What is the Lymphatic System?

It is a series of vessels that work in conjunction with the venous system to return fluid back to the heart.

 

What is Lymphedema?

 

A type of chronic swelling that is caused by overload of the lymphatic system.  It may affect the face, arm (s), breast, leg (s), torso, or genitals.

 

When does this happen?

 

• Surgical removal of lymph nodes or damage to lymph nodes after radiation
• Injury to the lymph system from surgery or an accident
• Unmanaged vein problems that eventually cause secondary damage to the lymph system
• Blood clots
• May occur at birth from a malformation of the lymphatic system and may not display symptoms until later in life

 

What are the Stages of Lymphedema?

• Stage o- Latency Stage: Swelling is not yet present, but the lymph system is function with a decreased capacity. This is the post surgical patient that has had lymph nodes, removed but does not display any current swelling.  There is no definite period of time for this stage to last.  It could be months or years.
• Stage 1- Mild Stage: Swelling has started into the extremity or trunk, but improves with limb elevation or overnight.
• Stage 2- Moderate Stage- Swelling is now consistently present. Elevation or sleeping overnight no longer improve the size of the limb.
• Stage 3- Advances Stage- Elephantitis- The skin has thickened, the swelling becomes fibrotic in nature, growth may occur on the skin, and extensive scarring may occur.

 

 

 

 

 

 

What are my treatment options?

 

Complete Decongestive Therapy (CDT) is the well-rounded approach that is broken into two phases.  The first phase is called the “Decongestion Phase”.  This is when the size of the limb is being reduced in size.  Once the limb has reached it goal, the maintenance phase is started.  Currently this condition is non-curable and therefore it must be maintained with a well balance program developed individually for each patient.

 

Phase One Includes:

 

Manual Lymphatic Drainage (MLD):  A specific hands-on technique used to stimulate lymphatic vessels and decrease swelling.

 

Compression Bandaging: provides gradient support to assist with decreased swelling.

 

Therapeutic Exercise: an individualized exercise program is created to utilize the muscular system along with the compression bandaging to decrease swelling.

 

Patient Education and Meticulous Skin Care

 

Phase Two Includes

 

Maintenance Phase: when the size of the limb has reached its goal the patient is progressed to phase two.

 

Compressoin Garments: the patient is measured and fit for functional garments to be worn daily.

 

Self Manual Lymphatic Drainage/ Compression Pump:

Used to assist with improved lymphatic function long term

 

How do I know if I should come in for treatment?

 

If you have had damage, injury, or surgery in and around an area that could have affected a lymph node (s), start to screen your limb.  If you notice:

• Heaviness or tingling in your limb
• Notice pitting (an indentation is left when you press your skin)
• The size of one limb looks larger than the other

These are signs that lymphedema could be starting.  In the state of NC Physical and Occupational Therapists have direct access, meaning you can come in for an evaluation without a referral and get the opinion of our lymphedema therapist to determine if treatment is right for you.  Your therapist will be in communication with any provider you release your records to in order to create a team approach to short and long-term management. 

 

Does early treatment make a difference?

 

 Yes! The earlier the condition is treated, the better.  Early intervention has been shown to:

• Achieve better results in limb decongestion in fewer visits
  • This means financially it is also easier on the patient with less co-pays associated with visits
• To decrease the likelihood of common set backs, which may include cellulitis. This is an infection of the skin that is treated with antibiotics, but can become serious and result in a hospital stay.

 

Is lymphedema completely preventable?

 

•  Depending on the amount of damage that occurs to the lymphatic system.  Onset of lymphedema is not always preventable.

 

Are there things I can do to decrease my chance of developing lymphedema?

•  
• Proper skin care: wash you skin with a gentle soap that is non-abrasive. Make sure to hydrate your skin daily with a lotion that is hydrating.  This means lotion that does not have perfumes or smells associated with it.
• Proper nail care: be careful to not nick cuticles during nail care.
• No needle sticks on the affected side- meaning injections, blood draws etc
• No blood pressure measurements on the affected side
• Avoid tight fitting clothing or items that may cause a tourniquet around the limb (meaning tight fitting socks, tight bracelets, heart rate monitors around the arm etc.)
• Proper wound care- if you develop a cut or scrape, ensure to dress it and care for it appropriately. An infection of a cut could lead to an exacerbation of lymphedema.
• When flying in an airplane- wear a compression garment(s) proactively. The change in the air pressure may result in development of swelling.