As you are aware there have been some new staff members at Sue croft Physiotherapy and one of the girls, Alex, is trained in lymphoedema management. I asked her to write me a blog to let you know what lymphoedema is and how to manage it.
Lymphoedema is the swelling that occurs when excessive amounts of lymph fluid accumulate in the tissue. This is caused by a compromised lymphatic system, which normally returns the lymphatic fluid back into the bloodstream. It mostly affects the limbs although it can also involve the trunk, breast, neck, head and genital area.
The lymphatic system is a network of lymphatic vessels and lymph nodes throughout the body. The vessels start like tiny fingers in the tissue and are getting larger on their way to the heart. The lymph system is no closed circulation, it is more like a half circuit. Our blood circulation system processes around 20 litres of blood every day through the capillary filtration in our skin, muscles and organs of which only 17 litres returns directly back into the blood vessels. The 3 litres left in the tissue is the interstitial fluid or lymphatic fluid that has to be picked up by the lymphatic vessels.
The lymph (from Latin, lympha: water) is a clear, protein-rich fluid that also carries any waste products from the tissue and bacteria. To help the lymph moving towards the heart the larger lymph vessels have muscles in their walls that help them to slowly pulsate and valves that only allow the fluid to go one way. On the way to the heart the vessels pass through many lymph nodes which act like filters. These ovoid shaped lymph nodes are present throughout the body but more concentrated around the trunk, neck, armpits and groins. They are important for a properly functioning immune system as they are major sites for B and T lymphocytes as well as other white blood cells.
The primary function is the filtering of the lymph fluid to identify and fight infection. That is when they become enlarged such as during tonsillitis. Lymphoedema may arises because the lymphatic vessels or nodes have not been formed correctly or due to damage.
Primary lymphoedema is the result of a congenital condition that affects how the lymph vessels were formed. It might be a result of a reduced number of vessels, vessels with an enlarged diameter and even the absence of vessels in some parts. Primary lymphoedema is present at birth or becomes apparent during puberty (sometimes it does also develop later in life). About one person in every 6000 will develop primary lymphoedema and females are more affected than males.
Secondary lymphoedema often occurs as a result of cancer treatment including the removal of lymph nodes and radiotherapy to groups of lymph nodes. About 20% of breast, genitourinary-gynaecological cancer and melanoma survivors develop lymphoedema. But it can also arise for other reasons for example following trauma, venous disease, infections or obesity. Secondary lymphoedema is the most common type.
Lymphoedema is a chronic condition, but there is treatment available. The most important things to keep in mind when lymph nodes have been removed is to take precautions in order to prevent lymphoedema.
Precautions for people at risk of developing or living with lymphoedema:
- Avoid limb constriction, for example jewellery, tight clothes and even measuring blood pressure on an affected arm.
- Avoid injuries to your skin including injections (or any needle for that matter).
- If you get bitten by mosquitos or sustain cuts ensure to keep the area clean and apply antiseptic cream if needed in order to avoid infections.
- Avoid extremes of temperature and sunburns.
- Watch for early signs of infections such as increased warmth, redness, tenderness and swelling.
As lymphoedema is progressive, early interventions are recommended. People at risk of developing lymphoedema should always be mindful of early warning signs and seek professional help as soon as possible. Early signs might be transient swelling, heaviness, stiffness, aching, tightness or temperature changes. Shoes or jewellery might feel tighter. Lymphoedema has a gradual onset and if swelling appears suddenly deep venous thrombosis (DVT) and infection has to be excluded.
The aim of lymphoedema treatment is to reduce the oedema and maintain the improvement.
- It is important to understand how the lymphatic system works and what factors might compromise it further.
- Skin care to optimise the condition of the skin and ensure prompt treatment of infections
- Exercise to improve the lymphatic and venous flow.
- Manual lymphatic drainage to reduce swelling and stimulate the lymph flow. Self massage is usually taught for self-management.
- Compression therapy to preserve the reduction of the swelling. Depending on the degree of the lymphoedema it might be initially compression bandaging followed by prescribed compression garment.
- Awareness of healthy diet, fitness and weight management are important factors too.
The treatment has to be individualised depending on the degree. With mild lymphoedema – education, skincare and exercises might be enough. There are other treatment options available for lymphoedema such as laser therapy, taping, hyperbaric oxygen and medications but there is need for more research to evaluate the benefits.
Thanks Alex for this overview. Alex is available for appointments on Monday, Tuesday and Wednesday (ph: 38489601) if you have problems following cancer treatment or you have questions about treatment for primary lymphoedema. Alex also conducts classes on a Tuesday at my exercise studio, Studio194 and does one-on-ones on a Monday morning and Tuesday at 12.15pm.
Australasian Lymphology Association: http://www.lymphoedema.org.au/;
Human Physiology: From cells to systems, Chapter 10 and 12
Stuiver MM, ten Tusscher MR, Agasi-Idenburg CS, Lucas C, Aaronson NK, Bossuyt PMM. Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD009765. DOI: 10.1002/14651858.CD009765.pub2.