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Lymphedema

 

Shedding Light on Lymphedema

What is Lymphedema?

Lymphedema is the swelling of a human body part caused by an abnormal  accumulation of fluid, proteins, and cellular waste in the tissues under the skin.  It occurs when there is a problem in the lymphatic system:

  • The failure of lymph vessels to develop properly
  • Damage to lymph vessels by trauma, surgery, or infection
  • Removal or destruction of lymph nodes, usually during treatment of cancer

Lymphedema can be a painful and disfiguring condition.  It can lead to decreased mobility, repeated episodes of infections (cellulitis, erysipelas, lymphagitis), and mental depression. It can require constant and chronic medical care and expense.  Severe cases involve thickening of the skin, hardening of the tissues (fibrosis), leaking of fluid, massive swelling and skin changes such as warty growths.  The extreme version of lymphedema is called elephantiasis when the limb becomes enormous and distorted, with drastic changes in the skin and tissue. Even when the degree of lymphedema is relatively mild, it can make wearing regular clothes more difficult, limit activities, and increase the risk for infections. Because lymphedema is a chronic progressive condition, even mild cases can eventually escalate and have serious consequences if not properly treated.

The Lymphatic System

The  lymph system consists of a network of lymph vessels carrying lymph fluid to lymph nodes.  The lymph vessels are located all over the body (usually next to veins) and transport lymph fluid - excess fluid in the tissues which is filled with proteins, white blood cells, germs and cellular waste products.  This fluid is carried up to the lymph nodes where it is filtered and detoxified, before being returned to the blood stream.

There are  500-1000 lymph nodes located all around the body:

  • The neck (supraclavicular and cervical)
  • The armpits (axilla)
  • Along the windpipe (trachea)
  • Adjacent to the lung (bronchial)
  • In the chest cavity (thoracic)
  • Along the intestine (abdominal)
  • Behind the abdominal cavity (retroperitoneal)
  • The pelvic area - The groin area (inguinal)

Lymph tissue is also found in the tonsils, spleen, intestinal wall and bone marrow.

What causes Lymphedema?

There are two general types of lymphedema:

    • Primary Lymphedema usually appears without obvious cause or after a minor traumatic event or an infection. It can happen at any age, but is due to a congenital abnormality, usually involving malformed or missing lymph vessels. This condition may be familial.

    • Secondary Lymphedema is an acquired condition resulting from the loss or obstruction of previously normal lymph pathways.  It often occurs after a surgical procedure where lymph notes or lymph vessels have been removed or damaged. Surgery and/or radiation for cancer treatment is one of the most common causes.  People who have had treatment for breast cancer, melanomas, prostate cancer, ovarian, cervical, or lymphomas are all at risk, although the swelling may not appear until months or even years later.  The rate of progression of lymphedema varies with temperature, humidity, activities and the number of infections or complications.

In the case of arm lymphedema developing after axillary surgery and/of radiation therapy the lymphedema is often more distressing to the person than the mastectomy or lumpectomy, because the person must deal with lymphedema and it complications for life.

In the legs, lymphedema is more distressing because people must deal with a variety of special problems such as a different shoe size for each foot, difficulty walking, excessive fatigue from heavy lower extremities, back pain, diminished agility, feeling forced into a sedentary lifestyle.

Diagnostic Test for Lymphedema

Although most cases of lymphedema are diagnosed on a patient's history and clinical findings, lymphoscintigraphy (isotope lymphography)  is now considered to be the best technique for evaluating lymphatic function and for differentiating causes of lymphedema.  It is minimally invasive and does not damage the lymph vessels as they are being visualized.

Treatment for Lymphedema

Lymphedema is not curable, but it is controllable. The aim of treatment is to improve appearance, increase function, and prevent further progression of the swelling. Treatment should begin as soon as lymphedema has been diagnosed. If left untreated, lymphedema can result in irreversible damage.  However, treatment can be very effective - even for people who have had lymphedema for many years - and greatly improve quality of life.

The best and most effective treatment for lymphedema is Complete Decongestive Therapy (CDT) which has five major components:

  • Manual Lymphatic Drainage (MLD) is a gentle message-like technique.  It opens the collateral lymphatic pathways to move the excess fluid to areas where the lymph system is functioning.
  • Compression Therapy/Bandaging and Garments, is an essential component of lymphedema management.  Keeping the limb wrapped in a multi-layer low-stretch bandage during treatment can decrease the excess fluid and help to soften the tissues.  After treatment, a strong gradient compression stocking or sleeve can help maintain results.
  • Exercise such as swimming and walking according to recommended CDT protocols can help maintain results.
  • Meticulous skin and Nail Care is critical to the affected limb to prevent skin cracking.  Using low pH soaps and lotions can help protect against bacteria infections (which can lead to cellultis). 
  • Excellent nutrition is also important.  Avoid fatty foods and salt: eat lots of fresh fruits and vegetables.  Controlling weight is necessary because studies have found that obesity aggravates lymphedema.  Avoid excessive intake of caffeine, nicotine, and alcohol.

Are you at risk?

Lymphedema most commonly follows a surgical procedure where there has been removal of or damage to the lymph nodes or vessels.If you have been exposed to any of the following procedures or situations, you may be at risk for developing lymphedema.

    • Biopsy of inguinal lymph node
    • Breast surgery, Prostate surgery
    • Radiation treatment, Chemotherapy
    • Other surgery involving lymph nodes
    • Broken limbs from accidents
    • Hernia repair
    • Venous insufficiency
    • Severe infection
    • Other medical procedures involving the lymphatic system

Precautions

    • Never have blood drawn or blood pressure cuffs on affected limb
    • Avoid lifting heavy objects such as luggage or purses
    • Avoid heavy breast prostheses
    • Avoid tight clothing, especially undergarments
    • Avoid hot baths, hot showers, hot tubs, saunas
    • Use care with rings, watches, bracelets, which can be constrictive
    • Use sunscreen to avoid dangerous skin exposure
    • Use electric razors to prevent razor nicks and cuts
    • Be aware the infections can result from insect bites, manicures, pedicures, skin punctures, cuts, pet scratches, gardening, etc.
    • When traveling, always wear a compression garment or bandages. On trips over 1 hour, it is suggested that you get up and move around as much as possible

Note: Always refer to your physician for complete medical advice and treatment plans. This information is not intended to substitute for medical care.

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