❌不需要直接按壓淋巴結

⭕刺激淋巴管,❌而不是刺激淋巴結
促進淋巴流動,加速淋巴循環. 其實是要傳送訊號給淋巴收集管上方的肌肉。
當平滑肌接收到訊號,就會整體加快收縮。
✅但大部分淋巴結是沒有平滑肌
(極少部分的器官旁淋巴結上可能有,但那也是觸碰不到的深層)

👩‍⚕️個案問,
要不要壓腋下淋巴結 ?? 要不要壓腹股溝(鼠蹊)淋巴結 ??要壓幾下，多大力??
👉其實是不需要直接按壓在淋巴結
上的

👩‍⚕️常常個案都把腋下和鼠蹊周邊的組織壓到紅腫,這反而是反效果。
因為不但沒有加速循環和加快流動,後續還造成周邊組織發炎,產生更多組織液。
而因為摸不到淋巴結,個案都力道過大想要壓到淋巴結,導致其他腋下或鼠蹊周邊紅腫,這也會影響到治療師治療時的判斷。

淋巴結有沒有腫大,是治療師每次執行治療時都需要去觀察的,若有莫名腫大,我們需要判斷是否有急性感染, 是否身體免疫系統出現問題,若出現問題,我們才能加快轉診或提醒個案注意皮膚傷口或免疫狀況。

👩‍⚕️
✅若是想加速上肢或下肢的淋巴循環～
👉上肢: 可以藉由延展stretch手臂內側皮膚或身體側邊靠近腋下的位置,給予神經訊號在這些鄰近位置來幫忙,但不需要真的壓到淋巴結

👉下肢: 同樣可以延展大腿內側,臀部,下腹部位置的皮膚給予淋巴管道刺激, 而不需要壓鼠蹊部.

（以下英文精簡版，看中文版比較清楚喔！）
……………………………………
👩‍⚕️No need to press the lymph
nodes directly

✅Stimulate the lymph vessels, not the lymph nodes.

Increase lymphatic flow and accelerate lymphatic circulation. In fact, it is to send a signal to the smooth muscles of the collector lymphatic vessel.
When the nerves of the smooth muscle receives the signal, it will accelerate the contraction.
But most lymph nodes have no smooth muscle.

🔽
The cases asked,
Do they need to press the axillary lymph nodes?? Do they want to press the groin lymph nodes??
How much pressure, how many times?

👉Actually, you don’t need to press directly on the lymph nodes.

If you want to speed up the lymphatic circulation of the upper or lower limbs:
Upper extremity: You can stretch the skin on the inside of the arm or the side of the body near the armpit. (Give nerve signals to the smooth muscles and help in these nearby locations, without actually pressing the lymph nodes directly.)

Lower limbs: It can also stretch the inner thighs, buttocks, and lower abdomen to stimulate the lymphatic vessels.
No need to press the groin lymph nodes directly.

#drvodderlymphedema
#drvodderlymphaticdrainage
#drvodder
#淋巴系統
#taichunglymphedema
#lymphaticdrainage
#Lymphaticsystem
@ Taichung, Taiwan

醫者有社會責任去保障公眾健康，我們認為梁卓偉教授和陳家亮教授作為香港兩所醫學院院長責無旁貸。因此，我們呼籲所有醫護人員參與連署，懇請兩位院長履行社會使命發表聲明保障社會大眾的健康和人身安全。

連署連結: https://forms.gle/teMGNCiZPMYatVbh8
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《致香港大學李嘉誠醫學院院長、中文大學醫學院院長的公開信》

梁教授、陳教授道鑒：

　　有鑑於在六月十二日、七月二日及二十一日，香港警察濫用武力以控制群眾。如此行徑實對公眾健康遺害無窮，我們一眾醫療人員對此極為關切。作為香港大學李嘉誠醫學院院長、中文大學醫學院院長，吾等懇請兩位院長細察香港警察控制群眾之手段，以保障公眾健康。

　　據多家本地及國際媒體報導，香港警察於六月十二日，發射多輪催淚彈、橡膠子彈及布袋彈，以驅散聚集在金鐘的示威者。報導提及，警方向示威者發射至少一百五十枚催淚彈，二十輪布袋彈以及數枚橡膠子彈，造成至少七十二人受傷。從多家媒體直播可見，橡膠子彈更直射一名教師眼球，創傷嚴重，對其視力之損害非同等閒。另外，警方亦曾以數枚催淚彈包抄示威者，堵塞其退路；而當示威者被逼退守至中信大廈，警方竟朝人群中央投以催淚彈，造成數以百計的市民受傷及呼吸困難，生死攸關，不容小覷。此外，警方向一名手無寸鐵的市民，近距離發射橡膠子彈，以致其下腹嚴重受傷，情況慘不忍睹。

　　據多份醫學期刊綜述──如《刺針》（Lancet）[1] 及英國醫學期刊（BMJ (Open)）[2]，橡膠子彈乃可致命武器。同時，橡膠子彈不易操控，準確性低，有引致重傷，乃至死亡之風險。多份期刊不約而同指出，橡膠子彈不適宜用於密集人群之管制。

　　然而，香港警察漠視上述已知風險，仍於七月二日及七月二十一日繼續使用此類武器。在七月二十一日，警察更於鄰近民居之地，向群眾發射多輪催淚彈及橡膠子彈，當中更殃及記者。此等武器之禍害影響深重，不單有損呼吸系統，更會導致燒傷、嚴重鈍物創傷及爆炸性創傷。據媒體報導，武器造成至少十四人受傷；更有市民懼於警方之搜捕行動，而未敢求醫，致使受傷數字難以估算。

　　人權醫療組織（Physicians for Human Rights）醫生哈爾（Dr Rohini Haar）在接受紐約時報訪問時指出，警方對市民使用不成比例的武力，實有濫用武力之嫌。早在二零一四年，潘冬平教授[3]亦對香港警察使用催淚氣體情況深表關注，擔心催淚氣體損害市民呼吸系統。可見，催淚彈、橡膠子彈及豆袋彈等武器危害不輕，對香港市民公眾健康的損害不容置疑。

　　兩大醫學學院一直致力培育杏林菁英，不遺餘力。一眾醫療人員亦謹承《希波克拉底誓詞》之教誨，不論病患身份職要，一直為全人類之福祉著想，嚴守不懈。學院循循善誘，吾等縷心刻骨。誓詞薪火相傳，代代不息；缺少對生命健康之尊重，醫療人員何以自立？故此，我們一眾醫療人員懇請院長，發表聲明，呼籲香港警察：

一、避免濫用催淚彈及任何類型子彈，以免導致人命傷亡及其他不可見之損傷。
二、在使用武力時，必須顧及市民安全，並保持專業克制。

　　醫療人員一直存仁心，行仁術；保護市民之健康，乃至生命，吾等責無旁貸。院長為學為醫，高風峻節，茍以吾等同心同德，捍衛市民之生命健康，必見杏林春暖。

　　謹祝
道安

一眾醫療人員謹上
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Dear Professor Leung and Professor Chan,

We are a group of healthcare professionals, some of us being also graduates from the Faculty of Medicine of the University of Hong Kong and the Chinese University of Hong Kong. We are writing to express our gravest concerns over the persistent and serious threats to the health of members of the public posed by weapons deployed in crowd control by the Hong Kong Police Force (HKPF) on 12 June, 2 July and 21 July. We hereby urge the Deans of the sole Faculties of Medicine in Hong Kong to take actions in censuring the HKPF and the Hong Kong Government against the serious health risks in their crowd-control tactics.

On 12 June, as reported by multiple local and international news agencies, the HKPF fired multiple rounds of tear gas, rubber bullets and bean-bag rounds to disperse protesters in Admiralty. Over 150 canisters of tear gas, 20 bean-bag rounds and several rubber bullets have admittedly been directed at protestors which resulted in at least 72 injuries. As evident in the live reports from various media sources, a teacher suffered traumatic ocular injury causing significant vision loss when his eye was hit by a rubber bullet; hundreds of citizens suffered various degrees of injuries and respiratory distress consequential upon the numerous tear gas canisters shot at Citic Tower in Admiralty where protesters were trapped in a life-threatening space filled with tear gas; an unarmed man sustained injury in his lower abdomen when a rubber bullet was directed at him in a short distance.

According to multiple studies and reviews from high impact factor medical journals, in particular the Lancet[1] and BMJ (Open)[2], rubber bullets can be lethal. Their notorious inaccuracy and risk of severe injury and death render them inappropriate and unsafe means of force in crowd control.

However, despite the known risks of these weapons, the HKPF tenaciously deployed them on citizens on 2 July and 21 July. On 21 July, 55 canisters of tear gas, 5 rubber bullet rounds and 24 sponge bullets were admittedly shot, some without immediate warning, at protestors and even at journalists notwithstanding the numerous residential buildings and citizens in the vicinity. The use of these weapons has left members of the public with at the very least, various types of injuries and further, burns, blunt force trauma and explosive injuries. 14 injuries have by far been reported where others did not present themselves to the hospital in fear of the risk of prosecution.

Dr Rohini Haar of Physicians for Human Rights had in a recent interview told the New York Times that the force used by the HKPF was disproportionate and excessive. In Hong Kong, Professor Ronnie Poon had as early as in 2014 expressed openly his earnest concern over both the short term and long term health risks in the use of tear gas in particular to one’s respiratory system when the HKPF first fired tear gas at Hong Kong citizens [3]. It is indisputable that these named weapons put the health of Hong Kong citizens at serious risks.

Doctors have striven to stand by the Hippocratic oath that they remain members of society, the identity of which comes before their profession, with special obligations to all fellow human beings. The two medical schools in Hong Kong have been established accordingly for the nurture of healthcare professionals to serve the public with benevolent hearts and minds. This is the time to honour our oath that human life should deserve the utmost respect and to maintain by all means such noble traditions of the medical profession.

We, as healthcare professionals, therefore implore the Deans of the only Faculties of Medicine in Hong Kong, in the service of humanity with conscience and dignity, to take the lead in safeguarding the public’s health and to issue a statement to urge the Hong Kong Police Force to:

(1) refrain from using tear gas and bullets in any form on protestors to prevent further bloodshed and severe non-reversible injuries; and

(2) exercise due restraint over the use of force when handling protests and at all times, put the safety of Hong Kong citizens at the highest priority.

Regards,
A group of healthcare professionals
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Healthcare professionals have a social responsibility to safeguard the health of members of the public. We believe that, as Deans of the faculties of medicine in Hong Kong, Professor Leung and Professor Chan bear a paramount obligation in this regard. We appeal to all healthcare professionals to join us in this petition to urge the deans to issue a statement to honour their obligation to defend the public from health risks.
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Petition Link: https://forms.gle/teMGNCiZPMYatVbh8
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參考資料/References
[1] Mahajna, A., Aboud, N., Harbaji, I., Agbaria, A., Lankovsky, Z., Michaelson, M., . . . Krausz, M. M. (2002). Blunt and penetrating injuries caused by rubber bullets during the Israeli-Arab conflict in October, 2000: A retrospective study. The Lancet, 359(9320), 1795-1800. doi:10.1016/s0140-6736(02)08708-1

[2] Haar, R. J., Iacopino, V., Ranadive, N., Dandu, M., & Weiser, S. D. (2017, December 01). Death, injury and disability from kinetic impact projectiles in crowd-control settings: A systematic review

[3] Professor Ronnie Poon Facebook: https://www.facebook.com/138599119760/posts/10152753050039761?s=1014598371&sfns=mo

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希望大家可以幫吓可仁啦😢 我希望個個小朋友都可以健康快樂咁成長，可以一齊去公園玩

【最新消息：募捐行動已於2018年12月3日結束】中大校友慈善基金感謝各界慷慨支持，募捐行動已結束。所得善款將支持張可仁及患上相類疾病需免疫治療的其他6位病童。

詳情請參閱中大校友慈善基金網頁：https://www.facebook.com/cuhkacf.org/posts/589827338133781

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(2018/11/22)

中大醫學院向大家作出緊急呼籲，支持我們2000年的醫科畢業生張俊傑醫生，拯救他只有17個月大的兒子張可仁的性命。

可仁早於出生第4天時已被診斷罹患一種罕有心臟病「主動脈狹窄」(Coarctation of Aorta)，需要接受緊急手術。極之不幸的是，可仁最近再被確診患上「第四期神經母腫瘤」(Stage IV Neuroblastoma)，目前可仁的頭骨至腰椎和盆骨均受到癌細胞擴散，脊髓神經線受到癌細胞壓住，痛楚非常，並有癱瘓的危機，癌細胞更正轉移至骨髓。

可仁現時正住在威爾斯親王醫院兒童癌症中心隔離病房，極容易受到感染。他已開始接受化療，而治療方案將包括化療、手術、放射治療、骨髓移植、免疫治療，治療時間約一年至一年半。他完成化療、手術和放射治療後，會進行骨髓移植，之後需要免疫療法，這可大大提高存活率，由20%升至50%。

然而，免疫治療需要病人自費，所需費用高達港幣200萬元。張醫生另一兒子患有自閉症，太太辭掉小學主任一職，全職照顧兩位小朋友，並要照顧父母親，經濟上未能承擔高昂的醫療費用。

中大醫學院2000年畢業同學會發起是次籌款，目的包括：
1. 為可仁進行骨髓移植後的免疫治療；
2. 引發社會人士及政府對兒童罕有癌症治療的關注。

查詢：
香港中文大學校友慈善基金
電郵：info@cuhkacf.org
電話：2180 4316

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【Fundraising Campaign Completed on 3 December 2018】According to CUHK Alumni Charity Foundation, the fundraising campaign for Mark CHEUNG Ho Yan has completed. The fund raised will be used to support the immunotherapy of Mark and 6 other patients who are suffered from the same disease. Thank you for all your kind-hearted support and generosity.

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(2018/11/22)

This is an urgent appeal for your generosity to save the life of the 17-month-old son of Dr. CHEUNG Chun Kit, our medical alumnus of Class 2000.

Dr. Cheung Chun Kit is a CUHK medical graduate of Year 2000. His younger son, Cheung Ho Yan Mark, has recently been diagnosed to have Stage IV Neuroblastoma in November 2018, and is in an emergency need of donation to provide the necessary funding to support the life-saving yet expensive immunotherapy.

Mark was presented to his paediatrician for fever and cough in late October 2018. His cough resolved with treatment but his fever never completely went away. Two days prior to his diagnosis, Mark was more clingy than usual and did not like to walk. On a video clip, Mark was noted to have foot drop, a very significant red flag which may indicate a compression on the spinal cord. Emergency scans were immediately performed that night, and Mark was found to have a large tumour on the left side of his abdomen. The aggressive tumour had already spread silently to the back of his skull, his spine, his hips and had compressed his nerves which control his lower limbs, resulting in pain on standing and difficulty in walking. Mark is facing an imminent risk of paralysis.

Mark is diagnosed to have a rare childhood cancer which is called Stage IV neuroblastoma, a cancer which typically presents at late stage because it arises deep in the abdomen. To cure his aggressive cancer, Mark needs to survive through rounds of intensive chemotherapy, radiotherapy, surgery, bone marrow transplant, and finally, immunotherapy. The whole treatment duration lasts 1.5 to 2 years. To completely eradicate all cancer cells, immunotherapy will be needed to boost Mark’s survival from 20% to 50%. However, immunotherapy is a self-financed treatment in the public hospital and the treatment costs could be up to 2 million.

Such close encounter with death is not the first time for Mark. At the first week of life, Mark was diagnosed to have a rare heart problem called “Coarctation of Aorta”. Mark had received life-saving surgery to reestablish the blood flow across his aorta, the major blood vessel that allows blood to go from the heart to the brain and the rest of the body. In a report published in 2002, only 67 cases with dual heart condition and neuroblastoma were reported, giving an odd of 1 in 100 million for a child to be hit by these two rare diseases. Scientists have not yet completely understood the mechanisms that may cause the two conditions to appear in a single child.

It never rains but pours that Mark’s elder brother, now 5 years old, was diagnosed to have autism at around age 2. To enable the elder brother to have intensive training to improve his outcome and development, Mark’s mommy quit her job as a primary school teacher since the diagnosis of autism was made for his elder brother. Dr. Cheung, who is a medical doctor for the elderly, became the sole bread-winner of his family.

CUHK Medical Graduates of Year 2000 have initiated a fund-raising campaign for Mark and his family with the following two objectives:

1. To appeal for donation to support the costs of immunotherapy for Mark
2. To increase the public awareness on the grave needs of children with cancers

Enquiries:
CUHK Alumni Charity Foundation Limited
Email: info@cuhkacf.org
Telephone: 2180 4316