Effect of Sea Urchin Sting in Lower Limb Primary Lymphoedema and adjunctive Self Care with the Magcell Microcirc Device

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The following article and patient photographic diary shows the healing of a wound using a combined treatment approach of initial standard care for wound healing: oral antibiotics, MLD DLT, laser and as an adjunct, a MAGCELL® MICROCIRC (pulsed electromagnetic field therapy), which was carried out by the patient at home between 17th March 2020 and 10th May 2020, for up to 30 minutes daily, with nightly self-bandaging and elevation of foot in the daytime when possible.

The lady received the Magcell just 3 days before the COVID-19 lockdown on 20th March 2020, hence home treatment was very much appreciated to expediate the healing process.

Clearly, as both Magcell and bandaging have been utilised at home, it is not possible to say which of the approaches or the combination of both aided the wound healing, or indeed, whether it was the first two-hour treatment by the Lymphoedema Practitioner with combined therapeutic approaches that enhanced the healing process, together with the early intervention of the oral medication prescribed.

The caveat in this case, perhaps, is that the patient was diagnosed with Primary Bilateral Lymphoedema as a teenager and Lymphoedema could have been a factor in a delayed healing response.

NB. The intention of this article is to promote awareness of the possible potential for Magcell in the wound healing environment and perhaps a wound healing clinic would like to carry out further investigations to indicate the role of this non-invasive modality in the wound healing process. If of interest, please email info@physioequipment.co.uk

Patient Background

Mrs C, aged 65, is a very fit lady with a healthy lifestyle. She owns equestrian facilities on a livery basis and has her own horse which she rides regularly, she is a Pilates participant and swims daily. Mrs C lives with primary bilateral Lymphoedema of the lower limbs, attending Christine Talbot, MLD DLT Practitioner for maintenance treatment on a two/three monthly basis with MLD and Deep Oscillation. Mrs C has had an appendicectomy, an oophorectomy and salpingectomy for a tubal pregnancy and varicose vein surgery which worsened her overall lymphatic condition, which had become apparent aged eighteen.

The Sea Urchin Sting

In February 2020, Mrs C was on holiday in Guadeloupe, and had taken a boat trip with friends. Enjoying a swim from the boat to a beach, she accidentally trod on a sea urchin which was happily resting on coral concealed by the sandy surf. The sting was in the right foot, it is the right leg that is adversely affected by Lymphoedema.

Initial Action

When Mrs C returned to the boat, she soaked her foot in warm salty water, attempting to dig out the spines (approximately 20), with a sterile needle. Because the spines were grouped together, it was mostly impossible to remove them because of the barbs.  

The foot was ‘painful’ but not agonisingly so, and Mrs C managed to walk around for a couple of days. However, the strap of the sandals worn during these two days rubbed on the edge of the now swelling leg and three days later, blood-filled heel blisters developed.

Becoming Unwell..

Mrs C became very unwell with a headache and extreme fatigue on 26th February and on the 27th was prescribed Phenoxymethylpenicillin from the boats onboard medical supplies. A retired GP holidaying with Mrs C attended to her writing a full medical report for further healthcare professionals

It was proffered that the attempt to dig out the barbs, even with a sterile needle, caused the ensuing Erysipelas, (although the venom from the sea urchin would also have had a significant effect). The barbs were embedded in five places on the sole of her foot and little toe. Back ashore in Guadeloupe, Mrs C visited a GP, who diagnosed Erysipelas, due to the purpuric rash and superficial red streaks and she was prescribed a stronger antibiotic pyostacine to further avoid developing a staphylococcal infection, a common bacterial skin infection, however Mrs C had an extreme reaction to the drug after one tablet, with severe vomiting and headache, so her medical friends located other supplies of the phenoxymethylpenicillin.

DVT Concerns

Mrs C's medical friends were seriously concerned she would not be allowed to fly home due to the size of the right limb, which had quadrupled in size and the potential to develop a flight induced DVT, so they acquired enoxaparin, an anticoagulant, giving her one dose twelve hours prior to flying and a repeat dose twenty four hours later. She was seen by a GP at the airport before flying home and was given augmentin and a probiotic. Back home, a further ten-day course of antibiotics were prescribed, with the advice to keep the leg elevated and to attend the practice nurse for a dressing for the blisters. 

Please note that the patient dispensed with the blister dressings provided by her surgery, as she felt they would have stuck to the delicate healing tissue.

Contacting Christine Talbot MLD DLT Lymphoedema Practitioner

12th March 2020 - Two Hours Treatment with Christine Talbot

Protocol - techniques and modalities

Vodder MLD is a gentle, non-invasive manual technique that has a powerful effect on the body. Research in Australia, Europe and North America has proven its efficacy as a stand-alone treatment and in combination with other therapies. Developed in France in 1932 by Emil and Estrid Vodder MLD has grown to be the most well-known manual technique to assist lymph flow and aid in drainage of tissues. The skin is stretched and torqued in a specific manner, based on scientific, physiological principles that have proven to encourage lymph flow. When performed correctly with the correct pressure, direction and speed, this can greatly enhance recovery and facilitate drainage. It also has profound effects on systems in the body.

Christine combines Vodder MLD techniques with DEEP OSCILLATION® (DOT) electrostatic lymph drainage applied through gloves hands and via 9.5 cm special oscillator head

* See more detailed information on DEEP OSCILLATION at foot of article.

Low Level Light Laser Therapy (LLLT):

"Low level laser therapy (LLLT) is the use of low energy laser light in injuries and wounds in order to improve wound healing, reduce inflammation and alleviate pain. The laser light is monochromatic, coherent and in the red or near infrared spectrum (600 nm – 1000 nm). It is applied at low power density (1 mW to 500 mW/cm2) (“low energy laser”). In contrast to other medical laser applications LLLT is not a thermal method (i.e. surgical lasers), but produces photochemical effects in the tissue in a similar way to photosynthesis in plants. LLLT is simple to use, effective and cost-efficient and free of side effects. Treatment takes a few minutes and depending on the indication is repeated at longer or shorter intervals and in accordance with healing success. The success of LLLT is based on the following general action principles: tissue regeneration, inhibition of inflammation, alleviation of pain, improvement in circulation, reduction in swelling" Low-Level-Laser-Therapy (LLLT) in Chronic Wounds - Ludwig-Maximilian University Munich, Germany

Modalities used:

• Quantum Wave Laser (QWL)
• Red Laser Pointer (RLP)

Method

The right leg was pre-bandaged (DLT), and the rest of Mrs C's body treated in the supine position, with the majority of the treatment applied towards her abdomen and groins to stimulate leg drainage. The pre-bandage was removed showing a good response to the limb softening, the blisters were cleaned with sterile surgical spirit and hydrogen peroxide and the RLP applied to the blistered heel interspersed with QWL on a capillary setting, the total duration for laser therapy was approximately 35-40 minutes (intermittently), re-booting the QWL timing after four-minute intervals.

The right leg was treated with MLD and DOT, applying laser therapy when using the applicator head. Mrs C was then turned into the prone position for treatment to the back of the legs, paying particular attention to the popliteal nodes which were heavily engorged, the 9.5 cm deep oscillation applicator head was used on the back of the legs, Mrs C was turned back into the supine position, her abdomen and groins were retreated with MLD.

A below knee compression bandage was applied to her right leg for the journey home (light short stretch bandage,

Comprilan short stretch 8cmx1, 10cmx2, 12cm,1. and a Yellow Line Coverflex Stocking). Compression hosiery would have been too traumatic on this limb, normally Mrs C has Easy Wrap 20-30mmHg but at this time her leg was four times as big from its normal Lymphoedema presentation. As Mrs C has an equine background and is used to bandaging horses’ legs, Mrs C was instructed exactly as to how to bandage her own leg at home. 

Adding MAGCELL® MICROCIRC

As the Magcell cannot be used in conjunction with DOT; a unit was demonstrated at the end of the treatment. Knowing the amazing results on a wound healing self-care case, Christine additionally contacted Physiopod to enquire as to whether a MAGCELL® MICROCIRC could be loaned to her patient in order to aid and increase circulation, specifically to the groin and the right foot and for its general ability to improve chronic tissue repair. Contraindications checked, the device arrived on 17th March 2020 with the patient for self-care.

COVID-19 Pandemic Lockdown

By Friday 20th March, the United Kingdom was placed on lockdown due to the COVID-19 pandemic and access to healthcare services was greatly reduced. Mrs C was so pleased that the unit had arrived in time to be able to treat herself in the safe environment of her own home and be actively involved in the healing process of the resultant blisters.

Treatment Protocol

1. Begin treatment by placing Magcell on right groin, where Inguinal node drainage is compromised, as any increase in blood flow could be beneficial. Secondly, placement of the Magcell behind the right knee to stimulate the circulatory flow to the Popliteal nodes, an area often congested and painful. 

2. Next, there were two specific areas on Mrs C's right foot which required treatment:

a) Back of the heel (collection of blood-filled blisters caused by the friction of the sandal strap) - it was suggested to move the Magcell back and forth along this area. 

b) The sole of the foot (where the Sea Urchin barbs penetrated and where Mrs C tried to dig them out). The skin on this area is thickened normally, however the inflammatory process to a foreign body had increased the thickening, it was suggested Mrs C sit with her foot placed on the Magcell regularly throughout the day, or when her leg is elevated to secure the Magcell to the area. Each Magcell treatment is 5 minutes in duration.

** Read more detailed information on Magcell at foot of article

Patient photographic diary and notes after Magcell treatments

A signed and dated consent form has been received by the patient to use the copyrighted photographs and the notes beneath all photographs are those of the patient.

Day One - 17th March 2020

"The blisters had leaked and layers of skin were beginning to peel."

Day Twelve - 28th March 2020

"Blisters were very much drier and nearly healed over, though still very sensitive, deep and reddened. I have been bandaging and elevating every night, and wearing a support stocking for at least the morning. I am now able to wear a large shoe and wear padding wrapped around it to prevent rubbing. The blistered area and the sole of the foot is still very sensitive particularly where I have lost skin layers. I have been applying Aloe Vera Gel to the blister area."

Day Seventeen - 2nd April 2020

"My leg recovery is amazing. The blistered area is now fully healed and as you will see the areas of sensitivity are also pretty much reduced too. Approximately three weeks ago, I could only wear a large shoe with additional padding, I used some horse Gamgee and vet wrap to hold it in place; approximately a week later, I was wearing my normal trainers. I say normal trainers, they are big wide shoes, and now I am able to wear my riding boots. This means that the swelling is much reduced, and probably back to where it was pre accident. It does go up in the day and is definitely even more when it is hot. I have been elevating and religiously bandaging at night, elevating in the day where possible!! 

It is now a month of treatment, and if I may keep the Magcell for a week longer, I am going to run a small experiment to see what happens to the swelling if I’m not using the Magcell over the course of the next few days, then if I need to, I could give myself more treatment to return the Magcell at the end of the week.  As I have been doing during the treatment, I have measured and recorded the leg in various different areas. Yesterday was the first day (21st ) without treatment, and at night after elevation the leg returned to its pre-untreated a.m. state of 20th. I will shortly forward the remaining photos. 

I am so pleased with the results, I am absolutely certain the blisters would have taken months longer to heal and the swelling probably would never have returned to what is probably nearly it’s pre-accident size. 

Day Twenty-Two - 7th April 2020

"The areas of the blisters were far less red and sensitive and the leg far less swollen"

Day Thirty-Two - 17th April 2020

"The blister area is scared but not at all sensitive to pressure"

Day Fifty-Four (Eight weeks after treatment began) - 10th May 2020

"Completely healed -

Thank you all for allowing me to participate in the trial.  I would definitely recommend this to anyone for the healing of deep blisters and for the reduction in swelling. Great credit too, to Christine Talbot for knowing of this forefront treatment and putting me forward to you for the trial too." 

Practitioner's Conclusion: 

"I think Mrs C's ability to be able to bandage the limb has hugely benefited her repair process and the more rapid response in the reduction of limb volume aiding the healing to occur more effectively overall. I advised her to soak the foot in a solution of warm water and bicarbonate of soda and then apply hydrogen peroxide and surgical spirit to dry and shrink the blisters and to dry the cleaned area with a hairdryer on a non-heat setting.

I think four main criteria have contributed to a very successful healing process for Mrs C, which given all factors related to the localised trauma to the foot could have had a catastrophic outcome both from incident location, the need for urgent medical care, flight duration back to the UK and the vulnerability of the severe infection with the potential for Sepsis, if unresponsive to oral medication".

1. Immediate antibiotic therapy and to be overseen by medical friends.
2. Anticoagulant medication for the flight.
3. Decongestive lymphatic drainage utilising in the first instance deep oscillation (see more detailed information below) and the initial laser treatment.          
4. The loan of the MAGCELL, restoring good circulation to oedema impaired areas (see more detailed information below).

* Deep Oscillation

Deep Oscillation is a unique, internationally patented treatment method. Its special structure allows you to create biologically effective oscillations in the treated tissue using electrostatic attraction and friction. The gentle, pleasant oscillations have a deep-acting effect on all tissue components (skin, connective tissue, muscles, blood and lymph vessels).

In contrast to externally applied mechanical forms of vibrational massage (which only act on the surface of the skin), deep oscillation works in the entire tissue layers, permeating a depth of 8 cm (Solangel, 2010), with clinically proven effects in the interstitial spaces of connective tissue structures, which is where we find the build of excess inflammatory matter and fluid post-surgery.

Read more about Deep Oscillation including references here

** Magcell®

MAGCELL® is a portable hand device for electrode-free electrotherapy. Magnetic alternating fields are produced over rotation by permanent magnets. A sinusoidal pulsating electromagnetic field (PEMF) is generated over the special magnet arrangement and device function principle. However, with a value of 0,105 tesla field strength it is many times higher than for commercially available magnetic field therapy devices with coils or mats, which generally operate with field strengths of maximum 100 gauss or 0.01 tesla. By contrast MAGCELL®-therapy units produce field strengths, which are generally stronger by factor 10 than these devices.

According to induction law induced time-variable magnetic fields induce electric fields. The physical effects of MAGCELL® derive from the electric fields produced in living cells and tissue based on induction law. Depending on tissue conductivity the field incites an electric current. Considering the specific conductivity for various body tissue and liquids, this electric current can be calculated. Its strength, or more precisely, current density (= current strength per area, A/m²) determines biological effectiveness.

All calculated current densities exceed 10 mA/m² and are thus within the range of effects internationally confirmed and classified as ‘good‘: above the ‘subtle biological effects‘ and within the range of ‘confirmed macro effects‘ (10-100 mA/m²). Induced current densities are much higher again in blood and body fluids. The term ‘electrode-free electrotherapy‘ for MAGCELL® derives from the distinctly strong induced current densities and exceeding of the threshold value of 10 mA/m²: both of which are not found on equipment using coils or mats.

Body fluids (e.g. joint fluid) play a key role in the relevant therapy indications for MAGCELL® devices. The cells in this fluid or adjacent tissue are exposed to the established current densities. MAGCELL® exceeds by far the recognised effective current densities so that treatment is effective even at a tissue depth of 3-5 cm. MAGCELL® also induces above-threshold current densities in the blood, which are crucial for clinical therapy effects, for instance in respect of blood flow stimulation and immunomodulatory processes. The same applies for interstitial liquids, which moreover are found in virtually all organs and tissue. In bones and fatty tissue with low conductivity current densities are well below the effectiveness threshold of 10 mA/m², so a therapeutic effect in this tissue can scarcely be envisaged. Read more about Magcell including references here

Contact PhysioPod and PhysioEquipment on 01159 167 685 or email info@physiopod.co.uk or info@physioequipment.co.uk for more information on therapies or products.