Lower limb and leg lymphedema

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Lower limb and leg lymphedema

Postby patoco » Sat Jun 10, 2006 12:20 pm

Lower limb and leg lymphedema

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Lower limb and leg lymphedema

Just as lymphedema of the upper extremities can become a complication after post surgical removal of breast cancer, lymphedema of the lower extremities can be a debilitating condition with several cancers. Prostate, lung, liver, lymphomas, ovarian, and abdominal cancers can cause swelling of the legs. The swelling can come from any compression or surgical removal of the lymph nodes in the lower body. It can also come secondarily to production of fluid into the abdomen (ascites) which spreads into the legs. When under treatment for any cancer, if your protein levels fall into lower levels, fluid will leak into your whole body including legs

When you first notice swelling in your legs, you need to act to reverse it. Once you let the legs blow up to large size, it is harder to reverse the process. This must be discussed with your doctor. The use of elastic stockings with at least 30 mm hg pressure is the first step. If the edema is only at the ankles and feet, then you only need stocking to the knee. Any medical supply store can help fit the stockings. You should read the package and measure your ankle,calf and the length from the knee to the heel so that you are sure that they fit you correctly. These measurements are usually listed on the box. If the edema goes up to the knee or past, you will need thigh high stockings. You must keep pulling these up as the stocking fall down with wear during the day. The stockings are all hard to apply. You need someone with strong hands. Sometimes it helps to wear rubber gloves to get a better grip on the stockings. There are also leotards for edema that goes above the thigh. When you apply these stockings, they should be perfectly smooth. If you leave wrinkles, it will become painful underneath or you can cut the circulation in that spot. The stockings should be worn through the day from when you first get up. You do not sleep with them on. At night you remove the elastic hose and elevate your legs on pillows in the bed. Try to get them above your heart. You can wrap legs with elastic wraps.

This is difficult to do correctly. The wraps should be on a diagonal. If you go in straight circles, you could end up with a turnicate like constriction of the leg and make the edema worse. If you develop numbness in your toes or coldness, that means that you have wrapped it too tightly. You should totally remove it and apply it again.

For men, often the edema will go up into the scrotum. You should also elevate your penis at night to try to empty the water back in to the abdomen. Wearing a jock strap helps support the heavy and often painful scrotal sack when you are up and about.

When the edema is not responding, you can use the external pump devices if so desired. These devices can be rented from a medical supply house. They are usually covered by insurances. After pumping you must then wear the elastic stockings until bed time. You pump daily for 2-3 weeks to get the severe edema under control. You can also go to outpatient physical therapy or edema clinics for treatments.

When you are sitting you need to elevate your legs during the day or lie down at intervals with the legs elevated on pillows. Do not wear tight shoes as any kind of constriction only adds to the edema above or below the constriction. You must also be very careful not to cut yourself or open the skin. You must immediately see an MD if you have a weeping sore. It will take careful treatment to heal it without infection developing. Sometimes antibiotics are necessary.

Exercises like pumping your feet up and down, leg kicks, going up and down on your toes in standing will help decrease edema. A regular exercise program of walking, exercise with light weights or any kind of movement activity is also helpful. In some instances, decreasing your salt intake becomes necessary.

Other precautions are to be careful with heat or ice on severely swollen legs. That includes your shower or bath water. Bathe legs with regular soaps and rinse well. If you develop athlete's foot, be sure to treat it with one of the common sprays or powders. Be careful cutting your toenail. Get treatment for ingrown toe nails. The problems are more complex when severe edema is involved.



Venous dynamics in leg lymphedema.

Kim DI, Huh S, Hwang JH, Kim YI, Lee BB.

Division of Vascular Surgery, Samsung Medical Center, College of Medicine, Sung kyun kwan University, Seoul, Korea.

To determine whether there is anatomical and/or functional impairment to venous return in patients with lymphedema, we examined venous dynamics in 41 patients with unilateral leg lymphedema. A Volometer was used for computer analysis of leg volume, a color Duplex Doppler scanner was used to determine deep vein patency and skin thickness, and Air-plethysmography was used to assess ambulatory venous pressure, venous volume, venous filling index and the ejection fraction. In the lymphedematous leg, volume and skin thickness were uniformly increased (126.4 +/- 21.3% and 156.9 +/- 44.5%) (mean +/- S.D.), respectively. The ambulatory venous pressure was also increased (134 +/- 60.7%) as was the venous volume (124.5 +/- 37.5%), and the venous filling index (134.5 +/- 50.5%). The ejection fraction was decreased (94.9 +/- 26.1%). Greater leg volume correlated with increased venous volume and venous filling index (values = 0.327, 0.241, respectively) and decreased ejection fraction (r = -0.133). Increased subcutaneous thickness correlated with increased venous filling index and venous volume (r = 0.307, 0.126, respectively) and decreased ejection fraction (r = -0.202). These findings suggest that soft tissue edema from lymphatic stasis gradually impedes venous return which in turn aggravates the underlying lymphedema.

PMID: 10197322 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=99213071


Lymphedema Of The Legs And Ankles

By Linda Fisher

The obstruction of the flow of lymph from a given area results in the accumulation of abnormally large amounts of tissue fluid in that area. Such an accumulation is called lymphedema. Lymphadema is not only uncomfortable, it may cause such problems as pain, infection and recurrent infection, difficulty in movement, clothing restrictions, and air travel restrictions.

Remembering that the lymph moves upward in the body toward the heart, from the finger tips in toward the heart, and from the top of the head down toward the heart, we can see that the fluid moving furthest in the body is from the lower extremities. Some causes of lymphedema of the lower extremities is congestive heart failure, trauma to the back or lower abdominal area, blockage in the groin (inguinal nodes), or blockage behind the knee (popliteal nodes).

I often use the analogy of a traffic accident on the freeway to explain movement of lymph. At the point of the accident, all traffic either stops or slows to a near halt, until the accident is cleared away, thus allowing the traffic to again flow naturally. Anatomically, at the point of blockage, everything slows down and begins to accumulate backward along the path of flow. If the feet and ankles are swollen, it generally means that there is a blockage "up ahead."

Even in slender young people, we sometimes see signs of lymphedema in the legs. This appears as "heavy ankles" or as a little pouch of fat on the inside curve of the knee area. When present in this portion of the population, we usually find that the individual is not getting the right exercise and eating largely of the wrong foods, or just the opposite. Many joggers, tennis players, and aerobic exercise enthusiasts exercise and eat properly, but they get this problem because repeated hard impact will slow lymph movement.

In the middle age and senior group, we may see a different, but very common, problem - shuffling the feet instead of walking comfortably. When you cannot lift your feet to step properly, you may just accept that you probably have an "arthritic problem." Many times, you may have a large mass of lymph fluid behind your knee that has pooled, and then hardened. Imagine the pain this would cause. It would be like strapping a tennis ball behind your knee and then attempting to walk!

There is more than one cause of lymphedema in the lower extremities. The ones mentioned above are just some of the more common ones.

Tips to Avoid Blockage:

Do not wear tight jeans or tight under garments.
Do not cross the knees when sitting; cross feet at the ankles instead.
For the exercise enthusiast, integrate some form of slow, rhythmic exercise - yoga and pilates are excellent, as is walking.
Bouncing on a trampoline is excellent - no need to jump. Bend your knees and get a gentle bounce going for a minimum of 12-15 minutes a day. If balance is a concern, hold onto a stationary item or purchase a balance bar that attaches to your trampoline. Also, if wheel chair bound, place your feet on the trampoline and have someone else bounce it for you - you will receive a positive benefit from this.
Lie on a slant board.

And, as always, drink plenty of clean water, practice deep belly-breathing, and eat plenty of fresh, unprocessed foods. Caution: In the case of congestive heart failure, be absolutely sure to check with your health care practitioner before attempting any form of exercise and, of course, no slant-boarding!
"Creating free lymphatic movement through the body is a vital part of any healing process."

Linda Fisher owns the Lympathic Wellness Center in Santa Maria.
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