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Old 08-31-2013, 05:58 AM   #1
sarah
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swollen hand and arm due to bug bite

Hello,
3 weeks ago I was bitten on hand, on the side I had 15 lymphs taken out of and it became extremely swollen. my GP gave me 3 days of cortisone pills for inflammation, I took anti-histamines off and on but 3 weeks later, i'm still swollen. it hurts a little bit but less than at first and it has gone down a bit but still very swollen. i'm starting to worry that this could become permanent. any thoughts on this? I believe I was bitten by what is called here an aoutat, an august bug - tiny mite like creature you never actually see them but lurk in the greenery and I was bitten while weeding. they had bitten me elsewhere but only caused itching. I asked about having lymphatic massage but that was pooh poohed.
It's my right side and I'm right handed so it's a bit of a handicap.
A friend who's an acupuncturist tried a session and will try another but.....going a little crazy. I realize this is a petty problem compared with others on the site but.....would appreciate any solutions.
thanks
sarah
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Old 08-31-2013, 07:19 AM   #2
Mel3
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Re: swollen hand and arm due to bug bite

I'm sorry this happened to you. A friend had a similar issue with a mosquito bite and I'm sorry to say that she now has permanent lymphedema. Do you have a compression sleeve? If so, you should definitely wear it as much as possible. I'm disappointed your doctor did not agree to lymphatic massage. If there is any away for you to see someone, that would be a good start to recovery. Good luck.
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Old 08-31-2013, 08:02 AM   #3
sarah
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Re: swollen hand and arm due to bug bite

thank you for your quick reply. I do have a compression sleeve as I had a slight tendency to lymphedema before this but it had been manageable.
thanks
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Old 08-31-2013, 08:18 AM   #4
NEDenise
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Re: swollen hand and arm due to bug bite

Sarah,
I don't think your concern is petty at all.
If I were you, I would push for treatment, and/or get another opinion.

I would definitely not take this lightly. You are so right! This little bit of lymphedema could easily become permanent. Don't risk it, my friend!

Please let us know how things turn out.
Denise
ps - I think wearing the sleeve as much as you can stand is a good idea, but I'm a little concerned about infection too.
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Old 08-31-2013, 12:16 PM   #5
Ellie F
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Re: swollen hand and arm due to bug bite

Hi Sarah
I too have slight lymphoedema in my arm. My therapist here in England recommends that following an insect bite a prophylactic course of antibiotics should be taken to prevent infection and cellulitis especially as insects carry all sorts of bugs! Indeed when I travel abroad I take a course with me. Steroids are great for the inflammation but not for the infection.
Elevation of the arm plus compression are key things but maybe a good idea to try to get a therapist experienced in lymphatic drainage.
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Old 08-31-2013, 01:36 PM   #6
Lani
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Thumbs up Re: swollen hand and arm due to bug bite

Lymphedema is not a sexy topic so there hasn't been a lot of money put into lympedema research, unfortunately

Compression sleeves and manal draining seem to be the first steps listed in the literature, but there are not a lot of large studies and lymphedema has in the past been difficult to accurately measure, making meaningful comparisons of alternate treatments difficult

NEVERTHELESS DURING THE PAST WEEK THERE WERE 2 HOPEFUL ARTICLES PUBLISHED--hot off the press, but not yet ready for prime time FOR TREATMENT THOUGHT YOU MIGHT FIND THEM INTERESTING AS THEY SHOW AT LEAST SOMEONE IS LOOKING INTO THE AREA

: Public release date: 26-Aug-2013

http://www.eurekalert.org/pub_releas...-nff082613.php


[ Print | E-mail | Share ] [ Close Window ]
Contact: Cornelia Halin
cornelia.halin@pharma.ethz.ch
41-446-332-962
ETH Zurich
New function for a well-known immune messenger molecule
The molecule interleukin-7 (IL-7) is an important immune messenger protein which ensures that a
sufficient number of T cells are present in our body for immune defence. Researchers from ETH Zurich
have now demonstrated that IL-7 has another important function: it enhances the drainage function
of lymphatic vessels, which collect fluid that has leaked out of blood vessels into the body tissue and
return it to the bloodstream. In the future, this finding could become useful for lymphedema patients,
whose lymphatic drainage system does not work properly, resulting in fluid accumulation and tissue
swelling.
The predisposition to develop lymphedema may, on one hand, be hereditary. On the other hand,
lymphedema often occurs in the aftermath of a tumour surgery. When primary tumours are surgically
excised, tumour-draining lymph nodes are often removed as well, as they may contain tumour cell
metastases. In the course of such surgical interventions, the lymphatic tissue is damaged. As a
result, tissue fluid can often no longer be drained properly, leading to the occurrence of lymphedema
in 20 to 30 per cent of patients.
No drug treatment yet
Currently, the only treatment options for lymphedema patients are wearing compression garments
and undergoing manual lymph drainage by a medical massage therapist. "In IL-7, we have
discovered a molecule and a mechanism for enhancing lymphatic drainage which could potentially be
useful for lymphedema therapy," says the head of the study Cornelia Halin, Assistant Professor of
Drug Discovery Technologies.
In their study, the researchers found that IL-7 is produced by the so-called endothelial cells, which
form the lymphatic vessel wall. These cells also express the receptors that specifically recognise IL-7
based on the lock-and-key principle. "Although we have not formally proven it so far, we assume that
the lymphatic endothelial cells produce the messenger substance so that it can affect their own
function directly," says Halin. So far, IL-7 is one out of only few molecules that have been identified
to support lymphatic drainage. A few years ago, other researchers discovered that the endogenous
growth factor VEGF-C might also be an interesting molecule in this regard.
Insights from an animal model
Halin and her colleagues demonstrated the drainage-supporting function of IL-7 by performing
drainage experiments in mice where they injected a blue, albumin-binding dye into the ear skin of the
mice. Notably, albumin is an endogenous protein, which can only be transported out of the tissue via
the lymphatic vessels. By quantifying the dye that remained in the tissue one day after the injection,
the researchers were able to determine how well the lymphatic drainage worked in these laboratory
animals.
When performing this experiment in mice lacking a functioning IL-7 receptor, they observed that
these mice were only able to remove half as much dye from their ear skin in comparison with mice
possessing a functional IL-7 receptor. By contrast, they observed a considerable increase in lymphatic
drainage in mice with increased IL-7 production. Finally, in a third experiment, they administered IL-7
protein to unmodified, healthy mice and observed that this therapeutic treatment led to an
improvement of lymphatic drainage function.
Already tested in patients
New function for a well-known immune messenger molecule 8/26/13 6:50 PM
http://www.eurekalert.org/pub_releas...-nff082613.php Page 2 of 2
The scientists are now planning to conduct similar experiments in mice in which lymphatic vessels
have been surgically destroyed, similarly to the situation found in patients after cancer surgery. Here,
the researchers would like to test whether treatment with IL-7 could help to prevent lymphedema or
whether IL-7 could even be administered in order to reduce existing lymphedema.
The long-term goal is to explore the potential of an IL-7-based medication for lymphedema. Notably,
IL-7 is already being tested in clinical trials, albeit for different indications: because of its immunestimulatory
activity on T cells, IL-7 is currently being tested in patients with immunodeficiency
diseases, such as HIV, or hepatitis infections, or who have undergone bone-marrow transplantations.
###
Literature reference
Iolyeva M, Aebischer D et al.: Interleukin-7 is produced by afferent lymphatic vessels and supports
lymphatic drainage. Blood, 2013, published ahead of print, doi: 10.1182/blood-2013-01-478073


EVEN HOTTER OFF THE PRESS--

Plast Reconstr Surg. 2013 Sep;132(3):580-9. doi: 10.1097/PRS.0b013e31829ace13.
Molecular analysis and differentiation capacity of adipose-derived stem cells from lymphedema tissue.
Levi B, Glotzbach JP, Sorkin M, Hyun J, Januszyk M, Wan DC, Li S, Nelson ER, Longaker MT, Gurtner GC.
Source
Stanford, Calif. From the Hagey Laboratory for Pediatric Regenerative Medicine; Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine; and the Institute for Stem Cell Biology and Regenerative Medicine, Stanford University.
Abstract
BACKGROUND:
Many breast cancer patients are plagued by the disabling complication of upper limb lymphedema after axillary surgery. Conservative treatments using massage and compression therapy do not offer a lasting relief, as they fail to address the chronic transformation of edema into excess adipose tissue. Liposuction to address the adipose nature of the lymphedema has provided an opportunity for a detailed analysis of the stromal fraction of lymphedema-associated fat to clarify the molecular mechanisms for this adipogenic transformation.
METHODS:
Adipose-derived stem cells were harvested from human lipoaspirate of the upper extremity from age-matched patients with lymphedema (n = 3) or subcutaneous adipose tissue from control patients undergoing cosmetic procedures (n = 3). Immediately after harvest, adipose-derived stem cells were analyzed using single-cell transcriptional profiling techniques. Osteogenic, adipogenic, and vasculogenic gene expression and differentiation were assessed by quantitative real-time polymerase chain reaction and standard in vitro differentiation assays.
RESULTS:
Differential transcriptional clusters of adipose-derived stem cells were found between lymphedema and subcutaneous fat. Interestingly, lymphedema-associated stem cells had a much higher adipogenic gene expression and enhanced ability to undergo adipogenic differentiation. Conversely, they had lower vasculogenic gene expression and diminished capability to form tubules in vitro, whereas the osteogenic differentiation capacity was not significantly altered.
CONCLUSIONS:
Adipose-derived stem cells from extremities affected by lymphedema appear to exhibit transcriptional profiles similar to those of abdominal adipose-derived stem cells; however, their adipogenic differentiation potential is strongly increased and their vasculogenic capacity is compromised. These results suggest that the underlying pathophysiology of lymphedema drives adipose-derived stem cells toward adipogenic differentiation.
PMID: 23985633 [PubMed - in process]
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Old 08-31-2013, 05:38 PM   #7
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Re: swollen hand and arm due to bug bite

Sarah,

My lymphedema specialist & physical therapist had me do some exercises and feathering.

Try this exercise:

Start with you right arm down by your side and flex and extend your wrist as far as it will go, bring your arm up a few inches and repeat flexing and extending wrist, repeat the wrist flexing and extending until your arm is as high as it goes.

Don't do the exercise more than 2-3 times at a time, and you can do this each morning and evening.

Feathering: starting at the right shoulder draw your fingers lightly over the skin to the opposite axilla, repeat 2-3 times. Next draw your fingers down along side the "breast" to the waist. Repeat 2-3 times. Draw your fingers up your arm from the wrist to the axilla. Repeat 2-3 times.

If you have any signs of infection in the lymphatics in the arm - red lines going up from the bug bite don't do the exercise or feathering and see the doctor immediately.

I hope this will work as well for you - it did the trick for me when I had fluid backing up in the lymph vessels.
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Old 08-31-2013, 09:02 PM   #8
Debbie L.
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Re: swollen hand and arm due to bug bite

Sarah, I agree with everyone else. This is not a small thing and you're right to be worried. I'm sorry you are not getting the right response from your doctor.

I agree with Denise, Mel3 and Ellie who advised pushing harder to get this evaluated and treated by a lymphedema specialist, asap. And with Lani who points out the sad lack of evidenced-based advice that is available.

One thing about the compression sleeve -- it's to wear only during the day, when you are moving the arm. It is supposed to help the "muscle pump" action which is what moves lymph fluid thru our body (there is no pump for lymph circulation like the heart does for blood). When worn at night when the arm is likely to be still and/or squished -- it can do the opposite of its purpose, actually restricting flow rather than encouraging it. People do wear compression bandaging and special sleeves at night, but those are not elastic like the regular compression sleeve.

Lymphedema treatment should be 4-pronged. Basic skin care (clean, moisturized, not chafed), lymphatic massage/MLD (manual lymph drainage), exercise, and compression.

The "massage" is not really massage as most would think of it -- it's much more gentle and must be done in certain directions and in certain sequences. You can be shown how to do it, but it's not (imho) really something you can read about and then do. It needs a specialist to do it for you at first, and then to teach you (and/or a loved one) how to do it yourself.

The compression, in the beginning and for severe cases for the duration, may be special wrapping, at least at night -- rather than just the sleeves. (and, as Lani said, evidence is sparse for almost all lymphedema treatment but it's especially lacking in the area of compression sleeves -- not that there is evidence they are bad, but neither is there evidence that they help, at least not last time I looked).

The exercises are also specific to lymphedema. There are quite a few different ones to choose from and most people find the ones that work best for them thru trial and error. Every arm with lymphedema is not the same, and it's to the arm's owner to learn the specifics of her arm -- what triggers worsen the swelling, and what works best to control it when it flares.

I do hope you're able to see a specialist about this. I don't know what's available to you. Germany has historically been the leader in lymphedema treatment and research, but I don't know about the rest of Europe.

Please keep us posted. Good luck!
Debbie Laxague
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Old 09-01-2013, 07:00 AM   #9
Cath
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Re: swollen hand and arm due to bug bite

Hi Sarah,

I'm so sorry you are having trouble with lymphedema. My arm started to swell right after my surgery. I have been to a lymphedema specialist several times. Also wear the compression sleeve and gauntlet in the day, special night time garment at night, do manual compressions and exercises every day and use a compression pump every day for 2 hours. It is quite the pain! The swelling does not go down but over the past year it has not grown either but it is quite huge and ugly. My doctors (surgeon and onc) have always been very pro-active in trying to help me with this problem. In fact at my last onc visit he asked me if I wanted to see the lymphedema person again. I declined because I have been told everything that can be done has been done and with my insurance I have to pay a co-pay every time I see one. Yes, I have also tried the wraps also but that doesn't work either. So I hope you get your doctor to listen to you so you can at least keep your arm from getting anymore swollen. I'm sure yours will go down with treatment. Mine is just a very stubborn case. Please let me know if the acupuncture works as at this stage I would try anything.

Take care.
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Old 09-01-2013, 07:51 AM   #10
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Re: swollen hand and arm due to bug bite

Wow, you guys are the greatest!!! I was feeling slightly desperate when I posted but in my heart I thought if anyone can help or advise, it's my HER2 family! and boy was I right.
I can't seem to find my compression sleeve, would never throw it out so it's here somewhere but I've moved since I last used it.
I will definitely do the exercises starting right now! 'Lizabeth I hope you're not still suffering from lymphedema and Ellie I hope yours is going away. It definitely makes you feel handicapped and my husband is about to have foot surgery and be stuck in bed for 6 weeks so I need to be able to do stuff and carry things, etc. very bad timing.
Lani, thanks for this info, good to know it's being worked on. I also hope someone's working on inflammatory bc, a dear friend died of that. but of course, there are so many things.
I also plan to call a physical therapist tomorrow and make an appt. asap. and I'll continue looking for the sleeve and hand compression thing. It's in that famous "safe place"!
I'll ask about anti-biotics, I had wondered about that since I obviously had a very allergic reaction and the cortisone didn't help.
I love you guys and appreciate you so much.
Be in touch if you ever come to the south of France.
Health and happiness
hugs and love
sarah
PS when I had a pericarditis, my HER2 family came up with a quicker solution to solve it and the pain than the cardio who just wanted to see me in a month to see if it was worse!!! experience pays off. thanks
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Old 09-01-2013, 10:30 AM   #11
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Re: swollen hand and arm due to bug bite

Sarah,

I had a different type of lymphedema, axillary web syndrome. The back up of fluid was contained in the lymph vessels and they popped out in my arm like violin strings. It was painful, but my doctor's arm exercises and feathering did the trick. I went into a prescription exercise program after it resolved and was able to lift significant amounts of weight. I can't tell you how many mishaps I've had with the arm on the side of the mastectomy. Earlier this month sliced open my index finger and needed 3 stitches. I didn't even think about lymphedema until I was being sew up and apologizing because maybe the laceration wasn't bad enough to be at ER. Then I thought about the risk of lymphedema and infection and didn't feel guilty after that. I can't believe a little bug did all this to your poor arm.

I'm glad you are calling the physical therapist. I just didn't want suffering with your arm. I'm right handed too - so I can relate. With my splint and stitches in for a week I couldn't do much either. It is very frustrating, oui?

The acupuncturist sounds like a good idea. I've had some amazing results with healing from an infection in the axilla. It was the most pain I'd ever had and it was resolved in about 15 minutes. My back pain took about 6 visits, but it was chronic pain. So you will likely need more visits.

I hope you find the magic that works for you and it is just a one time flukey event. No more aoutats for you!
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Old 09-01-2013, 10:14 PM   #12
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Re: swollen hand and arm due to bug bite

Sarah, as has been said, this is not petty at all and needs treatment so not become chronic. Cellulitus I have mild lymph edema and was given massage by some one especially trained. I am not sure a physical therapist is the right person. At any rate, I saw an MD who specializes in this. Once when I got too much sun exposure and my arm got irritated and swollen she put me on Cipro an antibiotic. I carry it with me on trips now just in case.
Debbie has made some very good suggestions and advice. Massage and sleeves are very specific and should be monitored by someone knowledgable
Wishing you well. Keep the faith
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Old 09-02-2013, 09:57 AM   #13
sarah
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Re: swollen hand and arm due to bug bite

Hello,
saw my GP today, she took one look and said you need lymphatic massage so now will be getting that officially! thanks for all good your advice. I already feel less panicky.
hugs
sarah
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Old 09-02-2013, 07:20 PM   #14
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Re: swollen hand and arm due to bug bite

http://www.newhorizonspt.com/lymphedema.html#lymphTreat

http://www.newhorizonspt.com/patient...ml#relatedInfo

http://www.newhorizonspt.com/patient...ml#relatedInfo

Sarah,

Sounds like progress to me. I hope you get the therapy soon. I was reading on my physical therapist's website and they have detailed information on Lymphedema. They are the leading experts on my medical team on Lymphedema and exercise for cancer patients.

Some links are from Dr. Cheryl Rock who leads much of the nutrition research that I participate in at UCSD.

I should check PCOMs site about acupuncture to see if they posted about Lymphedema. They have a Doctorate program and some of the members specialize in cancer.

If I am lucky enough to get to the south of France we'll do lunch!
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Old 09-02-2013, 10:21 PM   #15
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Re: swollen hand and arm due to bug bite

Sarah,
My husband and I live on a lake. This year, due to a wet spring, we had an infestation of tiny bugs, just like you describe. They caused extreme swelling around the bite area for many people in our lake community. I was bitten on the top of my hand, and my hand looked like a rubber glove filled with water! The swelling lasted about 2 weeks. One man at our lake, had his whole body swell. My neighbor had his entire ankle swell from one bite. The bugs were just tiny little nats that looked harmless. We have never had them at the lake before. There was a yellow, clear liquid that seeped from the site of the bite. I hope this information helps.
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Old 09-03-2013, 01:45 AM   #16
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Re: swollen hand and arm due to bug bite

Thank you again for the info, sites to check. I'll look at right now.
Yes, the bugs on the lake sound similar - couldn't see them! head swelling sounds really worrying.
yes, 'lizabeth would be fun to meet up down here. Stephanie came by once and even found our little village without directions from me!!! and hopefully she and her husband will come back next year. She of course recognized my avatar, tania, immediately!
A plus as they say here,
hugs and love, stay well and like the song, don't worry, be happy!
sarah
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