Lymphedema

Lymphedema is the swelling of the soft tissue caused by a build-up of lymph fluid (proteins and water). Depending on the type of surgery and other cancer treatments,  it is possible for lymphedema to happen in the arm, hand, breast, trunk, leg, or abdomen. if left untreated the high protein content of this fluid can cause additional problems such as fibrotic tissue or hardening of the tissue and infections.

Lymphedema is a long-term (chronic) condition, that can't be cured, but it can usually be well controlled. Patients need to know how to reduce their chances of getting it or managing it in the early stages. 

Primary Lymphedema or congenital, is a rare congenital or inherited condition in which the lymph nodes or lymphatic vessels are either absent or abnormal. The vessels may be characterized by:

     - Hypoplasia - the lymph collector vessels are so small that they are ineffective      - Hyperplasia - the lymph vessels are too large and are ineffective                          -  Aplasia - absence of lymph vessels

Primary lymphedema is usually apparent at birth or within the first two years of life and has been linked to several genetic chromosomal abnormalities. The swelling usually affects one lower leg; however, oedema may also be present in multiple limbs, the genitalia, and the face.

There are three types of primary lymphedema:

• Lymphedema praecox - This is the most common form of primary lymphedema (up to 90% of cases). It affects women more than men by a ratio of about 10 to 1, and usually emerges during puberty. Most cases are unilateral (one-sided) and are limited to the foot or calf.

• Congenital lymphedema - This form accounts for up to 25% of cases of primary lymphedema. It affects females twice as often as males and is three times more likely to affect the legs than the arms. Most cases are bilateral (either both arms or both legs) and, while rare, it can also affect the face and genitalia.

• Lymphedema tarda is also known as Meige Disease - This form of lymphedema becomes apparent only after the age of 35 and accounts for less than 10% of cases of primary lymphedema. Typically, patients have an overabundance of vessels which are very tortuous, with many oddly shaped bends and turns. Lymph valves are often absent or malfunctioning.

Secondary lymphedema is caused by outside factors such as:

Cancer- Cancer cells block the lymphatic nodes and vessels and can cause lymphedema. The most common causes; are breast cancer, melanoma, cervical or vulval cancer, and prostate cancer

Damage to Lymph Nodes and Lymph Vessels- Caused by surgery, trauma, radiation, burns, tumours, and accidental injury.

Venous Diseases- Cause certain Cardiac Conditions that affect blood flow and damage the venous system, which can result in Chronic Venous Insufficiency (CVI); CVI, Venous Stasis Ulcers, DVT (blood clots) and Varicose Veins are venous diseases that can lead to leg swelling and Lymphedema.

Infection/Cellulitis- Lymph nodes can be damaged by an infection (cellulitis) or by a parasite. Spider Bites can also cause an infection and lymphedema. Inflammation caused by Rheumatoid Arthritis and eczema may damage lymph nodes as well.

Immobility-due to stationary lifestyle, prolonged illness, lengthy plane/car trips and Paralysis

Obesity - Obesity is a major risk factor for developing secondary lymphedema.

While there is presently no cure for lymphedema, it can be managed with early diagnosis, diligent care of your affected limb with Lymphatic drainage, compression, and a Pneumatic Compression Device too.

Manual Lymphatic Drainage is an effective treatment that uses slow, rhythmic strokes that help the body increase lymphatic circulation and decrease excess fluid (oedema), helping to move fluid from an area where the lymphatic system may be compromised, such as following lymph node dissection or radiation treatment for cancer, to an area with healthy lymphatics. Certified Lymphedema therapists are skilled at doing this work right

Lymphedema Treatment

COMPLETE DECONGESTIVE THERAPY (CDT)

The "gold standard" of treatment for lymphedema is Complete Decongestive Therapy.  There are two-phase: Phase 1  and Phase 2.  Our goal is to reduce the swelling and maintain the reduction, that is, to bring the lymphedema back to stage 1 or latency. 

Phase 1 - Intensive Phase

Lymphedema Phase 2- Maintenance

This is the phase I offer my services.

Once the swelling of your limb has decreased, it is essential to continue your care to maintain the reduction of swelling. Phase 2 is an ongoing part of CDT in which the patient assumes the responsibility of maintaining and improving the treatment results achieved in Phase 1 through Manual Lymph Drainage (MLD) - either self or provided by a Certified Lymphedema Therapist.

What I offer in this Phase 2 Lymphatic Drainage for Maintenance:

• Advanced Manual Lymph Drainage (MLD) to decongest the area or keep reduction.
• Advice on Compression garments (if you need it) - wearing the right and good quality compression garment helps you keep swelling from returning.
• Exercise Advice- This includes doing specific exercises to do to help push fluid up and out of your limb.
• Skin Care Advice - The purpose is to keep skin moisturized to avoid cracking. 

Stages of Lymphedema

1. STAGE 0 (Non-Visible or Latency Stage)Lymph fluid transport is already impaired during this stage, but no physical effects are apparent yet. It can take months or even years before any symptoms appear.
2. Stage 1 (Mild or Spontaneously Reversible Stage)The arm, leg, hand, foot, or other area looks slightly swollen as lymph fluid builds up, but elevation or compression of the affected arm or leg will help reduce or even reverse it. Pitting or sinking of the skin in the affected area may occur.
3. Stage 2 (Moderate or Spontaneously Irreversible Stage)Swelling and dermal fibrosis (uncontrolled formation of scar tissue) continue to develop. The swelling is managed with the daily wearing of compression garments, both during the day and at night. Prolonged non-surgical treatments may provide relief from symptoms but will usually not be as effective as surgical procedures.
4. Stage 3 (Severe or Lymphostatic Elephantiasis Stage)The affected limb becomes large and misshapen, and the hardened skin takes on a leathery, wrinkled appearance. Lymph fluid may leak from breaks or folds in the skin and should be kept clean and dry to avoid infection. The continued fibrosis also causes the muscle and fat to solidify, making it very difficult to move the limbs. 

Symptoms of lymphedema

The most common symptom of lymphoedema is swelling. 

• You have a feeling of fullness or heaviness 
• Your skin feels tight 
• Your hand, wrist, foot, or ankle is less flexible 
• Your clothes feel tighter in one specific area
• Your ring, watch, bracelet, or shoe feels tighter some people also feel heaviness, tension, or aching in the involved area. 

Symptoms can appear any time after cancer treatment, days, months, or even years following cancer treatment. If you've recently had cancer surgery involving your lymph nodes - your doctor may diagnose lymphedema based on your signs and symptoms.

If you notice any of these symptoms, please let your doctor know. You may benefit from a referral to a lymphedema therapist. 

I AM HERE TO HELP 

Pictures courtesy of Lymphedema Management book