WHY TREAT LYMPHEDEMA?
Thom W. Rooke, MD, and Cindy L. Felty, RN, MSN, C-ANP
Lymphedema is the accumulation of tissue fluid in interstitial spaces, mainly subcutaneous tissues (beneath the skin). It is the result of an overload of fluid in the lymphatic system. There are four reasons for treating lymphedema: pain (when present), lack of strength and mobility from heaviness, disfigurement, and prevention of future problems, such as worsening of swelling and cellulitis (infection of the skin and underlying tissue).
There are six steps in the treatment of lymphedema.
|Step 1: Get a proper diagnosis|
Conditions that may mimic lymphedema are congestive heart failure, venous disease, cellulitis, drug-induced swelling, reflex sympathetic dystrophy (changes caused by the sympathetic nervous system from an injury), tumor, lipedema (subcutaneous fat deposits), and others. Two or more conditions are commonly present in swollen limbs.
Whether or not to have treatment for lymphedema is an individual decision. The benefits of treatment are relief of pain, improvement of limb function, and significant improvement in appearance. The drawbacks are financial expense (from the cost of elastic stockings, pumps, or massage services), the physical discomfort and time commitment involved in the consistent use of compression devices, and the feeling of having a "disease."
|Step 3: Choose goals of treatment|
When a decision is made to have treatment, the goals of treatment need to be defined. Short-term goals are relief of pain and reduction of swelling. Patients with primary (hereditary) lymphedema may consider lifelong treatment strategies such as consistent pumping and massage to achieve long-term benefits.
|Step 4: Reduce the swelling|
Swelling needs to be reduced by the following methods before maintenance treatment with compression stockings.
Bed rest and leg elevation. Although bed rest is one of the best methods available for decreasing limb swelling, strict bed rest and leg elevation usually require hospitalization to be maximally effective. Leg elevation-the higher the better-uses gravity to drain fluid from the limb. Pillows, wedges, and slings are helpful
pneumatic pumping of the limb is done 1-3 times per day for 30-60
session on an outpatient basis. When the limb swelling can be reduced
pumping is stopped, and other maintenance therapy is begun.
There are several types of pumps:
SINGLE CHAMBER. These pumps have an inflatable single chamber sleeve that encases the limb. Pressure is usually 60-100 mmHg for 20-40 seconds. The pressure forces fluid out of the limb through the veins and the lymphatics.
MULTICHAMBER. These pumps "milk" the fluid out of the swollen limb by applying sequential pressures. They are more expensive than single-chamber pumps.
CARDIAC-GAITED. These pumps inflate during a specific portion of the cardiac cycle to 60 mmHg, then deflate for the rest of the cycle. They are very expensive.
Manual lymphatic drainage and complex decongestive therapy. Light massage 2 or 3 times per day for about 2 weeks plus diet, specific exercise, and elastic compression reduces swelling (Figure 2).
|Step 5: Prevent fluid re-accumulation|
Prevention of re-accumulation of fluid is achieved with elastic or nonelastic compression.
Elastic wraps. Elastic bandages come in a variety of types, widths, thicknesses, and materials. They also come in long-stretch (quite stretchable) and short-stretch types (stiff).
Elastic compression stockings. These stockings can be worn all day and look better than bandages (Figure 4). They may be difficult to put on and are more expensive than wraps.
Nonelastic wraps. These wraps are applied over the ankle and calf. They have adjustable compression bands that are secured with Velcro to the desired tightness.
Elevation and pumping can be done on an as-needed basis in addition to the other means of prevention.
|Step 6: Maintain with diet, medications, and follow-up|
Avoid excessive salt intake, which increases fluid in the body.
Avoid excessive weight gain. Excess body tissue makes the limb harder to compress and more susceptible to edema.
Diuretics (drugs that promote excretion of urine) are most important during the initial phase of treatment for lymphedema. These drugs may play a minor role in maintenance therapy.
Whenever possible, avoid drugs that cause fluid retention: nonsteroidal anti-inflammatory drugs, calcium channel blockers, steroids, and estrogen (in some people).
Infections should be treated promptly with antibiotics, preferably penicillin or a similar drug. The drug may be given in small doses daily or regular doses for 1 week each month.
Screening for angiosarcoma or other malignancies is recommended. Patients should check their limbs carefully for tumors or lesions and contact their physician if they find any tumors or lesions.
Because of primary lymphedema's hereditary nature, genetic counseling may be recommended.
Psychological counseling may help a person cope with lymphedema.
American Venous Forum
Treatment of lymphedema
Complications of Lymphedema
Comprehensive Lymphdema Managment: Results of a 5-year
Bonnie B. Lasinski, MA, PT, CLT-LANA and Marvin Boris, MD
Presented at the 18th Congress of the International Society of Lymphology
Genoa, Italy, September 2001
Published in Lymphology 35 (Suppl):301-304, 2002
Persistence of Lymphedema Reduction Over 36 Months After Non-Invasive Complex Lymphedema Therapy
Marvin Boris, M.D., Stanley Weindorf, M.D., Bonnie B. Lasinski, B.S. P.T., M.A. Lymphedema Therapy, Woodbury, New York
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Lymphedema People - Support Groups
The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.
No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.
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Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.
Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.
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Page Updated: Dec. 14, 2011