What is Lymphedema?
Swelling of the arm or leg, sometimes both arms and legs due to the accumulation of the lymph fluid which causes swelling of the tissues is known as lymphedema. This happens due to the prevention of draining of the lymph fluid either due to blockage or removal of the lymph nodes. The swelling can range from mild to quite severe. Lymphedema cannot be cured, but with proper therapies and treatments, can be managed well enough.
Lymphatic system of the body runs alongside the blood circulatory system and consists of the lymph nodes, lymph glands and lymph vessels. The excess blood gets filtered into lymph vessels and becomes lymph which mainly consists of proteins, lipids and White Blood Cells (WBCs), which in essence means all the blood parts except Red Blood Cells (RBCs). Lymphatic system of the body helps in getting rid of the waste products, fighting infections etc. Eventually the lymph is returned back to the bloodstream. The blood circulatory system and the lymphatic system work in a synchronized and balanced way with each other.
Lymphedema occurs when the lymphatic system gets blocked for some reason.
Treatment of breast cancer is considered the most common cause of lymphedema especially in the United States of America. It may take lymphedema a few to many years to manifest after cancer treatment is done.
Types of Lymphedema
Lymphedema is actually of two types viz. primary lymphedema and secondary lymphedema.
Primary lymphedema is an inherited condition and is present at the time of birth or developed at the time of puberty. It may even develop late into adulthood. It is a very rare condition in which there is an anatomical defect in the lymph vessels.
Secondary lymphedema occurs when an injury, damage or blockage occur to the lymph vessels during the life of an individual. It may occur due to a disease called filariasis which is a parasitic infection or due to a cancer surgery especially in breast cancer. The chances of secondary lymphedema increase if the surgery is followed by radiation treatment.
Signs and Symptoms of Lymphedema
Signs and symptoms of lymphedema include mild swelling in the extremities which is barely noticeable to really advanced swelling causing the disfigurement and discoloration of the affected limb. Some of the signs and symptoms of lymphedema include the following:
- Signs of lymphedema include swelling of the limbs and edema.
- The feeling as though your clothes, jewelry and wristwatch are too tight is one of the signs of lymphedema.
- Reduced flexibility of your joints especially your wrist and ankles is also one of the symptoms of lymphedema.
- If you cannot feel or see the veins and tendons in your limbs that can also mean you are suffering from lymphedema.
- Patients suffering from lymphedema can also feel pain from various other secondary complications such as pressure developed due to accumulation of the fluid, restricted blood flow, musculoskeletal disorder etc.
- Lymphedema can cause redness in the skin, puffiness and discoloration in the limb which has swelled.
- Hyperplasia or increased tissue growth due to an increase in the growth and division of the cell is also a symptom of lymphedema.
- Another symptom of lymphedema is hyperkeratosis or the thickening of the uppermost layer of skin due to an increase in the production of keratin which is actually the protein present in nails and hairs.
- Papillomatosis is a condition which refers to an elevation in the skin surface making it look uneven and undulating under a microscope and is caused by papillary projections of the epidermis layer. It is also one of the signs of lymphedema.
- Ulcers on the skin surface can also be an indicator of lymphedema.
Causes of Lymphedema
The causes of primary lymphedema are not yet known. It usually occurs due to poorly developed, defective or missing lymph nodes or any other part of the lymphatic system.
Secondary lymphedema can occur due to any one of the following reasons:
Surgery is one very common cause of lymphedema. Lymph nodes can get damaged, injured or removed during surgery,which can result into lymphedema. For example lymph nodes are removed during breast cancer surgery to check the spread of the cancer.
Cancer can also cause lymphedema especially if the cancer is present near the lymph nodes. The cancerous growth of the cells can block the flow of fluid in lymph vessels resulting into lymphedema.
Radiation Treatment of Cancer
Radiation therapy to treat cancer can also cause lymphedema. Radiation can cause the lymph vessels and nodes to become inflamed or scarred which can cause retention of the lymph fluid causing lymphedema.
Infections can also cause lymphedema such as filariasis also known as elephantiasis which is an infection caused by a parasite which causes swelling in the legs making the limb look similar to that of an elephant, hence the name. It can also be caused by cellulitis which is a bacterial infection occurring in the inner layers of the skin and may involve lymph vessels.
These kinds of infections usually occur in developing countries especially those which are present in tropical and sub-tropical regions.
Occurrence of lymphedema has also been associated with the use of the drug tamoxifen. Use of this drug can cause the formation of blood clots and Deep Vein Thrombosis (DVT) which can lead to lymphedema.
Diagnosis of Lymphedema
Diagnosis of lymphedema is usually done on the basis of a visual exam. Color, presence of hair, visible veins, size and any sores or ulcerations are taken into account while doing an exam. As the lymphedema progresses the affected limb is measured in size and circumference etc. to the unaffected limb. That is why early diagnosis of lymphedema is difficult as there is not much difference between the limbs in the early phases of lymphedema. It is mostly just reduced flexibility and tightness of the limbs that indicates anything out of the ordinary.
Bioimpedence is another process that is used to diagnose lymphedema and it is the most efficient and sensitive method as it measures the amount of fluid present in a limb. Before diagnosing the problem as lymphedema, other potential problems which could lead to similar symptoms should be ruled out.
Treatment of Lymphedema
Treatment of lymphedema most commonly involves a combination of various treatments depending on the severity of the condition. Although a combination treatment is most ideal, treatments could be used individually too. Some of these treatments are as follows:
Complete Decongestive Therapy
Complete congestive therapy consists of manual manipulation of the lymphatic ducts, short-stretch compression bandaging, therapeutic exercise and skin care. Lymphatic ducts are manually manipulated by giving them a gentle and rhythmic massage. This helps in getting rid of theaccumulated lymph fluid by stimulating it to return to the blood circulation system. A session of complete decongestive therapy usually takes anywhere from 40 to 60 minutes.
Compression of the affected limb can also help in managing lymphedema. Any or all of these following compression techniques could be used or compression:
Elastic compression garments such as compression sleeve is worn over the affected area to reduce the swelling and cause reduction of edema after complete decongestive therapy.
Wrapping layers of short stretch bandages and padding over the affected area is called compression bandaging or wrapping. Short stretch bandages are used instead of long stretch bandages because they are able to produce proper therapeutic tension which reduces lymphedema.
Intermittent Pneumatic Compression Therapy
In intermittent pneumatic compression therapy, a multi-chambered pneumatic sleeve is used which has various overlapping cells. This helps in moving the lymph fluid.
Regular exercise which includes resistance training and other forms of exercise helped in reducing edema in some patients. Compression garments and bandages should always be worn while exercising.
Several surgical procedures are also available to patients suffering from lymphedema. These surgical procedures provide long-term solutions.
Low Level Laser Therapy
Low level laser therapy was also found to be useful in reducing swelling in lymphedema patients. It was cleared by U.S. Food and Drug Association in 2006 to be used as a treatment for lymphedema.
Some Precautions for Lymphedema Patients
Here are some precautions for lymphedema patients which can help in keeping it under control. It can even help people who have had radiation treatment for cancer from getting lymphedema if they follow it diligently.
- Protect the area around the surgical wound from injury even if you have had surgery a long time ago.
- Do not let doctors draw blood from the arm which is on the side of the lymph node surgery.
- Do not let anyone place a blood pressure cuff on that arm as well.
- Use an electric shaver for underarms hair removal if you have had a surgery of lymph node removal from your arm.
- Protect your hands and arms from cuts and injuries after the surgery as well.
- If you have had a surgery for lymph node removal from your groin, make sure you wear comfortable pantyhose and shoes.
- Avoid stockings and garters.
- Soaking your feet in lukewarm water daily, using a mild soap and moisturizer will also help if you have had a groin lymph node removal. Do not use hot water for bathing your feet.
- Use sunscreen and insect repellant to protect yourself from insect bites and the sun.
- Treat your injuries and cuts exactly as your doctor instructed you to do.
- Wear compression garments that fit you exactly right as ill-fitting garments can make the swelling worse than before.
- Use a compression garment if you are travelling by a plane as change in pressure during air travel can increase the swelling.
Contact a physical therapist who has some expertise in treating lymphedema. It is better if your doctor refers you to him so that you can get insurance claim. Most insurance companies don’t pay for physical therapies unless a doctor refers to them.
Contact your doctor immediately if you observe any of the above mentioned symptoms and signs of lymphedema.