Treating the swelling effects of lymphedema
lymphede...@gmail.com
Published: August 31, 2007
Lymphedema (or "Lymphoedema", "lymphatic obstruction") is a condition
of localized fluid retention caused by a compromised lymphatic system.
The lymphatic system (often referred to as the body's "second"
circulatory system) collects and filters the interstitial fluid of the
body. Lymphedema has been barely recognized as being a serious health
problem; however, this is slowly changing due to education and
awareness. The danger with lymphedema comes from the constant risk of
developing an uncontrolled infection in the affected limb. Still,
physicians and medical staff who practice in fields where this disease
is uncommon may fail to correctly diagnose the condition due to the
apparent lack of information regarding this disease.
Lymphedema may be inherited (primary) or caused by injury to the
lymphatic vessels (secondary). In the United States it is most
frequently seen after surgery and/or radiation therapy, in which
damage to the lymphatic drainage system is caused during the treatment
of cancer. It is especially common after surgery or radiation therapy
are used in combination to treat breast cancer. Lymphedema may also be
associated with accidents or certain diseases or problems that may
inhibit the lymphatic system from functioning properly. Many cancer
patients find this condition may develop after their therapy has
concluded. In tropical areas of the world, a common cause of secondary
Lymphedema is filariasis, a parasitic infection.
While the exact cause of Primary Lymphedema is still unknown, it is
usually manifested by poorly-developed or missing lymph nodes and/or
channels in the body. Lymphedema may be present at birth, develop at
the onset of puberty (praecox), or not become apparent for many years
into adulthood (tarda). Some cases of Lymphedema may be associated
with other vascular abnormalities. In the lower extremity it will be
unilateral or bilateral. If it is bilateral, one leg may be worse than
the other.
Lymphedema affects both men and women. In women, it is most prevalent
in the upper limbs after breast cancer surgery and lymph node
dissection, occurring in the arm on the side of the body in which the
surgery is performed, and in the lower limbs or groin after surgery
for colon, ovarian or uterine cancer requiring the removal of lymph
nodes. In men, lower-limb Lymphedema is most common, occurring in one
or both legs or occasionally in the genitals following treatments for
prostate, colon and testicular cancers, particularly where lymph nodes
have been removed. Lymphedema can also occur in those who are obese,
as the lower abdominal area can hang and cause a disruption in the
lymph flow, which may cause swelling in the abdomen and/or legs due to
accumulation of lymph.
Therapists can receive certification in Manual Lymph Drainage massage
through special classes conducted by organizations such as Academy of
Lymphatic Studies, Klose Training and Consulting, and The Lymphology
Association of North America.
Increasingly, Complete Decongestive Therapy (CDT) is being used to
treat Lymphedema. CDT consists of manual lymphatic drainage, short
stretch compression bandaging, therapeutic exercise, and skin care.
MLD was initially pioneered by Dr. Emil Vodder in the 1930s for the
treatment of chronic sinusitis and other immune disorders. MLD is now
recognized as a primary tool in Lymphedema management. Sessions
involve gentle, rhythmic massaging of the skin to stimulate the lymph
nodes to open and drain. The treatment is very comfortable and
nonaggressive. A typical MLD session will involve drainage of the
neck, abdomen, trunk, and involved extremity and lasts approximately
40 to 60 minutes, depending on the severity and extent of the
lymphedema.
Compression bandaging is the application of several layers of
compression garments to the involved area(s), which includes one or
more short-stretch bandages. Short-stretch bandages are preferred over
long-stretch bandages (such as Ace(r) bandages as the long-stretch
bandages cannot produce the higher tension necessary to safely reduce
Lymphedema. The bandages allow comfortable wear during sleep and rest
in most cases, unlike Ace(r) wraps which can become very tight and
cause cutoff of blood circulation without regular body movements.
During activity, the short-stretch bandages provide increased
resistance against the affected areas and, therefore, help to soften
fluid-swollen areas as the muscles push out during exercise and daily
activities.
Therapeutic exercise is used to help improve lymphatic flow while
compression bandaging is worn. Also, some patients with chronic
Lymphedema or large, swollen areas will have poor strength or range of
movement. These patients benefit from exercise prescribed specifically
for them by their therapist to help improve their function and
comfort.
Skin care is an important component of CDT. People with Lymphedema or
who have had lymph nodes removed are at a higher risk for infections
of the affected areas. Teaching higher risk sufferers about the signs
and symptoms of infections is key to early identification and
treatment. Untreated infections can further damage an already impaired
lymphatic system and lead to more severe Lymphedema and skin ulcers.
Initially, CDT involves frequent visits to a certified therapist with
a doctor's prescription. Once the Lymphedema is reduced, increased
patient participation is required for self care along with the
instruction and use of compression garments to further reduce the
swelling.
The use of compression pumps is sometimes used in the treatment of
Lymphedema. Special care needs to be taken to ensure that the involved
trunk quadrant is properly treated with manual lymphatic drainage
before the application of a compression pump for patients with
Lymphedema. If adequate treatment of the trunk is not carried out, the
edema may be pushed into the upper portion of the leg, genitals, or
arm. If a patient's Lymphedema worsens during a course of treatment of
compression pumping, reassessment for
Many treatments are available. Most often, medicines such as diuretics
are prescribed. But without additional treatments, diuretics have very
poor long-term results and should not be used solely to treat
lymphedema. Diuretics only help to remove water from the affected
area, leaving the proteins behind. When a patient comes off the
diuretics, the protein-rich area may attract the water once again,
causing the swelling to return.
Sometimes, pneumatic compression pumps can be used. However, if used
alone, they also present downfalls similar to using diuretics without
additional treatment. Pneumatic compression pumps temporarily remove
the water, leaving the proteins behind to potentially attract more
water once the pump is removed. In addition, the pump may actually
destroy remaining functional lymph vessels, causing an increase in
lymphedema with long-term use.
Currently, the treatment of choice is complete decongestive therapy.
This type of therapy consists of four components: manual lymph
drainage, compression therapy, exercise and skin care.
Manual lymph drainage is a gentle technique in which the accumulated
fluid is manually moved out of the congested area and re-routed,
sending the lymph liquid to a clear area where it can successfully
move back into the body's normal circulation. Compression therapy,
done through the use of bandages and compression garments, helps
prevent future accumulation of fluid once it has been manually
removed.
Exercise is important in this method of therapy, if done properly. If
the wrong exercises are performed, they can actually make the
condition considerably worse. A trained professional will develop a
customized exercise program designed to facilitate the use of muscle
activity to push the fluid out of the affected limb. Finally,
information is given on the importance of skin care and how to care
for the swollen limb properly to avoid infection and avoid triggers
that may cause the recurrence of lymphedema.
When treated properly, lymphedema can be sent into remission. If
patients initially receive proper treatment for this life-long
condition and learn how to prevent its recurrence, they can return to
their daily activities and a normal way of life.
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Kathleen Edwards DPT, CLT is a doctor of physical therapy and
certified lymphedema therapist at The Center for Rehabilitation and
Sports Medicine at Beverly Hospital.
http://www.eagletribune.com/pulife/local_story_243093851?keyword=secondarystory
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Pat O'Connor
Lymhpdema People
http://www.lymphedemapeople.com