Also, the reduction of fluid proceeds in a particular way. The hand fluid drains into the lower arm which then drains into the upper arm, and then onwards to the neck and chest. However if the participant's fluid is collected mostly in the hand and lower arm, this can adversely affect the data. This is because we measure the arm as a cylinder, and this does not include the measurement of the hand. So if the fluid is moving slowly, it may still be in the arm when we take the 'after' measurement straight after treatment , which means the arm may read as bigger than it was before the treatment, even though the hand may have reduced to normal.
The fluid will eventually reduce down to a lower measurement, but this might be several hours after the treatment, and a while after the measurement has been taken. - Those taking part report a large volume of urine being passed in the 24 hours afterwards - which is what we would expect in a reflexology session anyway, but we might speculate that this is a bit more than people without lymphoedema might expect to pass.
We've also had ladies who have a pocket of fluid around their bra strap on their back or behind their shoulder. This is also not picked up in the arm measurement, but can be seen visually to reduce directly after treatment.
Its frustrating, but it will inform future research design, so hey ho, every cloud and all that!
Watch this space, more updates to follow, dear reader.