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Lymphoedema – Cause, Information & Assistance

Lymphoedema

Lymphoedema or Lymphoma is a swelling that occurs when your body’s lymphatic drainage system has insufficient function. It causes long term chronic swelling and oedema.

This Lymphoedema website is here to assist you to reduce and control your lymphoedema swelling. It provides information and resources for patients and doctors useful for this purpose.

Please use the links below or in the sidebar to find more lymphoedema control information. The information provided shows ways to manage your lymphoedema swelling and make your treatment a more pleasant and easier experience.

Introduction

What is lymphoedema?

Lymphoedema is an oedema or swelling of the tissues termed a ‘high protein oedema’. This condition is caused when normal lymphatic load into the tissues is greater than the available lymphatic transport out of the tissues, long term and over prolonged and indefinite periods of time.

What causes lymphoedema?

Lymphoedema is caused by compromised lymphatic function in an affected part of the body. The compromised lymphatic system allows excess protein to accumulate at a level greater then 2%. in the fluid bathing the cells of the body (interstitial fluid). Interstitial fluids are the fluids contained in the spaces between the cells in body tissues,

Is there a cure for lymphoedema?

Until a way to regenerate a dysfunctional lymphatic system is devised, then the cure for lymphoedema is yet to be found. The most effective care for this condition is by persistent planned treatment to make a lymphoedema affected limb smaller and more normal. This  is achieved by gradually treating the cause of the oedema and swelling. Outcomes of treatment are normally increased mobility and to generally make you feel better about how you look.

Lymphoedema care re-routes excess protein (the cause of oedema/swelling) from a lymphoedema affected area to other areas of the body where the lymphatic system is functional. This allows protein to be naturally removed from the body tissues to be returned back to the blood circulatory system. Once this is achieved lymphoedema can be controlled, it will reduce in size and more easily be kept manageable, even if at this time there is no known permanent cure.

If your lymphoedema is increasing in size, in most cases it will eventually have a period of stability or latency when it does not worsen and seems to settle down. This occurrence should not be confused with a cure for lymphoedema. Times may last for months or years. Many times after a period of stability (latency), lymphoedema affected limbs will commence activity again with resultant increased swelling and discomfort to grow larger. This is a normal progression of lymphoedema if left untreated.

When lymphoedema is treated reductions can be best described as Lymphoedema in reverse as reductions often are achieved in stages and are sometimes spasmodic.With concentrated combination treatment, lymphoedema swelling may also be reduced quickly over a short period of time. In most cases after a fast reduction in size from a combination treatment, a time of waiting and application of maintenance therapy must elapse before the next significant reduction can be obtained.

In the cooler times of winter Lymphoedema is more easily managed than in the warmer weather of summer. Winter is a good time to have, or commence lymphoedema reduction therapy.

Diagnosis & grades of lymphoedema

Diagnosis of lymphoedema

Tests used to ascertain Lymphoedema. Following are the main accepted medical tests for ascertaining lymphatic function/dysfunction which will ultimately cause lymphoedema. Some of these tests  may be used in conjunction with checking blood circulatory problems which also impact on unwanted swelling.

Lymphoscintigraphy

A radio-nuclide with water is injected near finger or toe of affected limb and its progress is traced with a gamma camera up the arm or leg. From this information it can be ascertained how well the lymphatic system is working and to what degree of the normal expected lymphatic uptake is available.

Computed Tomography (CT Scan)

It shows cross section images of tissues or MRI Scan where malignancy may be suspected.

Duplex imaging study

Ultrasound to identify/rule out chronic venous insufficiency.

Bio-Impedance Analysis (BIA)

An extremely small electrical current is passed through the body and depending on the electrical resistance encountered it is possible to presume/predict the probability of a lymphoedema condition becoming evident, prior to clinical signs becoming noticeable, and after taking into account the risk of a patients susceptibility.  

Grades of Lymphoedema

The grades of lymphoedema are medically defined as;

Grade 1 Lymphoedema:

When the skin is pressed hard with the end of a finger or blunt object the skin will remain indented (pitted) after the finger or object is removed. If the affected limb is elevated higher than the other parts of the body (normally overnight) the swelling is reduced

Grade 2 Lymphoedema:

Grade 2 lymphoedema has much more excess fibrous tissue contained within the affected limb, and if the skin is pressed hard with the end of a finger, it does not indent or ‘pit’. There will be little or no reduction to the swelling or oedema by elevation of the limb, even if the limb is elevated and rested in bed overnight, or for 2-3 days. The limb gradually ‘hardens’ because of the excess fibrous (scar) tissue due to chronic inflammation.

Often at this stage there will be evidence of lack of oxygenation in the tissues. This will be indicated by discoloured skin and elevated temperature of the whole limb. Sometimes only the lymphoedema affected part of the limb may have elevated temperature and discoloration..

Grade 3 Lymphoedema, Elephantiasis:

With Grade 3 lymphoedema there appear gross changes to the skin with many protrusions and huge bulges in the tissues of the affected limb. It is often considered irreversible lymphoedema, however, this is not the case and much can be done to alleviate the condition with proper lymphatic therapy, care and attention.

Important Points on Diagnosis of Lymphoma

  • It is to be noted Doctors and Lymphoedema therapists alike describe lymphoedema according to its grade.
  • There is no substitute for a Doctors opinion. Your doctor can arrange tests to ascertain if a condition is really lymphoedema. These tests may be expensive as they are not always covered by health insurance or be government funded. Additionally tests are not always readily conclusive, so always take into account family history and probability of lymphoedema occurrence with the results of tests.
  • Lymphoedema is not only the only cause of oedema. All possibilities need be explored to  obtain diagnosis. Testing for all possibilities may take time so patience is often required.
  • Symptoms that do not show conclusive evidence of lymphoedema from testing may be visually recognizable to many experienced lymphoedema practitioners, who can then in conjunction with your doctor ascertain a suitable treatment regimen.
  • You, your doctor and lymphoedema practitioner working together is the most helpful way forward to control your condition. Your Doctor can often help locate a suitable Lymphoedema Practitioner for assistance/treatment when this is required.
  • Venous insufficiency and/or fragility of blood capillaries should always be considered as a possible trigger for oedema and lymphoedema look-alike conditions. Even after testing not all conditions show positive to all investigative procedures. A combination of small and seemingly insignificant adverse conditions may be contributory towards causing a high protein oedema and the consequential overload of a lymphatic system causing swelling, pain and discomfort.
  • For assistance with diagnosis look at family heredity; have there been other family or extended family with varicose veins, swollen legs, swollen ankles, knees or with not quite normal sizes to limbs or body? These can be good indicators for your diagnosis.
  • Circulatory problems normally respond well to dietary change and vitamin supplementation and can have a major beneficial effect in assisting lymphoedema reduction. See Diet and Lymphoedema for more information on this subject.

Diuretics, Antibiotics & Skin Care for Lymphoedema

Diuretics and Lymphoedema

Diuretics to control lymphoedema are not helpful long term to treat lymphoedema conditions. Diuretics remove fluid but not excess protein from the spaces between the cells of the body which are the cause of a lymphoedema problem.

If using diuretics for lymphoedema control, check with your doctor to see if they are required for other conditions. If not, find out from your doctor whether their use may be reduced over time. Long term use of diuretics to treat lymphoedema will normally exacerbate the problem.

Skin Care & Lymphoedema

Dry broken and cracked skin; tinea between toes or other fungal infection in skin folds can allow opportunistic invading micro-organisms entry to swollen tissues and cause infection. Prevention from infection is best policy. To assist prevention from infection, keep skin moist and supple using a cream (see creams for options) or just use plain sorboline cream daily.

  • To prevent injury, it is well advised to wear protective coverings over a lymphoedema affected limb when performing manual task.
  • Too much sun will exacerbate a lymphoedema affected area as the heat will reduce lymphatic function. Where possible wear suitable clothing for protection and a sun-block cream to prevent sunburn if impossible to do this.

Antibiotics for Lymphoedema

Lymphoedema affected limbs are prone to infection due to elevated protein levels and reduced levels of tissue oxygenation. Ask your doctor for antibiotics to have on hand ready for immediate use should infection become apparent. Always consult your doctor quickly if you suspect or see the signs of infection.

Signs of infection will vary. Unusually elevated temperature of limb and/or whole body and unexplained red coloured skin that may be blotchy or streaky over part or the whole affected limb indicate possibility of infection. In all circumstances if you suspect something is not right, and there is a possibility of infection then you should consult your doctor.

Recording size details for future reference

It is recommended to record measurements of lymphoedema affected limbs and also unaffected limbs for later comparisons prior to beginning treatment. You may not notice differences on a day to day basis. Recorded measures will allow you to plot reductions over time.

  • Measure sheets for arm or legs are in the self massage and bandaging books available for purchase at this website.

5. Optimal Lymphoedema management

There are a few ways to approach lymphoedema reduction;

(a) Hospital & Clinic Lymphoedema Therapy.

Hospital or clinic treatments should perform lymphatic draining massage, followed by bandaging of an affected limb. This treatment provides fast reductions of edema and swelling. You will be required to wear compression garments at completion of this type of treatment. Clinics and hospitals should also be able to provide ongoing therapy such as CPT Lymphatic Draining Massage to assist and maintain reductions of swollen lymphoedema affected limbs.

(b) Treating Lymphoedema from Home;

The website sponsor believes that Home Treatment for Lymphoedema offers the easiest long term and cost efficient option for treatment of lymphoedema. Treatment is similar to that described above. A helper is required for this therapy.

(c) Combination lymphoedema treatment;

A Combination of clinic/hospital treatments and self help at home work well and can give you the additional support and confidence for continued reductions to your lymphoedema affected limb

(d) Cost v Benefit of treating lymphoedema;

The cost of not treating your lymphoedema can result in a reduced capacity for paid work, or early retirement from paid work and subsequent loss of income. Insofar as enjoyment of social and family life is concerned, not treating lymphoedema often reduces your mobility and can reduce your opportunity to participate in many activities that you would like to do and enjoy. The cost of not treating your lymphoedema can have large costs to your income and your daily enjoyment of life.

The benefit of treating your lymphoedema can improve your lifestyle, make you feel less swollen, less conspicuous, let you be more mobile. All these things can make your life easier and more enjoyable. Proactive treatment of your own accord seems a better option than being forced into treatment due to immobility, infection or pain from a lymphoedema affected limb.

Clinic/ hospital treatment and self help home treatment all involve an initial monetary outlay. Provided you are willing to take control of your own lymphoedema condition, with a little help as required, the self help treatment option is normally the most cost effective over time.

6. How are lymphoedema reductions made?

The mechanics of lymphoedema reduction

Optimal Lymphoedema treatment will reduce the size of a lymphoedema affected limb by the use of lymphatic drainage massage, laser therapy, gradient compressive bandaging (in some cases), compression garments, good skin care, diet by eating beneficial foods that will strengthen and improve blood circulation and lymphatic function, and diet supplementation.

Physical lymphatic drainage massage therapy and laser therapy sequentially open a pathway for lymphatic fluid to return to the blood circulatory system via fully operational lymphatic systems in other parts of the body. This ensures there is a pathway available to drain excess fluid away from an affected limb. These two treatments (laser therapy and lymphatic drainage massage), we find, are the most effective pre-cursors to enhance all other parts of lymphoedema therapy.

Where does lymphoedema therapy start

Lymphoedema reduction lymphatic drainage massage and low level laser therapy should always commence near the neck. This therapy will progress in a sequential manner towards the lymphoedema affected limb. First the front of the body (above collar bone, chest and abdomen) will be cleared using massage and/or laser. Then the rear of the body is cleared (shoulders and back). Only after the front and rear of the body is cleared will the affected limb be cleared or treated.

 A Lymphoedema draining massage should last approximately one hour. The majority of massage stokes will be slow in motion and light in touch. A small part of a lymphoedema clearance massage will be firm or hard. The majority of lymphoedema reducing massage movements will be slow and light in touch.

Low level laser therapy in many cases uses a small hand held laser that sequentially treats many different points of the body and is used in conjunction with lymphatic drainage massage.

Clinic, or,  Lymphoedema treatment at Home. The Choices:

For people requiring large lymphoedema reductions quickly, CPT Lymphoedema Therapy performed in a clinic or hospital will normally provide a good result. Reduction of 40-60% of oedema can be expected from treatment taken over a 1-3 week period. The website sponsor provides full clinic lymphoedema therapy treatments and will also follow doctor prepared management plans if/when provided.

Clinic or Hospital Lymphoedema Treatment should include CPT Lymphatic draining massage and Low Level Laser therapy (if available). Immediately on completion of these therapies, gradient compressive bandaging should be applied to the affected limb to retain reductions from the massage. Bandaging also will further assist reduction of the lymphoedema affected limb overnight whilst the limb is bandaged. At final completion of treatment when no further reductions are achievable, compression garments must prescribed, fitted and regularly worn to maintain the reduction.

Home treatment for lymphoedema allows flexibly of treatment times and treatment at a frequency to suit you. The added benefit is treatments are performed in the privacy of your own home.Home lymphoedema treatment  compromises eating beneficial foods, a component of self massage, skin care, gradient compressive bandaging by a carer, low level laser therapy, compression garments and exercises. We strongly encourage all patients to actively eat the most beneficial foods and take food supplements where possible to obtain the best results form treatment.

  • The cost effectiveness of lymphoedema therapy at home is undeniable. Provided there are no additional complications and ongoing therapy is performed, reductions should be sustained and further reduced over time.

7. Diet & Vitamins for lymphoedema assistance

Diet can assist with lymphoedema control. Certain molecules in some foods stimulate the body’s secondary responses which can have positive effect on lymphoedema reductions. More detailed information is available at the diet for lymphoedema page.

8: New Lymphoedema Treatments

In late 2006 the FDA in the USA approved the use of a low level laser for the treatment of lymphoedema. Laser has proved an exceptional new tool for treating lymphoedema.

Other treatments with similar function to the laser are Bioptron/ Polarized light which are quite suited for use with children and Pulsed Magnetic Field Therapy combined with laser therapy.

All these new products are suitable for home use and are provided with personalised instruction for you when purchased from the website sponsor Poppy Lane Skin Care and Lymphoedema Clinic.

9. Conclusion

Lymphoedema occurs for a variety of reasons and has the one common denominator which is; Lymphedema is caused by an insufficient lymphatic system that is not working sufficiently well and allows too much protein to accumulate in the interstitial fluids of an affected body part.

If excess protein causing the condition of lymphedema is removed from a lymphoedema affected limb, the associated swelling and oedema will reduce and the condition can be controlled.