Waching daily Nov 27 2018

Vamos a comenzar con el Cuadrante Superior

and to work in this area

directing to the lymphatic nodes

that are located in the armpit

we started bringing the lymph

we started bringing the lymph

up to the axillary region

we massage the fingers first,

press 1,2,3 and drag the lymph

press 1.2.3 and drag the lymph

we work on the sides of the fingers

to where the metacarpal starts

we press with the heel of the hand

like opening the patient's hand

and we are directing the lymph

to lymph nodes that are located in the flexion of the elbow

to then guide the lymph to the nodules of the armpit

we can massage with drag movements

and pumping

remember not to massage over the

antecubital endargement area (front of the elbow)

but we work laterally

we started decongesting, with small circles

until bigger circles on both sides

to finally drag the lymph

As you can see, we always support the region where we are massaging

then we bend the elbow and bend the arm

positioning to drain towards the axillary area

in the armpit are the axillary nodes

are below where the axillary hair grows

that is the specific area to direct the lymph now

then, always holding

Let's first stimulate the lymph nodes

we continue to stimulate the lymph nodes

Once stimulated, I proceed with the massage

I continue guiding the lymph

we end up with a drag movement

I drag the remaining lymph with cup movements

For more infomation >> Video 5 Superior quadrant - Duration: 5:37.

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Video 1: Setting - Duration: 10:34.

Good afternoon, my name is Marian Sotelo-Paz

from Medical Massage Professionals

we are making this video with the collaboration of Cindy, Licensed Massage Therapist,

who will help me to show

all the accessories that we are going to need

when we are going to perform a post-surgical massage

this video is in Spanish, because the intention

is to teach in both languages, Spanish

and English

but the videos will be subtitled in English

The first thing we have to know

is that, although it is true that we are not going to manipulate bodily fluids

the patients come to us referred by the plastic surgeon

and they arrive with their compression garments and accessories impregnated in body fluids.

So the first thing we should observe are the hygiene measures

and the elements of biohazard

for everything that is manipulation of contaminated substances

First we are going to prepare ourselves to take care of those patients

The first thing we advise is to use face mask

just like Cindy is going to show

the face mask is placed and we open it, so that we have the adequate protection

we work with hair tied or with a headband like I'm wearing now

or with a cap as Cindy is going to use, so as not to be with the hair on the patient

the hygiene measures are the most important

because we are working with a person 24 hours after a major surgery

and that implies that your immune system is weakened

then they are more sensitive to acquire some infection.

I have the headband and I also wear face mask

also very important, disposable gloves

everything is going to be manipulated with gloves, absolutely everything

In this case, it is not the typical relaxation massage, where one works by transmitting the energy

with the hands

We will always use gloves that we will discard after each patient

because we are working with elements impregnated in body fluids

Many times patients come dripping bodily fluids

that is not absolutely blood, but they contain a part of bloody.

How are we going to prepare the massage table?

here we have some elements

Cindy is going to show a blue, triangle bolster

this bolster can also be folded

can be folded and made square

it can be used for the elevation of the patient's legs.

then we have this semi-cylindrical bolster

that we are going to use it for the lumbar part

and we have this one called botty pillow or donut pillow

which is used for the patient to support her hip and gluteal area

because remember that 95% of patients who get massages post-surgery

have had liposuction

remember that a liposuction is a surgery where fat is removed

and that fat is transferred or placed other areas, usually buttocks or hips,

that is called "fat transfer"

also known as "Brazilian butt lift" or BBL

That is the name given to this process

then they can not press the area with fat transfer in any way, they can not sit

Patients should use pillows that avoid pressure in areas with fat transfer

On the massage table the bolsters are placed like this

the botty pillow in the middle, the semi-cylinder in the lower back and the square in the legs

The square bolster can also be placed on the back (unfolded)

for the patient to lie down leaning

also the semi-cylindrical bolster, can be worn below the knees

what's ours in both ways because in patients who have tummy tuck, which is an incision in the lower abdomen

they can not have the abdomen extended because it hurts

then abdominal muscles are shortened with back inclination and leg raises, thus reducing discomfort

also important, we work using disposable underpads

We do not use the common sheets that are used in spa, we prefer to use disposable items.

we can use underpads, here we can observe

They have good absorption

we can use them and discard them easily

2 or as many as necessary are placed

You can also use the pet training pads

This is how we prepare our massage table, which is very different from how we prepare it for other types of massages.

in this case, Cindy, will show us, the position of the patient in the massage table

also how are we going to help you get up on the massage table

let's use a small stool, it can be foldable

to help the patient get on the massage table

why? because remember

that the patient may be weak or dizzy

then you will have to help

always on the opposite side of the massage table, leaving the patient in the middle. They help you to get on the massage table.

Patients feel heavy legs, we will also help you to raise your legs to the massage table

We have to have the massage table previously prepared.

we have one foot placed on the stool and her hands resting on the massage table. We are always helping, attentive and holding the patient

Once the patient is stable and sitting in the botty pillow, we will help her lift her legs

one leg first and the other one after

then placing our arm and hand holding the patient's back and head, they will help her recline on the massage table, slowly.

this is the position we have for the patient

we rearrange the bolster below the knees

here we have the botty pillow to support the hip

and here we have the triangle bolster

then we cover the patient

it is necessary to have several blankets

we also have a heater for a reason

Most patients feel very cold

also the massage rooms where we work are cold

have an approximate temperature of 67 degrees

which is the temperature required by the Department of Health to prevent the spread of bacteria

then the environment is cold, that's why we have the heater, blankets to cover the patients

and keep them comfortable

This is the first position of the patient to be able to start performing manual lymphatic drainage

We can also have another bolster like the blue triangle

in a tummy tuck case, where the abdominal area can not be stretched

then it is important that the patient has the legs elevated to 90 degrees

another bolster is placed, the patient will instinctively flex her legs

to reduce the tension of the abdomen

and decrease the level of discomfort

What we do is place another bolster under the legs at 90 degrees.

and there we started manual post-surgical lymphatic drainage

we already have the positioning of the patient to start the massage

Thank you.

For more infomation >> Video 1: Setting - Duration: 10:34.

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Video 4: Superior Quadrant :Supine Position - Duration: 5:01.

let's start the lymphatic drainage

placing the hands on the patient

and we're going to stimulate the lymph nodes in the neck

in one direction (towards the clavicle)

behind the mastoid process

we began to move the lymph towards the clavicular group

we rotate the patient's head a little to drag

the lymphatic fluid very slowly

we drain the lymph from the face

directing it to the pre-auricular area

then we pump and make small circles in the orbicular region

inhale

exhale

inhale

exhale

inhale

exhale

For more infomation >> Video 4: Superior Quadrant :Supine Position - Duration: 5:01.

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Video 12 : Anterior Dressing - Duration: 9:14.

well, as we can see,

we are in the front

and there are important things to know, and that is

that before putting the compression garment

carefully, the drainage is passed through the crotch hole of the compression garment

the drain has a clip

that if it is not crossed can not hang

it has to be crossed to make the clamp

this clip hangs down, on the leg of the compression garment

there are patients who come with the clip hanging on the top, and they say I'm not draining

it's because the drain has to be below the incision

helps the drainage fall the gravity

Observe where the incision is from where the drainage appears and this must be below.

we see that Cindy already placed the lipofoam vertically

the abdominal lipo-foam

and lateral lipo-foam are also placed

now she will place the "abdominal-board", calculating two fingers under the sponge

the edge of the board should always be lower than the sponge

why?

because if we place the board directly on the skin

the next day the patient comes with a large lump of fluid accumulated around the edge of the board

it's a painful lump

which is very difficult to reduce with massage

and so begin to be imperfections,

and that's why every detail is important

That's why the patient has to have the sponges

before putting on the other accessories

now she is closing the hooks

and the zipper goes up at the same time

Observe the position of the masseuse, kneeling or sitting so as not to hurt her back

or sitting so as not to hurt her back

always with gloves

you may ask, maybe it has to do with massages

all masseurs we do

When the patient comes, we will help

to remove these accessories if they ask

and to put everything after

that's why the massage also lasts 45 minutes,

because they take into account that undressing and dressing again, it takes at more than 15 minutes

then cite people

at a certain time, they must remind them

that they have to be at least 15 or 20 minutes earlier

to fill the intake form

undress and we can start the process on time

So that's how we end up "packaging"

we go back to review

and we did not put the "belly button", but we will show how it is

also called "marble" but in the case of this patient

is not very necessary

we see what marble is like and what it is for

All these elements contribute to a good result

the marble is a little ball,

that all patients put on their navels

what is it for?

to maintain the round shape of the navel

when fat is removed by liposuction

the skin is like "hanging"

not having the support of fat, falls

and the navel is horizontal, like a line, it is called "sad navel"

what is done to improve that, this marble is placed

the patient cleans it with alcohol

to be disinfected

and this navel button is placed

it is called in several ways,

It is placed over the navel and is held with a tape or bandage

so that it is in its place

that is taken out when they take a shower and it is put back clean

is used for a month and the navel is rounded again

and the overall result of the surgery is improving

this patient does not need it, she is young and has no children

but women who have 2 or 3 children

have more amount of extra skin hanging due to successive pregnancies

in that case they will see the photo that is in the book of this subject

when we put the board, we gentle lift the skin first,

we place the abdominal board

and then we drop the skin so that it adheres correctly

let's continue now

With the compression sockets, Cindy has everything ready

we are going to make this patient

go up to the massage table

she is a real patient. How many days after the surgery?

Patient answers: 5 days, 5 days post-surgery

Observe how she climbs,

and always hold the stool with the foot

you help the patient to climb

tell her to move "walking" with her knees

they ask her to remove her glasses

lie on her stomach

Cindy is going to hold the drain

on the side of the massage table

Now you are going to place the compression sockets

When the massage is finished, they can let the patient rest for about ten minutes,

because they feel weak or tired.

we have extra rooms

where they can recover before leaving

now she puts the compression sockets

if the camera can approach

it can be seen

which are quite difficult to place

because they are very tight

more than anything use technique

that is why placing them when the patient is lying down is better

These sockets prevent the formation of blood clots

and must be used at least ten days

permanently, take them off just to take a shower

they reach knee height or higher

perfect, now place the other

now place the other

compression socket

Cindy already has the experience

You can see that it's pretty tight

I am going to show how they are removed

so that the person is not unstable

and it can fall

It is preferable that they do it when lying down

with only two fingers of each hand, lower the compression sockets

When they reach the ankle, you just push the heel with your thumbs

and it goes without problem

if they do it when the patient is standing, it is very difficult and even risky for her to fall

now we let the patient rest for ten minutes

We will continue with the next part of this video

For more infomation >> Video 12 : Anterior Dressing - Duration: 9:14.

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Video 10 : Accessories - Duration: 4:22.

Lipo-foam: It is a polyurethane sheet that has a standard size of 8x11in with which we will work

This is called "triangle"

It is also called "lumbar compression"

actually

is placed on the sacrum rather than the lumbar region

we're going to see how we put it

this is called abdominal board,

or most commonly called "board"

then abdominal board or abdominal table and there are several models, oval

there is a more triangular shape, but the shape does not matter, it interests that it is hard

And what will the function be?

that when the patient flexes the body, there are no marked indentations

marks or wrinkles on the skin

and the skin adheres in a correct way

Here we have the 'CAMI-TOP' which is a small shirt, good simple

and this "cami-top" has as a function to protect the skin

when all these accessories are placed

They are not placed directly on the skin, but on this shirt

why? because most of these accessories are made of polyurethane or plastic derivatives

and they produce a friction that can damage the skin

also so that there are no marks on the skin

It is placed inside out

we make the seams are out

these are small suggestions that are given based on experience

in my case I have twenty-seven years working on this

here we have the compression garment

or "faja"

that has particular characteristics

Here is what I told you, that sometimes we have to manipulate, not directly the fluids,

But many times they come with fluid stains, and that is inevitable.

remember that they are newly operated

and we have to do the lymphatic drainage massage and touch the clothes.

What is special about this type of compression garment?

It has to be high under the arm

if it is not, the compression of the waist, pushes the fluids down the arm or armpit

If the liquid accumulates under the arm, it usually hardens

This can induce the formation of fibrosis or hardened tissue

this is not convenient

down is open, sometimes has a zipper, which allows them to use the bathroom

In this case it has a single line of hooks and zipper

another important detail, in the gluteal region there should be no pressure

this region is stretchable, here is the transfer of fat

this region should not be touched or adjusted, nor apply pressure for at least 6 weeks

at least, as indicated by the surgeon

to finish with the most important accessories, compression sockets

the patients already leave the surgery room with these sockets

they should use them approximately ten days

They should be used to prevent the formation of blood clots in the legs.

They should walk about ten minutes every two hours, as indicated by the doctor

that's something we're going to know

and these are the accessories that we will use to "package" the patient

So it is called in everyday use when we dress the patient, "pack"

Now let's "pack" the patient and show how each accessory is placed

then with a real patient,

we will see how to help her get on the massage table.

we will do it now, thanks

For more infomation >> Video 10 : Accessories - Duration: 4:22.

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Video 6: Lower Quadrant - Duration: 4:57.

For more infomation >> Video 6: Lower Quadrant - Duration: 4:57.

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Video 11 : Posterior Dressing - Duration: 4:38.

This is the part of the video

we will do it sequentially

where we can see that the patient has placed the compression garment

the bottom of the "faja"

and the "cami-top"

directly on the skin

important, we work using "walker"

to give security to the patient

they feel weak

remember that they come to our practice the day after having experienced a major surgery

come by prescription of plastic surgeons

at this moment Miami is the chosen place

as of preference, for plastic surgeries

Other places visited are the Dominican Republic and Colombia, but

but many people choose Miami, for the prices and

and for the security measures that are taken

we have many more "regulations" than in other countries

from there that the risks are lower

and the results are really very good

per day we have about twenty patients

of this nature

we are dedicated exclusively to post-surgical massages

and "fibrosis" which are imperfections

that could be left after plastic surgery

we'll see that later

for now we will finish placing the accessories.

observe that something as simple as this walker

It provides stability and allows us to work better

now Cindy is going to place the triangle

what is the function of the triangle

what can be done with a lipo-foam

what can be done with a lipo-foam

folding it in one way, in this way

and it is placed in the lower back

They can also be purchased in other materials

but this is very practical

for what do you use it?

the patient walks and gravity makes the fluid

is deposited in this area of the sacrum

that one of the bones that is at the end of the spine

that bone, by its shape, has depressions

then the fluid is deposited in those depressions

and if that fluid does not move from there

approximately in about three weeks

there is a great possibility

that area hardens

and the result is not the desired one.

then this triangle, which is also called lumbar support

or like the abdominal board,

this is lumbar board

prevents that fluid is stuck in the lower back

it is not placed here

but here below

actually it should be called "sacral" because it is placed on the sacrum

but it's called lumbar

ok, that's the first accessory that we put

second accessory are the sponges

or lipo-foam

important, the 2 that go to the sides that cover the sides

they are placed "horizontal"

or landscape

and the lipofoam that goes in the abdomen, is positioned "vertical"

they have to keep that in mind

watch as Cindy places them

hold them with the same compression garment

and raise the straps

now let's go to the front

For more infomation >> Video 11 : Posterior Dressing - Duration: 4:38.

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Video 8 Prone Position, Posterior Legs - Duration: 5:29.

Prone Position, Posterior Leg

we apply effleurage to spread the oil

we start with a pumping on the sole of the foot

we can apply gentle pressure with the heel of the hand

we repeat the massage on the other leg