Lymphedema

 
Lymphedema

A lot people with lymphedema believe nothing can be done to improve their condition. They feel helpless, powerless, discouraged and isolated because of their condition. While it is true that there is no cure for lymphedema, several things can be done to manage and dramatically improve the condition. The swelling can be reduced and life enhanced through education and specialized treatment.

What is Lymphedema?
Lymphedema is a chronic disorder characterized by persistent swelling in the arms or legs (or any body part, such as the face, neck, abdomen or genitals) due to blocked lymph channels (vessels or nodes). A type of lymphedema referred to as primary lymphedema due to impairment or abnormal development of the lymphatic system can be present at birth or develop later in life, often after puberty. Another type of lypmphedema called secondary lymphedema is commonly caused by surgery, trauma, infection or radiation therapy that can often impair or damage the lymphatic system. This damage leads to an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, inflammation and disability.

When the impairment becomes so great that the lymphatic fluid is too much for the lymphatic system to handle (transport back to the main system) an abnormal amount of protein-rich fluid collects in the tissues of the affected area. Left untreated, this stagnant, protein-rich fluid, not only causes tissue channels to increase in size and number, but also reduces oxygen availability in the transport system, interferes with wound healing, and provides an ideal environment for bacteria to grow. This bacterial growth can result in lymphangitis or cellulitis (serious infection).

Lymphedema in the arms is often associated with breast cancer following surgical removal or radiation treatment of the lymph nodes. It can occur shortly after insult to the lymph system or many years later.

Patients who have undergone treatment for cancer in the pelvis or lower extremity or treatment for Hodgkin's disease often suffer from lymphedema in the legs or genitals. Because the lymph nodes remove impurities from the circulatory system, damage to the lymph system affects the body's ability to fight infection, interfering with the normal healing processes. When the lymph system is impaired, even minor scratches or cuts can lead to infection. Left untreated, lymphedema can be painful and lead to irreversible complications.

Lymphedema should not be confused with edema resulting from venous insufficiency, which is not lymphedema. However, untreated venous insufficiency can progress into a combined venous/lymphatic disorder, which is treated in the same way as lymphedema.

Symptoms of Lymphedema
Lymphedema can develop in any part of the body or limb(s). Signs or symptoms of lymphedema to watch for include: a sensation of fullness in the limb(s), skin feeling tight, decreased flexibility in the hand, wrist or ankle, difficulty fitting into clothing in one specific area, or ring/wristwatch/bracelet tightness. If you notice persistent swelling, it is very important that you seek immediate medical advice, (and get at least one second opinion) as early diagnosis and treatment improves both the prognosis and the immediate condition.

Lymphedema develops in a number of stages, from mild to severe (referred to as Stage 1, 2 and 3)

Stage 1 (spontaneously reversible):

Tissue is still at the "pitting" stage, which means that when pressed by fingertips, the area indents and holds the indentation. Usually, upon waking in the morning, due to the limb being elevated, the limb(s) or affected area is normal or almost normal size.

Stage 2 (spontaneously irreversible):

The tissue now has a spongy consistency and is "non-pitting," meaning that when pressed by fingertips, the tissue bounces back without any indentation forming). Fibrosis found in Stage 2 lymphedema marks the beginning of the hardening of the tissues of the limbs and increasing size.

Stage 3 (lymphostatic elephantiasis):

At this stage the swelling is irreversible and usually the limb(s) is/are very large. The tissue is hard (fibrotic) and unresponsive; some patients consider undergoing reconstructive surgery called "debulking" at this stage. When lymphedema remains untreated, protein-rich fluid continues to accumulate, leading to an increase of swelling and a hardening or fibrosis of the tissue. In this state, the swollen limb(s) becomes a perfect culture medium for bacteria and subsequent recurrent lymphangitis (infections). Moreover, untreated lymphedema can lead into a decrease or loss of functioning of the limb(s), skin breakdown, chronic infections and, sometimes, irreversible complications. In the most severe cases, untreated lymphedema can develop into a rare form of lymphatic cancer called Lymphangiosarcoma (most often in secondary lymphedema).

How can TSI’s Lymphedema Management Program help you?

About the director of TSI and the lymphedema program

The director of TSI (Angelo Rizzo MS, PT, CLT) has received his master’s degree in physical therapy from Emory University. He is not only a Licensed Physical Therapist, but he is also a Certified Lymphedema Physical Therapist and is recognized as a leader in the field of oncology rehabilitation and lymphedema. He received his original advanced training in lymphedema through the Klose-Norton Training and Consultant group. More recently he obtained further advanced training at the world-renowned Foeldi Clinic in Germany, studying under doctors Ethel and Michael Foeldi (the founders of the present day standard of care for lymphedema called Complex Decongestive Therapy). He is currently serving his second term as the Vice President of the Oncology Section, and Section Chief Delegate in the House of Delegates, of the American Physical Therapy Association in Washington, D. C. He holds a board member position of the one of the largest lymphedema support groups (the Lighthouse Lymphedema Network) in Atlanta. He is presently working with physicians at Emory University’s Winship Cancer Center of Excellence on an NIH research proposal for exercise and cancer patients. He has previously served as board member and president of the Georgia chapter of the National Osteoporosis Foundation.

All TSI facilities are equipped to offer this specialized Complex Decongestive Therapy treatment for lymphedema and we are committed to providing quality care and education to help you manage your condition.

Our goals for your therapy are to:

• Reduce edema

• Provide education about the proper management of your condition

• Evaluate your lifestyle and work habits to achieve effective modifications

• Fit you with appropriate compression garments

• Improve your daily functioning and overall quality of life

• Recommend home compression units, when appropriate

Treatment plans are completely individualized to the patient's particular needs and situation. The standard treatment for lymphedema is referred to as Complex Decongestive Therapy (CDT). The treatment is performed by a certified Lymphedema Physical Therapist specialist and may include:

• Thorough evaluation and assessment, including a complete health history

• Compression treatment of the lymphedematous extremity with medical compression bandages or computerized limb compression devices

• Arrangements for custom-made elastic garment (sleeve or stocking) to provide appropriate amounts of compression

• Manual lymphatic drainage

• Evaluation of your lifestyle and suggested adaptive techniques

• Recommendations for individualized home exercise program

• Close communication and coordination with your referring physician

• Scheduled follow-up visits after the program are completed to evaluate progress

• Work modification recommendations

• Help with activities of daily living

Treatment is offered on an outpatient basis and is usually performed 3 times weekly until the edema reduction has plateau and then a custom garment is ordered for daily use. This treatment protocol is usually completed in 6-8 weeks. Old garments should be replaced every 6-9 months. The overall goal for each patient is to help you manage your lymphedema and live as comfortably and independently as possible.

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