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Lymphedema

Lymphedema — What is it?

If you've ever seen a person with an abnormally swollen arm or leg, you've most likely just witnessed somebody who has lymphedema.

This out-of-the-ordinary swelling, which can affect more than one body region simultaneously, stems from dysfunction in the lymphatic vessels or nodes: either they were damaged or they formed incorrectly at inception.

Causes

Lymphatic vessels absorb and transport away protein-filled fluids and waste products from body tissues. It's fascinating to think that, while you're reading a book or watching television, your body's sophisticated lymphatic system (fat cells, water, proteins, white blood cells) constantly works to flush out bacteria, viruses (and any other waste) to keep you healthy.

Lymphedema (or lymphoedema, if you're British, Australian or Canadian) occurs when this system is damaged, or obstructed. When this happens, lymph fluid backs up and limbs or other parts of the body swell to volumes far greater than normal.

It's not unlike a clogged drain pipe, an appropriate metaphor considering the lymphatic system is the body's waste removal equivalent. The word, lymphedema, stems from the term 'lymph', the name of the anatomy and 'edema', which means swelling.

Far too commonly, lymphedema is a side effect of cancer treatment which often includes lymph node excision and/or radiation. Both can have a devastating effect on the patient's lymphatic system.

The bad news is that lymphedema cannot be cured, and if left untreated, bulging tumescences filled with waste, water and protein, can grow worse, causing even greater swelling and tissue hardening, called fibrosis. Also, lymph fluid is a terrific medium for unrepentant bacterial growth — increasing the dangerous risk of bacterial infection.

The good news is that lymphedema can be managed, and there many products available to help patients gain control over this intractable condition.

Types

Although lymphedema may present in a number of ways affect any part of the body, it always share a similar characteristic — an imbalance of lymphatic fluid. Now let's differentiate between primary lymphedema and secondary lymphedema.

Primary lymphedema is due to a congenital (hereditary) predisposition to a lymphatic imbalance. Some people are simply born with a lymphatic system that is out of whack. Interestingly, though, primary lymphedema might not present at birth. Instead, onset occurs later, during puberty (or later). The problematic elements in primary lymphedema include hypoplasia of lymphatic vessels (not enough lymphatics to go around); hyperplasia of lymphatic vessels (now those lymphatic vessels are just too large to work properly); or aplasia of lymphatics (missing lymphatic vessels or system).

Secondary lymphedema is due to a physical interruption of the lymphatic system that can occur in a variety of ways. However, the likely causes are trauma, surgery and radiation.

For instance, a breast cancer patient might require radiation therapy and/or lymph node dissection. The havoc wreaked on the body as a result could include scarred lymphatic vessels, leading to impaired lymph drainage and lymphedema.

Or, let's say Joe rear-ends the car in front of him on the freeway and breaks / crushes both his lower extremities; or Bill falls from a ladder while painting the outside of his suburban house; or Madison has a benign tumor removed from the medial aspect of her upper thigh which involved a surgery that slices through her medial lymphatics and surrenders her entire leg to compromised lymphatic drainage. These are all real examples of event that lead to secondary lymphedema.

However, lymphedema secondary to venous disease is probably the most common cause of chronic lymphedema. Onset is often a slow degenerative process and is often associated with onset of other many chronic conditions, such as cardiac imbalance and congestive heart failure. But the main culprit is chronic venous insufficiency (CVI). This happens when a failure of adequate venous return to the heart and leads to blood pooling in the lower extremities, and that leads to changes in fundamental movements of fluids across cell membranes, which in turn leads to increases in fluid retention in cellular Interstitial spaces, which is edema, or lymphedema.

CVI and other types of chronic venous disease lead to lymphedema, limb heaviness or tightness, shooting pains, tenderness, aches, stiffness, heat — or any or all of the above.

Non-healing wounds are often the result. The recurrent cellulitis that accompanies non-healing wounds scares the lymphatic system further, reducing the body's ability to transport lymph fluid and increasing the severity of the lymphedema.

Treatment

Happily, many effective treatments exist for lymphedema sufferers. The first step begins with a qualified Lymphedema Therapist who can walk you through your treatment options.

If your Physician cannot refer you to a therapist, use Google. Search for 'Lymphedema Therapy Clinic' for a programs near you. Or, you can use our 'Contact Us' page to request the location of a treatment center near you.

First, your lymphedema therapist will help determine the etiology of your condition and explain how your history led to your condition. Depending on the severity of your lymphedema, they may recommend a course in Complete Decongestive Physiotherapy (CDT). They will teach you the techniques of Manual Lymphatic Drainage (MLD) and how to self-massage and undoubtedly take progress measurements to chart your improvement and establish objective baseline measures to refer to over time.

Compression, as a modality, is a critical to the treatment and management of lymphedema. Your therapist will determine how best to configure it use to your specific condition. It will undoubtedly take to the form of a compression garment of some type, and may involve the use of a pneumatic compression device.

Your therapist will develop an 'at home treatment' plan that incorporates the use of MLD, self-massage and compression therapy products so that you can manage your condition at home.

Compression therapy products such as compression garments, multi-layer wraps and pneumatic devices, combined with Manual Lymphatic Drainage (MLD) are the ideal therapy regiment to keep your lymphedema in check.

Yearly visits to your lymphedema therapist to assess your treatment plan and stay on top of the latest therapy products is the best way to manage your condition over time.