What is Lymphedema?
Lymphedema is a condition that causes swelling of an area of the body due to an accumulation of lymphatic fluid. This swelling occurs because of an impaired or damaged lymphatic system. Patients usually experience swelling of the arms or legs but can have swelling in other areas of the body as well such as the head, neck, chest, abdomen or genital areas. It is different from other forms of edema because of the high density of proteins in the fluid.
What causes Lymphedema?
Lymphedema can be congenital or hereditary; sometimes people are born with abnormalities of the lymphatic system although they may not experience symptoms until adolescence or later in life. Lymphedema can also be due to a secondary cause resulting in injury or damage that occurs to the lymphatic system. Surgery, radiation, trauma, tumors, or chronic venous insufficiency (CVI) are common causes that can trigger Lymphedema.
What are the signs and symptoms of Lymphedema?
Swelling of the affected extremity or area(s) of the body is the most common sign. Additionally, patients may experience a feeling of heaviness and/or pressure in the affected extremity, weakness, decreased flexibility, rings/watches/clothing that becomes too tight, tightening of the skin, hardened or thickened skin, small warts, or blisters that leak clear fluid.
Is there a cure for Lymphedema?
Currently, there is no cure for lymphedema.
What happens if Lymphedema goes untreated?
Lymphedema is a chronic condition, meaning it will only get worse with time. Left untreated, swelling will get worse and cause complications. Complications can include infections such as cellulitis and lymphangitis, lymphorrhea (leaking of fluid through the skin), and thickening of the skin into hard, leathery tissue called fibrosis. Untreated Lymphedema can also lead to chronic non-healing wounds.
How is Lymphedema treated?
Lymphedema is treated using components of Complex Decongestive Physiotherapy. CDP is a therapy that includes:
- Manual Lymph Drainage Massage (MLD): a gentle massage designed to mobilize stagnant lymph fluid to flow to properly draining lymph nodes. The massage manually encourages the fluid to functioning lymph nodes and should only be done by a trained professional.
- Multilayer compression bandaging: fabric compression bandages are used to reduce swelling in a limb. Bandaging is a key component of lymphedema treatment and works by applying pressure to the limb during normal activities, creating an internal muscle pumping action that moves fluid out of the tissues towards healthy lymph nodes. Additionally, bandaging helps to maximize the effects of MLD.
- Exercises: beginning with gentle range of motion exercises and progressing to strength training, exercise is a key component of lymphedema therapy. These exercises are relatively simple and can be modified based upon an individual patient's needs.
- Education: as with any chronic disease or condition, self-care is crucial to obtaining positive outcomes. Therefore, lymphedema therapists strive to prepare their patients as much as possible through quality patient education.
- Pneumatic Compression Device: an inflatable garment powered by an air pump, is used to apply gradient compression to the affected limb(s) and thus reduce swelling. As the garment inflates, it applies pressure and massages or "forces" the fluid back into healthy drainage areas where it can drain into the circulatory system and eventually be processed by the kidneys and excreted.
How is Lymphedema diagnosed?
Currently, the standard of diagnosis is based on a thorough history, and physical examination. A Licensed Certified Medical Professional will review your history looking for contributing factors and then perform a detailed physical exam looking for the signs of lymphedema. There is no need for invasive procedures or complex imaging.
Are there medications or surgical options for lymphedema?
An older surgical option is debulking, but this has been found to make lymphedema worse. There are two newer options being tested (lymph node transplant and lymphovenous anastomoses) but there is no long term data for their efficacy and their use is controversial since surgeries can cause lymphedema. As for medication, there are currently no medication options for lymphedema. The use of diuretics is an insufficient treatment since it removes water waste, but does not remove the dense proteins from the intracellular spaces that are the real cause of lymphedema.
What should I expect on my evaluation day?
The evaluation day is one of the most important aspects of care. It is essential that we get the diagnosis right, and the right treatment plan organized. That being the case there will be an extensive review of your medical history and a thorough physical examination. After the physical examination the Provider may order additional testing such as range of motion, an ultrasound to rule out the possibility of blood clots, and circumferential measurements, which are then converted to a volumetric report of the affected area. If the Provider feels you have lymphedema, and are an appropriate candidate for treatment, they will write a treatment plan to be executed by our multi-disciplinary team. A typical evaluation can last from 1-2 hours depending on complexity of the case.
What should I expect on my first day of treatment?
We recommend bringing loose fitting clothing, but we also have gowns for those patients who prefer them. Once in the exam room one of our skilled team members will go over your treatment plan with you, explaining each component and its effect on lymphedema. It is important for you to understand the program in order to maximize its benefit. The therapist will perform the components of CDP as written in the treatment plan such as skin care, manual lymph drainage, multi-layer compression bandaging, therapeutic exercise, and the possible use of an intermittent pneumatic compression device. Each treatment session lasts between 1-2 hours (but may be longer depending on the severity of the lymphedema), and is focused on results. Each session will also include education to prepare you to manage the condition.
What can I expect after my discharge from treatment?
We don't like to use the word discharge. We prefer to say a patient is entering the self-maintenance phase. Since there is no cure for lymphedema, a patient will need to maintain all of the benefits gained within the program outside of our facilities. It is our intention to prepare you with the knowledge and tools to enter the maintenance phase with confidence. By the time you enter the maintenance phase you should have experienced a significant reduction in swelling, improvement in the condition and health of your skin, increased functional ability of the affected area, and finally, the tools and know how to succeed at maintaining your condition. We will follow up with you regularly in the beginning to make sure you are doing well, and we will always be here to support our patients.