherapy damage to the site. Over months of treating the left arm pustulated blisters began forming on the left hand. This created distress within the client as doctors were unable to find the cause of the blistering or able to suggest any form of treatment.

Personal Decision:

Discussions about the left arm and what would be the best plan of management in the future was conducted over a long period of time. The client had considered amputation many years prior to the initial introduction meeting. Part amputation became the final result. The left arm was now above elbow to shoulder length, thick scar tissuing and lymphoedema problems where still very relevant.

New Treatment Program:

The left arm required post-operative care as well as Manual Lymphatic Drainage for the lymphoedema. A new treatment program was put into place and implemented for some months. Throughout this period the client often spoke about feeling the whole arm as if never amputated and could feel the treatment being performed in the upper part of the arm sending messages to the lower part of the arm even though not present. The wound site healed well and treatment continued as planned.


Over 90 percent of the scar tissue has been broken up and the left arm has approximately 30-40 percent range of movement. The client has become more confident and has found joy in many aspects of life. The client’s treatment plan is reviewed and adjusted as needed.

Key Points:

Be open minded when meeting a client for the first time.
Be confident in your scope of practice.
Be clear on the working agreement for improving health and health outcomes.
Remember you are part of a team even though you may not know the other team members.

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