What is Lymphedema?

What is LE  - What is Lymphedema?
Lymphedema (lymph = lymph fluid; edema =swelling) is an abnormal swelling of the body part, most often an extremity such as arms or legs, but it can occur in the face, neck or abdomen. The swelling is the result of an accumulation of protein-rich lymph fluid in the affected area. This occurs when the lymphatic system, which transports waste material (proteins, inorganic substances, water, fats, dead or damaged cells), is absent, underdeveloped or impaired in some way. The World Health Organization estimates that over 170 million suffer with Lymphedema.
How is Lymphedema diagnosed?

There are no specific diagnostic tests for lymphedema. The physician will complete a medical history and physical examination. The medical history may include questions regarding the following:

past surgeries
problems following the surgeries
onset of symptoms (When did the swelling of the affected area appear?)
history of edema (severe swelling)
current medications
other medical conditions such as high blood pressure, heart disease, or diabetes
Stages or Grades of Lymphedema

∑ Grade 1 - when the skin is pressed the pressure will leave a pit that takes some time to fill back in. This is referred to as pitting edema. Sometimes the swelling can be reduced by elevating the limb for a few hours. There is little or no fibrosis (hardening) at this state, so it is usually reversible.

∑ Grade 2 - when the swollen area is pressed, it does not pit, and the swelling is not reduced very much by elevation. If left untreated, the tissue in the limb gradually hardens and becomes fibrotic.

∑ Grade 3 - the lymphedema is often called elephantiasis. It occurs almost exclusively in the legs after progressive, long term, and untreated lymphedema. At this stage there may be gross changes to the skin and it may protrude and bulge. There may be some leakage of fluid through the tissue in the affected area, especially if there is a cut or sore. While lymphedema will respond to treatment at this state, it is rarely reversible.
Treatment for Lymphedema:

Treatment for lymphedema depends on the severity and extent of the condition. Prevention and controlling lymphedema play an important role with this condition since there is no cure.

Treatment may include the following:

Exercise
Exercise helps to restore flexibility and strength, and improves drainage. The type of exercises will be recommended by your physician and/or physical therapist.
Bandage
Wearing a customized compression sleeve or elastic bandage may help to prevent an accumulation of fluid
Diet
Eating a well-balanced diet and controlling body weight is an important part of treatment.
Prevent infection
It is important to follow preventive measures, such as good skin care, to protect the affected area from infection and skin breakdown.

Although there is presently no cure for lymphedema, treatment can delay or even prevent its progression to a more severe stage. Surgery is occasionally used to treat severe lymphedema. However it is
NOT usually the treatment method of choice for patients with mild or even moderate symptoms. Non-surgical treatments are thought to provide greater relief with fewer complications. Since infections can intensify the symptoms of lymphedema, antibiotics may be prescribed in individuals with frequent infections to reduce this risk.
The most widely accepted treatment for lymphedema, complex physical decongestive therapy (CPDT), involves four components which first establish drainage of lymph, and then maintain and improve the results of the initial intensive phase.
The first component of CPDT is decongestion or manual lymph drainage (MLD), which utilizes daily gentle massage and physiotherapy to improve the flow of lymph. Compression therapy then prevents the reaccumulation of fluid by tightly wrapping the limb following each MLD session. Once maximal reduction in swelling has been achieved, sometimes after one month of daily MLD, a special garment is custom-made to fit the limb. The final two components of CPDT include meticulous skin care to avoid infections and daily remedial exercises performed while wearing the compression garment to improve muscle tone and help propel the flow of lymph.
Preventing and controlling Lymphedema:

Protection of the swollen area is very important. Poor drainage of the lymphatic system may cause the affected area to be more susceptible to infection and to be less sensitive to extreme temperatures. Persons with lymphedema should avoid injury and infection and should be aware of those activities that put too much pressure on the affected the area. Protective measures include the following:

Make sure that all injections are given and blood tests are drawn in the unaffected area.
Avoid wearing nightgowns or clothing with elastic cuffs.
Carry your handbag or heavy packages in the unaffected area.
Use an electric shaver when shaving underarms/legs.
Avoid sunburns and other burns to the affected area.
Make sure that all blood pressure tests are performed on the unaffected area.
Wear gloves when gardening and when using strong household detergents.
Clean the skin of the affected area daily and apply lotion. When drying the area, be gentle, but thorough.
Keep the area elevated when possible.
Do exercises regularly to improve drainage, but first consult with your physician or physical therapist.
Eat a well-balanced, low-sodium diet.
Avoid extreme hot or cold temperatures on the affected area, such as heating pads or ice packs.
Take proper care of the fingernails and avoid cutting cuticles.
Clean all cuts with soap and water, and then apply anti-bacterial ointment and a sterile dressing.
Protect your fingers or toes from needle pricks and sharp objects. Use a thimble when sewing.
Avoid vigorous, repetitive movements against resistance (such as scrubbing, pulling, or pushing) with the affected area.
Notify your physician immediately of any signs of infection, such as redness, pain, heat, increased swelling, or fever.
Two Common Myths that are NOT effective for Lymphedema

Pumps for Effected area.  Please Reference  Lymphoedema Association of Australia (click on treatments for lymphoedema) 
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Diuretics ('fluid tablets')
These are useless for lymphedema (except in emergencies), but may of course be needed for another condition. They only remove water, yet lymphedema is caused by excess protein in the tissues, which retains the water. If the protein is removed, the water leaves via the blood system - hence the lymphedema is reduced. Diuretics concentrate protein in the tissues and increase its deleterious effects.
Diuretics have many bad long term side-effects. However if they have been taken over a period and the suddenly stopped, the body (i.e. the kidneys) does not cope, and takes a month to adjust. During this time, there is an immediate worsening of the lymphedema. This is why diuretics are thought to help in lymphedema. If, however, the dose is gradually reduced, at the start of MLD swelling is controlled, side-effects are minimal, and the patient is better off!
What are the sympthoms of Lymphedema?

Symptoms of lymphedema include tightness and swelling which are frequently unilateral and asymmetric, as well as joint immobility and pain which is sometimes misdiagnosed as arthritis. In addition, long term effects can include obesity, skin changes, minor or severe infections, and even risk of lymphangiosarcoma if the lymphedema remains untreated. Cosmetic concerns also present psychological issues for many patients.

The symptoms of lymphedema gradually progress through three stages. Stage I, or reversible lymphedema, is marked by swelling which is usually reduced with simple elevation of the swollen arm or leg. There is also pitting of the overlying skin when it is depressed. Stage II is referred to as spontaneously irreversible lymphedema and is marked by an increase in fibrous tissue and progressive skin hardening. There can be frequent infections, swelling is increased, and the skin no longer pits when depressed. Simple elevation is no longer effective in reducing swelling at this stage. Stage III, or lymphostatic elephantiasis, shows an extreme increase in swelling in which the limb becomes columnar (loses definition of the knee and/or ankle). There are more extreme skin changes with increased hardening, and there can be large hanging skin folds. Stage III lymphedema can infrequently be associated with Stewart-Treves Syndrome, a highly malignant angiosarcoma.
What is Manual Lymphatic Drainage treatment?

Manual Lymph Drainage is a highly specialized massage technique performed by physical therapists certified in lymphedema treatment.
Although an excellent form of treatment, many patients find the continuous bandaging very difficult. Often the bandaging must be done every day for life once a patient finishes therapy. The treatment has limited coverage from Medicare and Insurance companies.
Manual Lymph Drainage uses a specific light-pressure stroking action to stimulate the lymph vessels just below the surface of the skin.
Manual Lymph Drainage then works to stimulate the lymph vessels on the "good unaffected side" of the body (trunk region) which then helps suction lymph fluid from the "bad affected side" of the body. The therapist guides the fluid from sluggish lymph areas to various healthy lymph regions that are effective in draining excessive fluid. After the trunk or abdomen is decongested/drained, the upper part of the arm or leg is treated and then is followed the distal part and the limb.
Manual Lymph Drainage helps the lymph system remove excess water, protein and other wastes from connective tissues in different areas.. The lymph system then rids the body of this excessive fluid by eventually dumping it back into the blood stream.
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