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Lymphedema

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What Causes Lymphedema? Symptoms of Lymphedema Treatments for Lymphedema
Stages of Lymphedema Your Immune System  

I hope this page will to help you understand more about lymphedema. Our lymphatic system has the pressure of thousands of tiny hearts which pump lymph fluid throughout our bodies, most often in the arm(s) and/or leg(s). When the flow of this fluid is interrupted or impaired, swelling of the tissues and other problems can result.  Lymphedema can develop when lymphatic vessels are missing or impaired (primary), or when lymph vessels are damaged or lymph nodes removed (secondary).

Some individuals may acquire lymphovenous disorders as a result of the removal of lymph nodes during surgery or through damage to the nodes and lymphatic vessels following radiation used in the treatment of cancer. Other causes may include trauma to the limb or parasitic infiltration of the lymph nodes and vessels (such as lymphatic filariasis).

When the impairment becomes so great that the lymphatic fluid exceeds the lymphatic transport capacity, an abnormal amount of protein-rich fluid collects in the tissues of the affected area. Left untreated, this stagnant, protein-rich fluid not only causes tissue channels to increase in size and number, but also reduces oxygen availability in the transport system, interferes with wound healing, and provides a culture medium for bacteria that can result in lymphangitis (infection).

Lymphedema should not be confused with edema resulting from venous insufficiency, which is not lymph-edema. However, untreated venous insufficiency can progress into a combined venous/lymphatic disorder which is treated in the same way as lymphedema.

What Causes Lymphedema?

Primary lymphedema, which can affect from one to as many as four limbs and/or other parts of the body, can be present at birth, develop at the onset of puberty or in adulthood, all from unknown causes, or associated with vascular anomalies such as hemangioma, lymphangioma, or Port Wine Stain.

Secondary lymphedema, or acquired lymphedema, can develop as a result of surgery, radiation, infection or trauma. Specific surgeries, such as vulva cancer, surgery for melanoma or breast, gynecological, head and neck, prostate or testicular, bladder or colon cancer, all of which currently require removal of lymph nodes, put patients at risk of developing secondary lymphedema. If lymph nodes are removed, there is always a risk of developing lymphedema.

Secondary lymphedema can develop immediately post-operatively, or weeks, months, even years later. It can also develop when chemotherapy is unwisely administered to the already affected area (the side on which the surgery was performed) or after repeated aspirations of a seroma (a pocket of fluid which occurs commonly post-operatively) in the axilla, around the breast incision, or groin area. This often causes infection and, subsequently, lymphedema.

Aircraft flight has also been linked to the onset of lymphedema in patients post-cancer surgery (due to the decreased cabin pressure).

TIP: Always be sure to wear a compression garment (sleeve, stocking) when you fly, even if you do not have lymphedema. Also always get up and move around on those long flights.

Another cause of lower extremity lymphedema is that resulting from the use of Tamoxifen. This medication has been linked to blood clots and subsequent DVT (deep venous thrombosis).

Radiation therapy, used in the treatment of various cancers and some AIDS-related diseases (such as Kaposi-Sarcoma), can damage otherwise healthy lymph nodes and vessels, causing scar tissue to form which interrupts the normal flow of the lymphatic fluid. Radiation can also cause skin dermatitis or a burn similar to sunburn. It is important to closely monitor the radiated area for any skin changes, such as increased temperature, discoloration (erythema) or blistering which can lead into the development of lymphedema. Be sure to keep the area soft with lotion recommended by your radiation oncologist.

TIP: Glaxal Base cream is pure with no perfumes added.  It's great for post radiation dryness and wounds.

Lymphedema can develop secondary to lymphangitis (an infection) which interrupts normal lymphatic pathway function. A severe traumatic injury in which the lymphatic system is interrupted and/or damaged in any way may also trigger the onset of lymphedema. Although extremely rare in developed countries, there is a form of lymphedema called Filariasis.

Symptoms of Lymphedema

Lymphedema can develop in any part of the body or limb(s). Signs or symptoms of lymphedema to watch out for include: a full sensation in the limb(s), skin feeling tight, decreased flexibility in the hand, wrist or ankle, difficulty fitting into clothing in one specific area, or ring/wristwatch/bracelet tightness. If you notice persistent swelling, it is very important that you seek immediate medical advice, as early diagnosis and treatment improves both the prognosis and the condition.

Stages

Lymphedema develops in a number of stages:

Mild to Severe (referred to as Stage 1, 2 and 3:

STAGE 1 (spontaneously reversible):

Tissue is still at the "pitting" stage, which means that when pressed by fingertips, the area indents and holds the indentation. Usually, upon waking in the morning, the limb(s) or affected area is normal or almost normal size.

Stage 2 (spontaneously irreversible):

The tissue now has a spongy consistency and is "non-pitting," meaning that when pressed by fingertips, the tissue bounces back without any indentation forming). Fibrosis found in Stage 2 lymphedema marks the beginning of the hardening of the limbs and increasing size.

Stage 3 (lymphostatic elephantiasis):

At this stage the swelling is irreversible and usually the limb(s) is/are very large. The tissue is hard (fibrotic) and unresponsive; some patients consider undergoing reconstructive surgery called "debulking" at this stage.

When lymphedema remains untreated, protein-rich fluid continues to accumulate, leading to an increase of swelling and a hardening or fibrosis of the tissue. In this state, the swollen limb(s) becomes a perfect culture medium for bacteria and subsequent recurrent lymphangitis (infections). Moreover, untreated lymphedema can lead into a decrease or loss of functioning of the limb(s), skin breakdown, chronic infections and, sometimes, irreversible complications. In the most severe cases, untreated lymphedema can develop into a rare form of lymphatic cancer called Lymphangiosarcoma (most often in secondary lymphedema).

Your Immune System
Your body’s lymphatic system is part of your immune system, which protects you against infection and disease. It includes your spleen, thymus, bone marrow, lymph nodes and lymph channels, as well as your tonsils and adenoids.

Lymphangitis (Infection)

Signs and symptoms of lymphangitis (infection) may include some or all of the following: rash, red blotchy skin, itching of the affected area, discoloration, increase of swelling and/or temperature of the skin, heavy sensation in the limb (more so than usual), pain, and in many cases a sudden onset of high fever and chills.

Treatment for infections: Contact your physician as soon as possible.
A prescription of antibiotics will be given.

TIP:
Always carry antibiotics or a prescription with you when you travel.

Treatments for Lymphedema

Planning the treatment program depends on the cause of the lymphedema. For example: If the initial signs and symptoms of swelling are caused by infection (redness, rash, heat, blister or pain may indicate an infection), antibiotics will first need to be prescribed. Treating an infection often reduces some of the swelling and discoloration.

If the lymphedema is not caused by infection: Depending on the severity of the lymphedema, the recommended treatment plan should be determined. 

Click here to view images of the lymphatic system and lymph nodes

While no cure currently exists, there are a range of options available which can keep the swelling under control, reducing the possibility of infection and secondary skin change. These options can also help to maintain the motion and function of the affected limbs.

They include:
A) REDUCTION OF SWELLING (techniques used to push lymphatic fluid out of the affected limb(s):

Manual Lymph Drainage (MLD) & Complex physical therapy (CPT) - types of lymphatic massage performed by specially trained therapists, used to encourage the excess fluid in congested, swollen areas of the body to move to areas where it can drain away normally.

TIP: MLD Works!
But check with your doctor before having either of these therapies.  Also check with your Insurance company to see if you have coverage. In Ontario OHIP does not cover MLD. Treatments can be aprox $95.00 ca funds. Ins plans require you to have a RX from your doctor to cover MLD.

B) CONTAINMENT OF SWELLING:

Wrapping with low-stretch bandages - generally done to help obtain the "dry limb" or lowest level of swelling that can be achieved through use of the compression techniques above. Once that level is determined the individual is usually measured for a compression garment.

Reid Sleeves - These products control swelling  - and in the case of the Reid Sleeve - foam inserts.

Compression garments - support stockings and sleeves used to contain swelling after treatment with massage.

C) OTHER TYPES OF TREATMENT:

The maintenance of a healthy weight and diet - a balanced diet with low sodium intake.

Exercise - care taken not to put too much stress through exercise on the affected area. However, exercise to make the muscles (e.g. calf) acts as a pump which can be beneficial. Swimming is particularly good.

Meticulous and regular skin hygiene and nail care

Drugs - when infections take place, antibiotics must be taken immediately - in chronic cases of repeated infections antibiotics may be prescribed for long periods.

Surgery - not recommended except in exceptional situations.

Diuretics - not generally used in the treatment of lymphedema, but may be helpful in some cases. See your doctor.

With all lymphovenous disorders it is important to avoid the use of needles or blood pressure treatment in the affected area, unless there is no other choice.

 

NOTE: I do not recommend one treatment over another - what works for me may not work for someone else. Make sure you check with your doctor or other health care specialists in this area in developing your treatment plan or before you try something different. *****Always check with your doctor before trying any treatments.*****

 

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