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ADJUSTMENT TO LYMPHOEDEMA Professor Robin Davidson Dublin. Autumn 2008

Psychological predictors of response to chronic illness. Congenital optimismLocus of controlSpiritualityProblem solving styleSocial support. prevalence. 1.3 per 1000 for all ages5.4 per 1000 for over 65sAbout 7500 in Ireland with the conditionAbout 25% secondary to cancer47% of these develop

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ADJUSTMENT TO LYMPHOEDEMA Professor Robin Davidson Dublin. Autumn 2008

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    1. ADJUSTMENT TO LYMPHOEDEMA Professor Robin Davidson Dublin. Autumn 2008

    2. Psychological predictors of response to chronic illness Congenital optimism Locus of control Spirituality Problem solving style Social support

    3. prevalence 1.3 per 1000 for all ages 5.4 per 1000 for over 65s About 7500 in Ireland with the condition About 25% secondary to cancer 47% of these develop before 1 year after diagnosis. Cellulitis in between 20% to 30% of lymphoedemas

    4. CREST (NI) Guideline 2008 Diagnosis and assessment Management Risk assessment and reduction Lymphoedema services Education and training Future audit and research

    5. LYMPHOEDEMA Aims of physical interventions Restore maximum functional independence Reduce risk of infection Provide long term control of limb volume Maximise lymph drainage Restore maximum musculoskeletal function Correct postural imbalance

    6. Referral criteria Visible swelling Where there is a 5% increase in circumference in unilateral L compared with other limb or pretreatment baseline. Where patient complains of tightness or heaviness in limb.

    7. Factors associated with increased psychological morbidity among lymphoedema patients History of mood disorder History of alcohol/drug abuse Significant visible deformity Younger age Co morbid conditions Poor social support Low expectation of effective treatment outcome The presence of distressing side effects Associated and concurrent stressful life events

    8. Aims of psychological interventions Provide emotional support Educate patients in understanding their condition Rationale for treatment Promote self management Improve quality of life

    9. Quality of life assessment Most commonly used are SF-36 and FACT-B SF-36 particularily useful for lower limb lymphoedoma The Upper limb Lymphoedema scale(ULL-27) particularily sensitive for patients with ull. The Dermatology Life Quality Index is useful and sensitive for some patients.

    10. Assessment of depression symptoms include lack of energy loss of appetite low libido loss of weight poor self-esteem suicidal ideation diurnal variation in mood early morning waking

    11. EDUCATION AND CONTROL What are emollients Cellulitis? Exercise and mobility Air travel? Skin care Care of swollen feet Reducing risk

    12. Types of adjustment reactions to chronic illness FATALISM (Previously Stoic Acceptance) POSITIVE AVOIDANCE (Previously Denial) FIGHTING SPIRIT ANXIOUS PREOCCUPATION HELPLESSNESS/ HOPELESSNESS (Giving up)

    13. FATALISM Continues as before Does not complain Accepts diagnosis as one of those things The future will take care of it self

    14. POSITIVE AVOIDANCE Plays down the threat Refuses to accept the diagnosis May admit the diagnosis but deny or minimise the seriousness

    15. FIGHTING SPIRIT Rise to the challenge. Seek information and can seek out new roles e.g. new diet or exercise regime Determined to fight the illness Try to obtain as much information as possible Adopt an optimistic attitude May see the illness as a challenge

    16. ANXIOUS PREOCCUPATION Patients are constantly thinking about lymphoedma and interpret every minor physical change as a sign of deterioration Actively seeks information about lymphoedma but tend to interpret this pessimistically Worry about aches and pains May seek out alternative treatments Reacts to diagnosis with marked persistent anxiety

    17. HELPLESSNESS / HOPELESSNESS May feel overwhelmed by their illness and make little effort to cope or adjust. Usually go along with recommended treatment but take no initiative i.e. report a new symptom unless prompted. Hobbies/ interests abandoned Is engulfed by knowledge of the diagnosis Finds it difficult to think of anything else Adopts a wholly pessimistic attitude

    18. Tips for Coping: Staying Healthy Be kind to yourself Help others. Reaching out to someone else can reduce the stress caused by brooding. Don’t be afraid to say no. Polite but firm refusals help you stay in control of your life. Talk about your concerns. It’s the best way to release them. Learn to pace yourself. Stop before you get tired. Give in sometimes. Not every argument is worth winning. Get enough exercise. It’s a great way to get rid of tension and aggression in a positive way. Take time for activities you enjoy, whether it’s a hobby, club or special project.

    19. Tips for Coping: Staying Healthy contd... Take one thing at a time. If you’re feeling overwhelmed, divide your list into manageable parts. Set priorities. Don’t try to be Superman or Superwoman. Solve problems like an expert. Firstly, identify the problem and write it down, so it’s clear in your mind. Secondly, list your options with the pros and cons of each. Thirdly, choose a plan. Fourthly, list the steps to accomplish it. Then give yourself a deadline and act. Eat properly Get enough sleep Laugh at least once a day

    20. THE END

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