LYMPHEDEMA is an accumulation of protein-rich lymph fluid in soft tissue in one or more areas of your body. The lymphatic system consists of a series of lymph nodes and vessels throughout your body responsible for filtering lymphatic fluid. Lymph fluid is a regular body waste product that your circulation system does not handle including: protein, water, fats, and cell debris. Lymph nodes filter these waste products and ultimately return the fluid to the vascular system at drainage points.
CAUSES OF LYMPHEDEMA
PRIMARY- caused by malformation of the lymphatic system. They may be present at birth or may develop later during puberty or pregnancy.
SECONDARY- is a result of damage to the lymphatic system. Surgeries, mastectomies, lumpectomies with radiation, and/ or removal of lymph nodes are the most common causes. Other causes may include traumatic injury, infection or sever chronic insufficiency.
STAGES OF LYMPHEDEMA
LATENCY STAGE- unrecognized damage of the lymphatic, no edema yet.
STAGE 1- accumulation of protein-rich edema fluid, pitting occurs, edema reduces with elevation.
STAGE 2- edema persists, skin is thickened, elevating the limb does not reduce swelling.
STAGE 3- complicated swelling with pronounced skin changes, e.g. papillomas, hyperkeratosis, up to very extreme swelling (elephantiasis).
LYMPHEDEMA IS TREATED BY COMPLETE DECONGESTIVE THERAPY (CDT).
CDT incorporates the following:
MANUAL LYMPH DRAINAGE- A gentle hands-on technique that promotes systemic decongestion of deep and superficial lymphatic tissues, mobilizes protein rich fluids towards proximal intact vessels and nodes and helps improve immune function.
COMPRESSION BANDAGING- Involves using a series of padding materials in conjunction with medical bandages that aides in reduction of reflux of mobilized lymph after Manual Lymph Drainage. Compression bandaging increases absorption of lymphatic noads via lymphatic and venous system. It increases the efficiency of musculoskeletal pumps and reverses the presence of lymphatic fibrosis.
HOME EXERCISE PROGRAM- Designed to stimulate lymphatic drainage and decongest the affected extremity(s) through activity in combination with graduated compression therapy. The goal is to activate the muscle pump through targeted exercise and encourage fluid decongestion. An activity program can assist with stress management, weight management, improved strength, endurance, and mobility.
SKIN CARE EDUCATION- Focuses on promoting good skin integrity to reduce risk of skin breakdown and infection.
COMPRESSION GARMENT- Involves measuring and fitting with appropriate compression garments to help with long term lymphedema management. Compression garments include consideration of both daytime and night-time compression needs.