INTRODUCTION ABOUT LYMPHEDEMA

Article Submitted by:

Dr. Jagmohan, Occupational Therapist, Mumbai.

BOT (Kolkata), MOT (Mumbai), Cert. in Nutrition (California)

Contact Mobile N. - 9167170518.    E-mail ID – jlm_therapist@yahoo.co.in

What is lymphedema?

Lymph edema is an abnormal accumulation of high-protein concentrated fluid in the Space between tissues causing inadequate drainage due to damage or blockage in the lymphatic system.

Lymph edema can occur after any cancer or its treatment that affects lymph node drainage. Mostly seen in patients with breast & gynaec cancer.

Up to 90 % of the fluid portion of our blood returns to the heart via the venous system & Remaining 10 % (protein rich fluid), can only return to the central circulation via the lymphatic vessels.

What is Lymphatic system?

Lymphatic system is an integral part of the immune and circulatory systems, which consists of lymph capillaries, lymph fluids, lymph vessels, lymph nodes, lymphatic ducts…etc. Main function of this system is to remove waste & fluid from the tissues.

This lymphatic system is a low- pressure, open, pump less system & Lymph flow process is facilitated by:- - Skeletal muscles contraction, Respiratory movement, Local arterial pulsation, Rhythmic contraction of smooth muscle in walls of the lymphatic vessels, L. trunks & lymphatic ducts & unidirectional valves in L. vessels.

Classification of Lymph edema:-

There are two types of lymph edema, Primary & Secondary lymph edema.

Primary is caused due to congenital deformity of lymphatic system &

secondary is caused by an impairment of the lymphatic system due to cancer with involvement lymph nodes, Surgery (if lymph nodes and lymph vessels are removed), fibrosis in lymph node areas due to radiation therapy & surgery/chemotherapy & infection ( filariasis, cellulitis)…etc

Secondary lymph edema is more common than primary.

Early symptoms of lymph edema:-

Feeling of heaviness, fullness /tightness,Swelling on affected side, Feeling difficulty in fitting clothes, tightness of rings, watch or bracelet, Weakness, discomfort & pain on affected side, Pitting on pressing edematous part…etc.

Lymph edema is manageable easily with complete decongestive therapy, but if patients with lymph edema don’t receive / take / follow /do appropriate therapy, condition will become worse.

Staging of lymphedema:-

Stage 0: -

— - Also called subclinical or latent.

— - Swelling is not evident despite impaired lymph transport, but you may notice a difference in feeling, such unusual tiredness or slight heaviness.

— - Can last for years without obvious symptoms develop.

— - Time in which lymphedema is most likely to respond to treatment

Stage I (mild)

— - Represents an early accumulation of fluid which can temporarily be reduced with limb elevation.

— - There is pitting and the tissue is soft.

—- Can be managed with early treatment & often improves greatly.

Stage 2 (moderate)

— - May be non-pitting and fibrotic.

— - Can be improved with appropriate treatment

Stage 3 (severe)

—- This is the most advanced stage.

—- Tissues are hard and may have cartilage formation developing.

—- Elephantine changes & severe hyperkeratosis

—- Skin folds occur, creases within the folds encourage formation of fungal infection & open wound.

Treatment of lymhedema:-

Complete decongestive therapy (CDT) is primary tool in lymphedema management, which was Pioneered by Dr. Emil Vodder (20.02.1896-17.02.1986) in the 1930s.

CDT consists of four components: - Skin care during activities of daily living,

- Decongestive exercises ,

- Manual lymph drainage massage (MLD)

- Compression therapy including multilayer bandaging & compression garment / stocking.

- Treatment varies depending on the severity of the edema and the degree of fibrosis of the affected limb.

- Goals of treatment may vary with stage of lymphedema. Usually short term goal of CDT is to reduce oedema to prevent further complications.