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Lymphedema And Complete Decongestive Therapy

By DR FELICIA ADDERLEY

The month of March – in addition to being March Madness for all the sports enthusiasts – is observed as Lymphedema Awareness Month.

Lymphedema is localised swelling to the body due to an accumulation of lymphatic fluid/lymph. Lymph is a clear (sometimes milky), protein-rich fluid found throughout the lymphatic system. The lymphatic system is part of both the immune and circulatory systems and is responsible to carry lymph towards the heart. Lymph nodes are the small kidney bean shaped glands of the lymphatic system. They are concentrated in the armpits, groin, and under the jaw.

Lymphedema can be classified as primary or secondary. Primary lymphedema is caused by a defect of the lymphatic system at birth that manifests either at the time of birth or later in life (for instance during puberty or pregnancy). It most often affects the legs. Secondary lymphedema often occurs following cancer treatment, most often affecting the arms following breast cancer. As a result of radiation treatment, healthy lymph nodes can be damaged along with the cancerous lymph nodes. If it is discovered that cancerous cells have found their way to the lymph nodes, they may be removed surgically along with other cancerous tissue.

The lymph nodes that remain can often become overworked and burn out, resulting in a backup of lymph fluid in the nearest limb. Imagine if you worked in a department with 20 people and 15 of them went on vacation or were out sick. The work load would dramatically increase for the remaining 5. In the body, this usually results in a swollen limb nearest to the burnt out nodes, but can also affect the face, trunk, abdominal area or genitals.

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Severity of lower extremity lymphedema in different stages.

Complete decongestive therapy is the method used to treat lymphedema. It is a four-part treatment and all components are necessary for optimal results. These include skin care, exercise, manual lymphatic drainage or MLD and compression.

Adequate skin care/hygiene is important in regards to the affected limb. Especially in the intensive phase or in severe cases when the skin is oozing. Pay special attention to keeping the skin well moisturised with an appropriate lotion and watch for cracking as this can lead to infection.

Exercise for lymphedema patients should not be performed with heavy weights as vigorous exercise is not recommended. The appropriate, safe exercises to perform will be outlined by your health care provider and should be performed with either bandages or compression garments in place.

Manual lymphatic drainage is a manual treatment that assists in directing the flow of the fluid towards healthy lymph nodes remaining. It circumvents the lymph nodes that have been removed by surgery or burnt out due to radiation treatment for cancer.

Compression can be achieved by daily bandaging in the intensive phase, then both bandaging and using compression garments in the improvement phase. This is necessary to maintain the reduced size of the limb following MLD. The better the fit of the compression garment, the better it can effectively keep the treated limb at it’s new size.

Following the intensive phase of treatment with a health care professional trained in the area, comes the improvement or self-care stage. By this time the patient should be educated in how to bandage their affected limb and perform a simplified version of MLD, how to care for their skin, have a compression sleeve for daily wear and be compliant with appropriate exercises.

If you or anyone that you know has lymphedema and can benefit from complete decongestive therapy, do not hesitate to contact us at Adderley Physiotherapy at 326-3052. We are here to help you! Feel free to connect with us on Facebook, Instagram, Pinterest and LinkedIn.

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