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WHY TREAT LYMPHEDEMA?

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TREATMENT OF 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

Pumps. Typically, pneumatic pumping of the limb is done 1-3 times per day for 30-60 minutes each session on an outpatient basis. When the limb swelling can be reduced no more, 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.

Counseling

Because of primary lymphedema's hereditary nature, genetic counseling may be recommended.

Psychological counseling may help a person cope with lymphedema.

American Venous Forum

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Treatment of lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

Complications of Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

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Comprehensive Lymphdema Managment: Results of a 5-year follow-up

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

http://www.lymphedema-therapy.com/02paper2.htm

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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

http://www.lymphedema-therapy.com/97paper.html

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Related Lymphedema People Medical Blogs and Pages:

Bacterial Infections

http://bacteriainfections.blogspot.com

Antibiotics

http://antibioticinformation.blogspot.com/

Cellulitis

http://cellulitisinfections.blogspot.com/

MRSA Information

http://mrsainformation.blogspot.com/

Antibiotic Glossary

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=34

Antibiotic Therapy, Types of Antibiotics

http://www.lymphedemapeople.com/thesite/lymphedema_antibiotics.htm

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Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe: AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

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For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

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Lymphedema People - Support Groups

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Children with Lymphedema

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.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

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Lipedema Lipodema Lipoedema

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.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

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MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

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All About Lymphangiectasia

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.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

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Lymphatic 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.

DISCRIPTION

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.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

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Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet?  Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more.  Come and take a stroll! 

Lymphedema Glossary 

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing 

Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema 

Arm Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema 

Leg Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema 

Acute Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema 

The Lymphedema Diet 

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet 

Exercises for Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema 

Diuretics are not for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema 

Lymphedema People Online Support Groups 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups 

Lipedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema 

Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment 

Lymphedema and Pain Management 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management 

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)

http://www.lymphedemapeople.com/wiki/doku.php?id=manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt 

Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema 

How to Treat a Lymphedema Wound 

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound 

Fungal Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema 

Lymphedema in Children 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children 

Lymphoscintigraphy 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Extraperitoneal para-aortic lymph node dissection (EPLND) 

http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd 

Axillary node biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy

Sentinel Node Biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy

 Small Needle Biopsy - Fine Needle Aspiration 

http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Lymphedema Gene FOXC2

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2

 Lymphedema Gene VEGFC

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc

 Lymphedema Gene SOX18

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18

 Lymphedema and Pregnancy

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy

Home page: Lymphedema People

http://www.lymphedemapeople.com

Page Updated: Dec. 14, 2011