What is Lymphedema?
Lymphedema is a disorder of the human lymphatic circulation. It is marked by the accumulation of lymph fluid, often in the form of swelling of the arms or legs. This occurs when lymph vessels or lymph nodes are blocked or surgically removed.
When the lymph system is so impaired the lymph fluid exceeds the lymphatic systems transport capacity. This can cause an abnormal amount of protein fluid to collect in the surrounding tissue. Untreated, this stagnant, protein rich fluid not only causes tissue channels to increase in size, but also reduces oxygen though the transport system. This can interfere with wound healing, and provides a breeding ground for bacteria that can result in various infections. A chronic inflammatory condition stemming from this accumulation of fluid may result in fibrosis (hardening), of the extremity tissues.
What kinds of Lymphedema are there?
Lymphedema can be broken down into three types:
- Primary Lymphedmea is seen as a Congenital Abnormality, sometimes known as Milroy’s Disease. It usually strikes anytime during childhood, and up into the early twenties. There is no cure for this disease. It can however, be managed through therapy.
- Secondary Lymphedmea is the most common type of Lymphedmea. It results from damage to the Lymph Nodes or the Lymph system. The most well known secondary Lymphedema is Post-Mastectomy Lymphedema. It can happen after surgery or radiation treatments for breast cancer, cervical cancer, rectal cancer, or anal cancer.
- Venous Disorders are considered a type of Lymphedmea. Chronic Venous Insufficiency is a common problem. It occurs because of partial vein blockage or blood leakage around the valves of the veins. It can lead to Venosu Ulcers, Deep Vein Thrombosis in the legs, and Celluittus Infections.
Who is at risk for Lymphedema?
In the United States the onset of Lymphedema is associated with complications following cancer treatment by means of surgery, and or radiation therapy. An estimated 3-5 million Americans are affected with breast cancer-related Lymphedema alone. Women are particularly at risk of developing Lymphedema in their arms following surgery or radiation therapy for breast cancer, or in their legs following treatment for cervical, or uterine cancer. Men have also been known to have suffered from breast cancer, and both men and women have suffered from Lymphedema due to rectal cancer. Men also are at high risk for testicular cancer, and prostate cancer.
What are the Symptoms of Lymphedema?
Lymphedema usually begins with swelling of the hands or feet. Anybody who notices persistent swelling in an extremity should seek medical advice as soon as possible. If Lymphedema is diagnosed and if treatment begins early, the prognosis for improvement of the condition is much greater than if the swelling is ignored and remain untreated.
Is Lymphedema Curable?
No, Lymphedema is uncurable, but is readily treatable.
How is Lymphedema Treated?
Lymphedema can be controlled by a number of means. There is a considerable debate as to what method of treatment is best. Many physicians, and therapist that we at Advanced Rehab Technologies work with believe that a multifaceted approach is best. This means a combination of therapies should be used. Not depending on just one therapy for success.
The treatments for Lymphadema are as follows:
- Elevation: This means keeping the limb elevated, usually above the level of the heart. This allows gravity to facilitate the drainage of fluid from the limb. This elevation method usually takes a great deal of time to see results. On the plus side, it requires no special training, and can be done anytime, or place that you can elevate the arm. It requires no special equipment or insurance coverage.
- Lymphatic massage: There are a number of different techniques used for what is known as manual lymph drainage. Forms of massage have been used for over 100 years. This involves a trained therapist who will massage the arm, gently pushing the lymph fluid back up into the body. Therapist can be trained in a variety of methods to drain the arm with this technique. ie. the Vodder method, or the Leduc school. A trained therapist can teach you how do this some of these techniques yourself. As in all therapies, lymphatic massage requires dedication. It must be done on a daily basis. Insurance coverage varies for massage when done by a professional therapist. Some plans limit just how many times you can see a therapist in a year. Check your individual plan for details.
- Compression Garments: These are used to help maintain limb size. The garments can be off the shelf, or custom made for the individual. The garments can cover all of the limb, or just parts of it. The compression strength can also vary. The heavier the compression, the more effective the stocking. The heavier the compression though, the more difficult the stocking will be to put on and wear. These stockings need to be replaced every six months. As the compression lessens and the garment does less and less.
- Pneumatic Compression Pumps and Sleeves: These are air-filled appliances that fits over the swollen limb. Pneumatic pumps have been used since the 1950s. Notably, at the renown Mayo Clinic. The sleeve fills up with air that gently massages the stagnant fluid back up towards the body. There are several types of these pumps that have various advantages over others. Some have the ability to adjust the pressure over specific areas of the limb. The best pumps have what is known as gradient compression, meaning more pressure at the most distant location, and less pressure closer to the body. These pumps are easy to use, and are usually covered by insurance.
Most physicians, and therapist recommend a combination of these therapies to deal with Lymphedema. A recent study from the Stanford University Lymphedema Center showed that a combination therapy program of massage, and the pump was superior to individual methods of treatment.
What happens if Lymphedema is Not Treated?
Chronic Lymphedema is a progressive condition that must be treated. When Lymphedema remains untreated, the limb becomes more swollen, (edematous) and the skin can harden. Elasticity diminishes in the limb, reducing range of motion, and flexibility.