Wednesday, December 06, 2006

Breast Cancer and lymphedema: Can Lymphatic Pump Techniques work to reduce swelling?

The lymphatic pump is a method of manipulation used by osteopathic physicians to increase the rate of lymph flow in order to help fight infection.

Techniques to achieve this include the thoracic pump and abdominal pump. These methods increase the flow of lymph through the thoracic duct. It is believed that increased lymph flow is beneficial, as the lymphatic system is part of the immune system. Other techniques include Miller Pump (rhythmic, rapid, compression of the superior-anterior wall of the thorax), pedal pump, and diaphragmatic redoming. A modified version of Miller Pump can be used to treat atelectasis (loss of lung volume) by inducing sudden, rapid inflation of the lung. Indications for thoracic lymphatic pump include productive cough, upper respiratory tract infection, and extended bed confinement. Contraindications include osteopenia/osteoporosis, and injury (including surgical) to the thorax

Lymphatic treatments continue to be an important component of osteopathic manipulative medicine. [C.E.] Miller developed the lymphatic pump in 1926, stating that it is "an exaggeration of the movements of respiration." The lymphatic pump technique is used to treat patients with edema and infections because increasing lymphatic flow improves the filtering and removal of fluid, inflammatory mediators, and waste products from interstitial space.

During the influenza pandemic of 1917, [R.K.] Smith reported that osteopathic manipulative treatment (OMT) decreased the mortality rate from 5% to 0.25% among 100,000 patients.(Knott 2005)

Manual lymphatic drainage is a therapeutic technique used to a increase lymph flow. It consists of movement of the DO's hands over the patient's skin and subcutaneous tissue. The pressure applied is very gentle, and the movements are slow to correspond with the slow lymphatic pulsations. The massage sequence begins at the center of the body and moves to the periphery. The rationale for this is that the lymph nodes must be emptied before they can receive more lymph from the periphery. Each maneuver is performed in a distal to proximal direction.

A proposed benefit of osteopathic manipulative treatment (OMT) is enhancement of immune response to infection. This proposal intends to determine if lymphatic and splenic pumps can increase serum antibody and interferon levels against the varicella virus. Groups will consist of healthy adolescents not previously exposed to the virus. All subjects will receive the standard dose of varicella vaccine. The treatment group will receive OMT three times per week for two weeks after each vaccination. The control group will receive “sham treatment” consisting of standardized light touch protocol under the same schedule. Serum antibody levels will be measured using VZV latex bead agglutination assay. Interferon will be measured using cytopathic effect reduction technique. If osteopathic treatment is found to have an effect on antibody and/or interferon response, then results support benefits of OMT on immune response. This may result in using these methods among physicians to facilitate immune response post-vaccination.


Post a Comment

<< Home

WWW This blog