In this enlightening episode, the hosts engage in a rigorous exploration of the intricate interplay between lymphoedema and wound care management. They articulate the crucial role that an understanding of lymphatic health plays in the healing processes of various wounds, particularly in patients presenting with chronic conditions. The dialogue transitions fluidly through their personal clinical experiences, emphasising the need for clinicians to adopt a holistic view of patient care - wherein the assessment and management of swelling take precedence over the mere treatment of visible wounds. The hosts advocate for a paradigm shift in clinical practice, suggesting that clinicians should first interrogate the causes of swelling before attending to the wounds themselves.

Timestamps

00:00 Introduction

01:20 Wound consultancy though the eyes of an accredited lymphoedema practitioner

01:55 Swelling the inflammatory soup

02:50 Wounds, lower priority than managing chronic oedema

03:30 The acetic acid, chronic oedema/lymphoedema and pseudomonas conundrum

06:40 Unwounding yourself

09:24 Exudate v lymphorrhoea

10:15 Understanding the overlap of wounds and lymphoedema

12:09 The importance of understanding lymphoedema management in wound management

13:21 Moving the big paradigm ship around (link to Wounds Australia, Australasian Lymphology Association, Beat the Swell, Australasian College of Phlebology, Roelene Faihst, Matt Cash)

17:12 Howler to industry. Is it lymphorrhoea?

19:20 Marketing dressings for lymphorrhoea handling, not just exudate

19:47 When the lymphatics are excluded in wound research

22:14 Why aren’t wound clinicians attending phlebology conferences?

23:58 The emotional lability of wound consultants who understand lymphoedema

31:01 Shout out Matt Cash from Lily Clinic

32:20 More clinicians are talking about lymphoedema

32:42 Don’t forget to refer on to a lymphoedema practitioner

34:00 Call to action for managers to support accredited lymphoedema education

Resources mentioned:

• Matt Cash – Lily Clinic, Virginia Lily Clinic - YouTube https://www.youtube.com/@LilyClinicforlymph
• Roelene Faihst – Durbanville MediClinic, Cape Town https://www.instagram.com/lymph_draining_plus/
• Australasian Lymphology Association https://www.lymphoedema.org.au/education-&-resources/lymphoedema-training-courses/
• Beat The Swell https://www.beat-the-swell.org/
• Wound Australia https://woundsaustralia.org/
• Therapeutic wound and skin cleansing: Clinical evidence and recommendations https://woundsinternational.com/wp-content/uploads/2025/03/IWII_2025_Wound-cleansing-web-3.pdf
• The Australasian College of Phlebology https://www.phlebology.com.au/
• Australasian Lymphology Association socials https://www.facebook.com/ALAlymphoedema#

Endnotes

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The Two Echidnae Podcast is part of Advancing Wound Care, our online education platform for clinicians. Reach out to us on our other Advancing Wound Care Socials, where you’ll also find hints, tips and resources.

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The views expressed in this podcast are our own and is intended specifically for healthcare professionals. Always follow your organisation's policies and procedures or refer to your healthcare provider for individual wound advice.

Welcome to the Two Echidnae Podcast from Advancing Wound Care, an online education platform for clinicians.

You're with Monica and Donna, two advanced practice nurses with decades of experience in hard to heal wounds burrowing into prickly conversations. Welcome back to the next episode of To a Kidney Podcast from Advancing Wound Care. Welcome, Monica.

Welcome, Donna.

Good to have you.

Yes. And we're actually together again.

We are together again. We love getting together to record our episodes and hopefully listeners can feel a little bit of our energy, because we certainly feel it.

Oh, yeah.

Yeah.

We're ready for this next topic.

We are. And do you want to run with what we're talking about? Because I think. You think? I would love you to introduce.

Okay. All right. Even though we've got a long list of topics, we often turn on a dime and decide, what are we going to talk about?

We decide right at that moment and literally 10 minutes ago, we decided to talk about lymphoedema and wounds.

And it sounds very obvious because we've been talking about that throughout these podcasts, but really going to focus this next half hour or so on the topic.

Yes.

And where I want to start is what do I do? Being an accredited lymphoedema practitioner, as you are, when I now do a wound consult, it's not just knowing about lymphoedema of the lower limb.

It's about knowing about lymphoedema in general. What happens when we've got an impaired or overloaded lymphatic system anywhere in the body? And so basically, swelling anywhere is bad.

So whenever we have swelling anywhere, that's the first trigger for me. So often now when I do a wound consult, I'm actually not even thinking about the wound at that stage.

My mind and my thinking goes higher up and I start looking at, where's the swelling? Why is there swelling? Knowing that all swelling, unless it's acute and even in its acute phase is bad, because swelling equals inflammation.

And if we don't remove that inflammatory soup for whatever part of the body where we're looking at, then you are pushing the preferable uphill and literally struggling to get the lymphatic fluid up uphill. And that's the issue. So for me, as a wound consultant, it's the last thing I look at now, not the first thing.

And people get very frustrated like that.

So even edema around the pelvic girdle, edema of the abdominal pannis, facial edema, arm edema, a wound that has edema, an arm that has edema and has a skin tear yeah, fine, skin tear, but good grief, I've got to do something about the lymphedema because no matter what thousand dollar dressing I put on that, it's going to heal as fast as if I manage the swelling. So that's one thing.

And the other thing I wanted to talk about was what I learned about how to diagnose lymphedema during COVID Because in Covid, what I was hearing is that people were soaking people's leg in acetic acid or vinegar of all different concentrations.

And that was scary to the point where in my former role, I had to put out a region wide alert saying, when you use acetic acid, if you use acetic acid and it's not recommended, but if you do use acetic acid, get a medical order, get it compounded and then have a beginning and start date.

And at the time, I put loads of evidence in the email trail because what I was noticing was when people didn't know what to do about lymphorrhoea, they'd be not only not diagnosing the lymphoedema, but these people would get pseudomonas infection. And then people were chasing the pseudomonas infection with antibiotics.

And the number of times that people started on oral ciprofloxacin for, for the pseudomonas and they were actually resistant and no one had picked it up or they weren't on Cipro because they really weren't infected, but people were just slathering them with acetic acid.

So it got to a point where whenever anyone said to me, oh, they've got a pseudomonas infection, we're putting acetic acid on them, I'd say, has anyone diagnosed lymphoedema? But it was lymphoedema 100% of the time. Those people had either known lymphoedema.

And that's the short, I'd say anecdotally, 10% of the time, oh, yeah, they've got lymphoedema. But 90% of the time, not only did they have lymphedema, it wasn't diagnosed. That's just so terribly, terribly frustrating that.

All 100% resonates with me. And I've got a couple of clinical reflections.

My first initial question just with regard to what you just said about those cases where there was lymphoria, pseudomonas infection and lymphedema, was that very obvious in looking at the limb, like, were you, you were talking. That was in Covid time. Were you looking at photos of the Limb. Could you tell, reasonably, obviously, that there was chronic edema there?

That's the thing. I didn't even have to look at the wound.

Oh, that's wicked.

I didn't have to look at the wounds. And that's, that's, that's what I'm leading up to.

Yeah. And I, I have no issue with that at all.

And that leads actually to what my first comment was on both of those points you've made about, you know, it's the first thing that we see. And then all the issues you've had through Covid, and I still think we see those issues now.

Just, it's not that we're happening to be in covert, but I see them all the time. And here's my, my first point. Just last week I received a photo.

And you know, as I'm working up referrals in private practice, some people who I do know will just send me a photo and say, hey, you know, if you've got scope to take this on, blah, blah, blah. And you know, we love getting a photo, don't we? I'm looking at you now. People can't see me, but I'm looking at you now, rolling my eyes.

We love getting a photo, don't we? Like, can you help this? And it's like, it's not about the photo, but yeah, photo, okay. Gives us some clinical information. You don't have to see it.

But it was a good, it wasn't a bad photo because it was from the knee to the mid foot and there were wounds all around the gaiter at various points. But the first, very first thing that jumped out to me and I was being asked about the wound. Can you help that wound? Can you see this person?

First thing that jumped out to me and actually my response, because I knew this person, I responded as I knew them clinically, was a nurse, so a friend. And I said, yes, well, that's an uncompressed limb, isn't it?

Yeah.

Can you help me with this wound? And my initial response was, yes, well, that's an uncompressed limb and a dry limb as well.

Yeah, there wasn't lymphoria in this particular case, but I've no doubt it was pouring out the multiple large open wounds. And I often find just when I'm looking at photos, all the time I'm spotting what's in the background. I'm spot, I'm looking at this.

The skin on the limb is more important to me than the wound.

I isn't that.

I know I really, I can't even. Yeah, the wound is there.

Wounding yourself, it's.

Yes. And I often just find myself not looking at the. We're not even consciously. Just subcon. Yeah, I can see that it's there. I see you.

I can see there's some yellow in you or there's whatever issue with it, but I just don't even want to address the wound first because I don't need to.

Yeah.

Because in addressing the limb, we'll address the wound. And I find I more and more just do this. And that was in that reply to this inquiry that I had. Yeah.

But even just as you're talking, I'm thinking the more expert you come, the more you move away from the wound. You have to identify etiology.

We're not saying that, but it's all those other things that stop that wound from healing and in fact may have caused the wound. And let's talk about lymphatic wounds. We've just recently in the literature started hearing about lymphatic wounds and then even.

Even thinking about exudate. You know, just on. A year ago, I was in a forum, maybe a bit longer of my peers, and there was a big session.

This is actually quite timely because we're heading to our international conference soon.

Yeah.

But there's a big session on dressings, handling wound eggsudate, and I'm screaming in my head going, it's actually lymphoria that you're talking about. Like, we really have to change the language about how we talk about wound exudate.

Because often it's in the context of lymphedema and the wound is the point of least resistance. It's like a full bucket that you've now or a balloon that you've just punctured a hole in.

Well, case. In my example, there is on the same case that I had an inquiry from last week. How it transpired was the.

I was talking to the nurse who was involved in this case and we were talking about our service delivery. I was working up whether they wanted us to come and see the wound and. And they absolutely did.

But the question came at the end of the workup, was the end of the clinical conversation and the triaging call was, oh, okay, I understand that you're very experienced and that your team are all lymphedema practitioners, but are you guys experienced in wounds?

Oh, okay.

I was doing a too good of job of perhaps, if you want, selling our service. I was looking at this wound.

I was giving her all.

Looking at this leg, rather giving her all the information on where it may go, how we could possibly help. Yes, it's appropriate for our service. This is how it would look. Cause she, she was, you know, scoping us out. That's great, that's really good.

And that's why I have a conversation with people. This is why the conversation in the triaging is so important, why we'll not accept a referral without talking to someone first.

But that's our particular model of care. But I'd spoken so much about the limb to probably our own detriment in accepting a case.

And she said, yeah, but I'm referring what she was saying, yes, but I'm referring to you for the wound. Okay, you can deal with the leg, but are you wound experts as well? That was her actual words.

So I was able to then have that educational moment and say, well yes, actually we're wound clinicians first, we're probably more experienced in wounds. But I'm telling you this leg won't go forward without the chronic oedema and the clear lymphedema that was addressed.

And then what had transpired and getting back to your point, how it's important in health care, how we're going to turn this big ship in healthcare. So that was a nurse telling me that.

Later on in the conversation I learned that this particular limb slash wound was being managed at a medical center and the GP had decided to put the flat knit custom made garment that was used on the contralateral limb. So she, the lady had a node clearance 10 years earlier as cancer treatment. So she had established lymphedema in her alternate other leg.

She didn't have it in this current one. This was a traumatic wound three to four months earlier, but they decided just to use the custom garment and swap it over from one leg to the other.

And so at every point in care, no one's recognize that this limb needs its own treatment with regard to chronic edema. So yeah, then this is a weekly occurrence for us.

Yeah, look, I think you know, you were talking about moving this big ship around. I think that there have been a few big, big tiny turns. Can I describe them as that a big tiny turn, which I think is a good thing.

For example, the whole initiatives around wounds Australia and ALA collaborating on Beat the Swell.

Yeah, fantastic.

That campaign, I think it highlighted where the knowledge gaps are.

At one stage I asked the room full of people around, I don't know, 130 people there would be at least in that meeting, how many people have done an accredited lymphoedema course. And I'd say I was in the front of the room. How many would you say I was in the back? Seven.

I was gonna say between six and ten.

Yeah, between six.

You didn't have a dozen. Yeah, yeah, yeah.

So between six and ten put their hands up. So. And I know that three of them happened to come from. I knew them from the area that I used to practice in. Oh, I'm still practicing, but in.

In my public role. So that's still encouraging. I think that I've spoken now three times at the Australasian College of Phlebology in the conference there.

Just recently, spoke a couple of months ago. And this time I had many phlebologists.

Like, a lot.

Like, I couldn't eat my lunch because people were wanting to ask me questions about lymphedema, how to learn about lymphedema. And that's, for me, a huge turn. I'm seeing, you know, we're seeing a lot more people talking about lymphoedema on social media.

Just found a great one this morning. I think her name was Jolene.

She just calls herself Jolene and she's from South Africa and knows another guy called Matt and he has a clinic called the Lilly Clinic.

Yes, I was gonn could put these two in the show notes.

Yeah, yeah, actually, absolutely.

Because we're vouching for their shout out. We're vouching for their content.

Oh, Matt and Nolene. I mean Jolene.

Good.

Rollene rolling.

So good channels to follow. We'll link them.

Yeah. So I can see, you know, like from the last couple of years, little tiny shifts.

And also in another conference I presented on how we transition GPS language from talking about nothing about swelling on the referral to gps now discussing or putting terms like chronic oedema, chronic swelling, lymphedema on their referrals, which four years ago they were never appearing. Those words were never appearing on a referral. Yeah, so I think, you know, tiny, tiny changes.

I'm seeing that more in medical summaries and even in aged care as well. Like, I'm not getting so much referrals directly, directly to me from those sources, but I'm finding a lot more.

And it's just anecdotally noticing these things peppered. It's peppered through the documentation more. So I often have a diagnosis there by the time I hit someone, but not all the time.

And can I have a shout out to industry? Can I really shout this out?

You know, in Harry Potter, there's The howler where I've forgotten the mother's name in Harry Potter, but Harry's the Weasley's mum sends a howler if she wants to really get a message across. So can I send out a howler to industry when they're redeveloping their products and redeveloping their marketing? Really?

And we're going to bank this for another time. Talking about flea bow lymphoedema. And I will talk about another howler that I want to post in that episode.

But when you are talking about your dressings, when you are talking about its exudate handling capacity, I urge you all to learn about lymphedema and to question that. In fact, it's probably predominantly lymph fluid in an impaired or a overloaded lymphatic system. And I think that.

Because I think that's part of the barrier, because at the moment we're focusing so much that this dressing can handle this much exudate.

Yep.

And it's the ass end of it. Yep.

How many times have you taken off a SAP like a Super Soaker dressing? And it's been so heavy, but it's all been clear, predominant, predominantly clear fluid. Yeah.

And you can just, you know, we'll go about attending the.

The wound consult, and within a couple of minutes, like, you've soaked the wound, you've taken it off or whatever, whenever that wound is exposed and hasn't got a product on it, even within the wound, certainly the periwound, but even within the wound, it starts to build bead as opposed to ooze or seep.

Yes.

Exudate it.

Beads.

And you can see the beads sitting on the surface.

That's beading. Plus, if you are using acetic acid or burrow solution equals lymphedema. Now, is that scientific? No. Is it experience? Yes, absolutely. Yes.

We may be able to get two podcasts out of this.

Two episodes.

Yeah. If we get it. Yeah.

I actually think it'd be a lot more marketable if you talked about, you know, what your dressing is actually handling and talk about lymphoria in that context. And even those wounds that may have sort of a thicker exudate in the context of lymphoedema. It's a very proteinaceous fluid.

The lymph fluid is highly proteinaceous. So I think there's so much opportunity for research in that space.

And often research often doesn't really, in the methodologies, they often don't describe how they. Whether they assessed swelling in the limb and how Extensive. It was, you know, they've not classified the lymphoedema.

And so further to that on lymphora being highly proteinaceous, so it's got a lot of protein in it. I think you'll remember that we were at a conference a couple of years ago. The room was packed.

There was someone talking about having done some research in venous slug ulcers. They swabbed the skin and they found a lot of albumin on the skin.

And not at any point this person who'd done this high level research presenting at a conference, had talked about lymphoedema and then went on to say that when they swabbed the skin or did testing of the skin, guess what they found? Albumin. So you've probably forgotten this. I remember turning around and to you and going, what? Like it was almost dystopian.

Maybe I've blocked that out in. Oh, yeah, no, I would. Yeah, I haven't remembered that.

I. Yeah. And so you're probably, you're probably one.

Step ahead of me there anyway.

Yeah, maybe. Maybe.

Yeah.

Well, not maybe, but I think, because I remember approaching this person and asking them had they done a lymphedema? Cause.

Can I ask a question? Was it a wound conference?

Yes. Yeah. Yep. And I'd asked that person whether they'd done a lymphedema course and they said no. And look, had valid reasons why they'd not done it.

Absolutely.

That's.

Yeah, yeah, but. And so this is where the real disconnect occurs. And so for me, because I dabble in the wound world, the lymphedema world and phlebology world.

Sorry, you don't dabble.

Oh, okay.

At least you're borrowing.

Yeah, I borrow. Okay.

Yeah. So, yeah, that, that disconnect between those.

Spaces and they're not talking, you know, like at the phlebology conference. I'm the only nurse that attends. Good grief. And yet we've got here, I'm now on a roll.

And then we've got these Venus Lagos guidelines being developed all over the world and I'm not seeing nurses at phlebology conferences.

So can I ask a question? That, that presentation you were talking about with the albumin being found on the skin was that session about venous pathology.

I honestly can't remember what it was about because I've blocked it out of my head. Because I must admit, as soon as I heard that, I went, oh, no. Like there's, there's a whole.

That connection. But I, But I find you know, you and I have spoken about this a lot.

Will be at wound presentations, conferences and the like, but especially conferences. And the whole session is talking about venous leg ulcers and it's talking about X ray and managing and the photos will be up.

And we're just looking at that leg and we're just looking at each other, knowing exactly what we're thinking. The same thing. That's lymphoedema.

Yeah, yeah.

And the whole time it's just talked about venous pathology. So we are certainly getting into the next topic. We said we will talk about more in the future. You know, flebo lymphedema. But it's so tangible for us.

Oh, I know.

So tangible.

I know. And you just. And then. Okay, so this is what I see at wound conferences and again, I think it's going again.

That big shift is making little, little turns now, but a credit to a lot of people.

And the Beat this well campaign and the ALA and Wounds Australia getting together.

Yep. Yeah. I think that's really good. I think. Yeah. And I think that. But, but this is what you see. Okay. I'll explain how I feel emotionally.

Okay. Yes. Okay.

So great. You come and listen and you know, it could be any.

And the thing is it sometimes it's weird and wonderful wounds of the lower limb, you know, because often it'll be pyoderma gangrenosum. How many. How many case studies am I going to hear about pyoderma gangrenosum? It's not always, but there are a lot of PG's and we are looking.

For the complex all the time. We should be, but sometimes it's a little bit too readily jumped.

Yes. Yes. And so this is how I feel emotionally getting really excited right now. I'm going to learn something.

And then they introduce either whether it's a case study or a case series or the research and presenting all their data and. And this is of podiatrists as well, challenging podiatrists out there. Please do an accredited lymphedema course.

And I'm on the board of the ala, and that's one of the reasons why I'm on the board of the ala, to ensure that as many clinicians as possible, anyone who works with people who have legs, at the very least has to understand lymphoedema and be accredited in managing swelling, at least of the leg. Anyway, I digress.

No, you haven't. And we will also put a link. We've mentioned the ala, the Australasian LYMPHOLOGY association and the other two social links.

We'll put up the ALA social links we have put up before the ALA's website. But we will. It's worth. If we're telling people to follow other things on socials, we will include that link this time around too. But no, I've.

I've had the same thing.

Last month listened to a wound clinician present a case study at a industry funded, you know, dressing related educational event presenting a case study on an atypical wound that had pg.

It was about the dressing management, but what happened at the end of the case was that it only started healing when we compressed it and yet it was about the complex etiology and how the dressing handled it.

It's like actually that kind of proved the point that it also required compression or yes, it may have had a complex aetiology, but it was not going to progress without that.

But the case in point is that wound clinicians, even if you're not going to actively manage lymphoedema, you need to know about it to recognise these things.

Then to refer on.

Totally. Yep.

And so you've tied that really nicely in with my emotions because I go there, get really, really excited. Then they talk about this, these atypical wounds or typical wounds and the testing that they did.

And you know, and I'm looking at the image, it's lymphedema, there's at least lymphedema. And then I sit there, I'm really tense thinking, please, please diagnose and talk about the Tyrannosaurus rex in the room.

Talk about this inflammatory soup that this wound of whatever etiology is swimming in and all the. And we talk about inflammatory mediators in the wound. Well, guess what? There are inflammatory mediators that those inflammatory mediators are being.

The lymphatic system is desperately trying to collect all those inflammatory mediators and take it to the lymph nodes. That's the whole thing. So it's like the wound is the station, you know, for the concentration of the inflammatory mediators.

Anyway, but then I sit down, please mention. And this is. I've never thought about this until I'm articulating. Please, please mention about lymphedema. Please mention Mount Edema.

And then they say swelling and I get a little bit excited, I get really excited. And then nothing. They don't. And then you are spot on. They incidentally mention, oh yeah, we did compression incidentally, and.

But we added this really magical product that the company has asked us to present on. But we did, you know, we compressed and. And this magic product healed the wound.

Yeah.

So I go from.

Yeah, we sigh, don't we? We just time and time again, we're kind of laboring the point. But yeah, it really is.

But. But I'm like this abused. What is the word? Gaslit clinician or not gaslit. Constantly expecting a hopeful.

And so having said that, on a positive note, there are more shifts or another thing. One more thing I see.

Yeah.

Is I get really, really excited when the person puts up on their slide at a presentation. They're a wound consultant and either an accredited lymphedema therapist or a lymphedema therapist because, you know, from international conferences.

And I get really excited. But they present a case study and they don't mention. Oh, they just mention. Yes, lymphoedema.

It's minimal.

And then they don't talk about why that wound or what they did about the lymphoedema and how they manage the oedema. And so then I get.

Yep, I'll raise you.

Good, bring it on.

And. And I heard. I heard one recently and like, credit to them that they've done that course.

And I'm not sure why there's this disconnect, but they were presenting a case on another complex wound and we were managing it with garments with a. With an active wound. But they were managed. There was a. A reason for it. It was fine. I'm not. That's not my point.

I would rather bandage something than put a garment on when there's an active wound. But there's always going to be a cohort that just for whatever reason, they went with garments managed with around knit garment.

Struggling to heal, struggling to heal, struggling to heal. Put into a flat knit garment, all of a sudden healed. But it was the dressing that healed it.

Of course it was.

So why aren't they recognizing that? Like it's weak. That's clearly identified from me, the audience. But it wasn't even summarized as that. And I can. Well, I can tell you why it healed.

It healed because you changed the compression.

And he's keeping a tally of the wounds that he helps heal. The wounds that he helps heal with compression. And he tallies them up.

And he doesn't call himself a wound consultant because I don't think he is, but he understands.

So it's a standout for him because he's not a wound clinician, he's not.

Nursing, and it's so, it's fabulous. Shout out to you, Matt.

Love your work.

You know, he's counting his wounds. He's got just a little blackboard with 57. I love it. You know, he's a. He's an OT who from the sounds of it, hasn't done a wound management course.

So there you go. Anyway, we gotta check out love.

This has been a really stimulating conversation for us and maybe it's a bit of debriefing for us as well, which I think we do digress into a lot, but these are the real struggles. And we will talk about this a lot more. But we wanted to get back onto the lymphoedema and wounds topic because it is topical at the moment.

That's the other thing we have both noticed. It's a lot of people talking about this and we think that is a good, a good shift, a very positive shift, and we're very supportive of that.

We know that not everyone will be able to go on and attend or, you know, undertake a lymphedema accredited lymphedema course, but it's important to know to refer on and seek assistance, especially if you're already a wound clinician and maybe you don't want to go on and do a lymphoedema course, but can you align yourself with someone? Can you learn little things from them? Can you cross pollinate?

Because it's likely also that they will have wounds that they need to send to you as well. And as far as our most. I'm an advocate, I've said it a million times for networking and clinical connections.

You cannot function as an island in this space of complex wounds.

And I know I probably over collaborate to my detriment, but that's the model of care I have and we get amazing results with that in the most difficult of difficult circumstances. And we will change trajectories because we, you know, factor in the whole team.

But please have in your corner a lymphoedema practitioner and learn from them and refer to them even if you can't go on and do that course. That would be my. My takeaway.

Yeah, and I'm going to up that though. Not up it, but please do. Yeah. But I still think, and hopefully because I Think there. Well, there.

We know that there's some people who are in management position. Physicians listen to this podcast now as well. So again, a howler to those managers. Support your staff to do that support.

It will come back to you in spades because it's not just about running a lymphedema clinic, but your staff understanding the inflammatory soup that lymphoedema is will benefit. How drugs get, how antibiotics get into.

The skin, wound hygiene.

Yes, everything. How they manage their continence issues, all sorts like. Then that's another thing. Continence and lymphedema, another topic. How's that?

Continence and lymphedema. What's the connection? Stay tuned. Another podcast.

It'll increase the ability for consumers, patients, clients to self care.

Yep, yep.

Yeah, I love that.

I reckon that's a beautiful place to stop.

Well, we end on self care. I think that's pretty cool.

And we better self care ourselves now. So self care out of here.

We will. We will. We're saying that because we're sitting together and we've got this room for another eight minutes.

So thank you and please hop on to our socials, hop on to our website, hop on to our email list. We've got a lot more we're planning to get out for you guys really, really soon.

At Advancing Wound Care.

At Advancing Wound Care. Thanks, Monica.

All right, thanks, Donna. That was great.

At Advancing Wound Care, we're proud to stand alongside clinicians who lead with heart curiosity and a deep commitment to doing right by the people in their care. We are so grateful to have this opportunity to share our learnings and challenges with you.

Hopefully this episode has inspired you to keep burrowing down to issues that bug you.

If you liked today's episode, follow and subscribe to the To a Kidney podcast on Spotify, Spotify, Apple, and YouTube. If we were too prickly, we'd also like to know. Reach out to us on our Advancing Wound Care socials where you'll also find hints, tips and resources.

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All our contact details and links we've mentioned are in the show Notes below.

We will see you in the next episode and in the meantime, go forth, be curious and burrow into some ant nests. Take a round to cover you. Would you do what I do?