About Lymphedema

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Background:
Lymphedema is a swelling of a body part, most often the extremities. It can also occur in the face, neck, abdomen or genitals. Lymphedema is the result of the abnormal accumulation of protein rich edema fluid in the affected area. Remarkably, even though it afflicts approximately 1 percent of the U.S. population (2.5 million Americans), its seriousness and the problems it creates are poorly understood in the medical community. Lymphedema is classified as either primary or secondary. Primary lymphedema is the result of lymphatic dysphasia. It may be present at birth, but it more often develops later in life without obvious cause. Secondary lymphedema is much more common and is the result of surgery or a side effect of radiation therapy for cancer. Secondary forms may also occur after injury, scarring, trauma or infection of the lymphatic system. Lymphedema has important pathological and clinical consequences. In stage I lymphedema, the swelling consists of protein-rich fluid and may become temporarily reduced by simple elevation of the limb. If it remains untreated, however, the lymphedema causes a progressive hardening of the affected tissues, which is the result of a proliferation of connective tissue, adipose tissue and scarring (stage II lymphedema). Stage III lymphedema is characterized by a tremendous increase in volume, hardening of the dermal tissues, hyperkaeratosis and papillomas of the skin. Infections such a cellulitis, erysipelas or lymphangitis frequently develop in those suffering from lymphedema. Infections are most common in stage II and III lymphedema, each infection resulting in a worsening of the condition and necessitating frequent hospitalizations. Lymphedema treatments offered in the United States are: Surgery, Medications, Pneumatic Compression Pump Therapy (Pumps), Manual Lymph Drainage (MLD), and Complete Decongestive Therapy (CDT).

Complete Decongestive Therapy (CDT)
CDT is a combination of MLD, bandaging of the affected areas, remedial exercises and skin and nail care. CDT is divided into a two-phase program that first involves an intensive treatment phase, followed by a maintenance program that the patient continues at home. Carried out with great care, consistency and the expertise of a well-trained therapist, it is the treatment of choice for chronic extremity lymphedema. Even in advanced lymphedema, CDT can be used (free of side effects) with great success. Because CDT is labor intensive, time consuming and requires patient compliance, many patients have difficulty committing to the program at first. Nevertheless, because the results of CDT are always superior to all other treatments, more and more patients undergo CDT treatment and are then able to maintain the reduction of their limbs by diligently participating in a home maintenance program. Since CDT is fairly new in the United States, staff training and treatment standards vary a great deal from clinic to clinic. It is important that the CDT training that a lymphedema therapist received consists of all components of CDT (basic and advanced MLD, lymphedema bandaging, remedial exercises, skin and nail care). The therapist must also have a complete understanding of the anatomy, physiology and pathophysiology of the lymphatic system, the treatment of primary and secondary lymphedema, the indications and contraindications of MLD/CDT, as well as the measuring techniques for lymphedema support garments. Further, lymphedema therapy should not begin unless the patient has been examined and diagnosed by a board-certified physician who understands lymphedema and its complications. Once the diagnosis of lymphedema has been confirmed and treatment has begun, the progress must be monitored by the physician. Whereas the clinical diagnosis of lymphedema can most often be established without invasive testing, an electrocardiogram before the treatments begin and during the course of treatment is sometimes necessary to ensure safe treatment for each patient. Lymphangioscintigraphy (LAS), CT scans and MRIs are recommended to some lymphedema patients before they start CDT. The physician will be able to decide and inform the patient about the necessity of such procedures at the time of consultation. Because of the complications associated with lymphedema, the involvement and supervision of a qualified physician is essential in order to provide safe and effective lymphedema therapy.

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Surgery:
Surgical procedures are sometimes suggested to a lymphedema patient. Indeed, dozens of operations have been devised and thousands have been carried out over the past century. It is safe to say that not one has been shown to give consistent or dependable results. In addition, any surgery performed on lymphedematous (swollen) extremity may further reduce the transport capacity of the already incapacitated lymphatic system.

Try not to injure the skin as this may cause infection. Avoid…

Other activities which cause more extensive trauma to the delicate lymph vessels.

Temperature extremes cause the lymphatic system to labor.

Other lifestyle changes may lessen the risk of starting or of worsening lymphedema.