Lymphadema Still Underdiagnosed

Here's an article that came out recently in the amednews.com - the newspaper for america's physicians. Hopefully this will alert some doctors to recognize lymphedema in their patients and to help them get proper care.

Lymphedema no longer rare, still underdiagnosed

Washington -- Trained in family practice medicine, Caroline Fife, MD, didn't know what she was getting into when she decided to begin treating people with lymphedema.

She was operating a wound clinic at Memorial Hermann-Texas Medical Center in Houston and was receiving calls from people seeking relief for their swollen limbs. They seemed to have nowhere else to go. So she thought, "How hard can it be? I know a lot about leg swelling."

"Never say that," she cautioned. About nine years ago, she hired a part-time therapist for the clinic. Within a year she had eight therapists. "Patients came out of the woodwork."

She's been treating patients with lymphedema ever since, and she's had to reach out to others to learn how best to do so. "I had one lecture on the lymphatic system in medical school. [Lymphedema] seemed so rare I thought I would never need to know about it."

"It's an ignored field of medicine," said Saskia Thiadens, RN, the executive director of the National Lymphedema Network, based in Oakland, Calif., which she founded 20 years ago. "I would say that of the majority of patients who go to see their primary care physicians, the chances that he or she will be diagnosed are pretty slim."

Many patients are misdiagnosed for years, said Andrea Cheville, MD, associate professor of physical medicine and rehabilitation at the Mayo Clinic in Rochester, Minn. When diagnosing a patient with a swollen leg, for example, physicians tend to think, "Is it the heart? Is there a blood clot? Is there a tumor in the abdomen? Often patients get an echocardiogram. They will get an ultrasound of their leg and a CT scan of the belly. If those are negative, many times they are told, 'Well, this is nothing that is going to kill you. Aren't you glad? Good-bye.' "

Yet it's not so unusual to see patients, both men and women, with swollen limbs caused by a slowdown in the lymphatic system, which serves as an extensive drainage network to maintain the proper body fluid levels and defend against infections.

The numbers of people affected by the condition are difficult to come by. Estimates range from 35% to 45% of women treated for breast cancer -- a large number in itself considering that about 2.4 million women alive today have had breast cancer, according to the Centers for Disease Control and Prevention. This population is more commonly affected, since lymph nodes may be removed during treatment, thus slowing the entire system.

The lymphedema network has had a patient questionnaire on its Web site since 2001. Respondents are about equally divided as to whether they have primary lymphedema, which is congenital; or secondary, which seems to be due to a trauma, such as surgery.

But even that distinction has blurred as researchers are beginning to understand that everyone's lymph system is not created equal, Dr. Fife said. One person may have a fantastic drainage system that can continue to function well despite a huge assault, such as a radical mastectomy. Another person's system may be less robust and be disrupted by a minor injury.

Regardless, any slowdown can lead to the pooling of lymph and its cargo of protein molecules, salts, glucose, urea and other substances. The system carries several liters of fluid a day. An obstruction could result in tremendous amounts of fluid building in the body.

Another consequence of obesity

The rise in obesity is also contributing to the numbers of lymphedema patients. Ten years ago Dr. Fife didn't have any patients who weighed 500 pounds. Now, 2% or more of her patients are at this weight or heavier.

Why morbid obesity leads to lymphedema is unknown, but one theory is that fat may block the system. "So as everyone gets fatter, we have more lymphedema," Dr. Fife said.

Once a swelling has occurred, avoiding any stress on that body part is essential for preventing recurrences. Patients who have had lymphedema should not have a blood pressure cuff wrapped around the affected limb, or have injections or blood draws, Thiadens said. Go to the opposite arm or the leg.

Although there is no cure, controlling the swelling is important. Swelling can become permanent and cause irreversible limb distortions. In addition, other skin conditions can develop, including cellulitis. Plus, the body's defenses are impaired. One of Dr. Fife's patients, for instance, reads meters for the gas company. While tramping through backyards all day, he is bitten by mosquitoes and fire ants, and those bites often lead to infections and hospitalizations.

Treatment for lymphedema is a gentle massaging technique, called manual lymphatic drainage, which encourages lymph flow. Once a limb is reduced to near-normal size, efforts switch to compression bandages and garments to keep the swelling down.

Although lymph flow maps, complete with roadblocks, have not been available for years -- an earlier mapping technique had been painful and dangerous and was abandoned -- promising research is under way at Baylor College of Medicine, Houston.

Fluorescent dye is injected just under the skin, picked up by the lymphatics and transported throughout the system, said Eva M. Sevick-Muraca, PhD, professor of radiology at Baylor and principal investigator for the study. Its path is illuminated by shining near-infrared light on the skin. The light can penetrate several centimeters of tissue.

The technique, developed with funds from the American Cancer Society and the National Institutes of Health, has been tested in a phase I trial with normal subjects because, "We don't even know what normal lymph flow looks like," Dr. Sevick-Muraca said.

Researchers are beginning to test the system on lymphedema patients, specifically attempting to determine if lymph flow is enhanced by massage. "We image before, during and after the massage and see if the lymph is being pushed into the correct nodal basin," she said.

By Susan J. Landers, AMNews staff, 2007.

ADDITIONAL INFORMATION:

Lymphedema alert

Certain factors can lead to the development of lymphedema and may provide alerts to the cause of swelling in the arms, legs or other body parts. No diagnostic tests are available, but risk factors include:

• Breast cancer, if the patient received radiation therapy or had lymph nodes removed. Radiation therapy to the underarm area after surgical removal of the lymph nodes. Having a larger number of lymph nodes removed increases risk.
• Surgical removal of the lymph nodes in the underarm, groin or pelvic region.
• Radiation therapy to the underarm, groin, pelvic or neck regions.
• Scar tissue in the lymphatic ducts or veins and under the collarbones, caused by surgery or radiation therapy.
• Cancer that has spread to lymph nodes in the neck, chest, underarm, pelvis or abdomen.
• Tumors growing in the pelvis or abdomen that involve or put pressure on the lymphatic vessels and/or the large lymphatic duct in the chest and block drainage.
• Having an inadequate diet or being overweight may delay recovery and increase the risk for lymphedema.

Source: National Cancer Institute

I found another interesting article about a device to test for lymphedema before it becomes severe, and is associated mostly with post-breast cancer surgery. It seems like a very interesting device, and hopefully does help some people.

New Devices May Improve Life After Breast Cancer

Last Edited: Friday, 09 Nov 2007, 7:46 PM CST

Created: Friday, 09 Nov 2007, 7:46 PM CST

Many women survive breast cancer only to face another challenge: terrible swelling in an arm that doesn't go away. It's called lymphedema. Two new devices are helping by diagnosing early and treating it. Deborah Murphy is battling a recurrence of breast cancer, but that's only one of her battles. "It's very hard," Murphy said. "You have to take one day at a time and just focus on one thing at a time." The Grandview woman also has a very swollen, heavy left arm. It's lymphedema, and it can result from cancer surgery or radiation treatment. The arm's lymphatic or drainage system is damaged and fluid builds up. There's no cure although layer upon layer of wrapping helps control it. Now there's a device that may help save other breast cancer patients from severe lymphedema. "I'd like to catch it early so if there's a small change, we'll be able to know before it gets out of control," Anise Sewell, a breast cancer patient, said. The device is an impedance analyzer. "It's an electrical current that travels up through the body and measures the resistance of the flow of the fluid in the limb," Cheryl Morgan with Integrative Therapy Concepts said. Morgan said by checking patients before they have cancer treatment and periodically as they're treated, lymphedema can be caught before there are visible signs. And if trouble is caught early, all the patient needs to do is wear a compression garment to prevent swelling. It's too late for the analyzer to benefit Murphy, but another device may. It's a cold laser. In one small study, a third of those who had the laser treatments saw a significant reduction in swelling. Breast cancer patients typically are told to measure their arms regularly to check for signs of swelling. The impedance device may be more effective in detecting lymphedema early. For more on lymphedema, go to www.lymphology.org. The American Society of Lymphology will hold its annual meeting in Kansas City November 26-28. It's for professionals and patients. Meryl Lin McKean, FOX 4 News

Coping for HOW LONG?

Here is a reprinted article from the Columbus, Georgia's Ledger-Enquirer. If you suffer from Lymphadema it probably isn't telling you anything new, but I was happy to see an article out there educating the general public and maybe helping someone who doesn't know what's wrong with them.

Lymphedema sufferers must cope for a lifetime

BY BORDEN BLACK

Special to the Ledger-Enquirer

------

Lymphedema is one of those little-known conditions that doesn't spark telethons or poster children. It is life-altering, however, and can dictate lifestyle. I should know. I've had lymphedema since the lymph nodes in my legs were removed following cancer surgery.

About lymphedema

The lymph system has been described as the sewage system of the body. Waste products, bacteria, dead cells and large protein molecules are transported in lymph from tissue to the nodes where they are broken down and eliminated. When the system is broken, abnormal accumulation of protein-rich fluid can accumulate, usually in an arm or leg. This results in swelling in the limb and thickening of the skin known as lymphedema. The condition can be painful and disfiguring and can result in infections, depression and decreased mobility.

While primary lymphedema occurs at birth, secondary lymphedema is the result of damage to the lymphatic system. It is the most common form of lymphedema, and frequently occurs in cancer patients. Dr. Kathleen Francis, Medical Director of the Barnabas Lymphedema Treatment Center in Livingston, N.J., points out that if the lymph nodes in the armpit area are removed or radiated as a result of breast cancer treatment, it can lead to lymphedema.

She was among the doctors, therapists and patients who gathered in Atlanta recently for a conference sponsored by the Lighthouse Lymphedema Network. The nonprofit support organization was formed by Joan White, who developed the condition as the result of appendicitis. The idea for the organization grew from a discussion around her kitchen table in 1994. She points out that quality of life is a huge issue for those with the condition, many of whom have survived cancer only to find that they must continue to spend a great deal of time and energy dealing with the resulting lymphedema. The need for support, advice and awareness led to formation of the network.

The problems

Dr. Paula Steward, Medical Director of Lakeshore HealthSouth Rehabilitation Hospital in Birmingham, Ala., explained the problem faced by those suffering from lymphedema by quoting Dr. Robert Lerner: "In the past physicians played down the importance of lymphedema and pointed out that it is rare, that there is no effective treatment and that the patient must learn to live with it... . They have failed to instruct patients on how to avoid lymphedema... and continue to grossly understate the incidence of this serious and lifelong illness." She points out that correct diagnosis is essential in providing effective treatment.

Several other conditions, including inflammatory arthritis and post-phlebitic syndrome, have similar symptoms so accurate tests are needed for proper diagnosis. Currently, ultrasound, magnetic resonance imaging and computed tomography (CT) are used, but a diagnostic tool being employed in Europe is seen as the best option. Dr. Waldemar Olszewski, a world renowned expert in lymphedema, came from the Polish Academy of Science Hospital in Warsaw to discuss with conference attendees isotopic lymphoscintigraphy. The procedure has yet to be approved for use in America, but according to Olszewski: "It is necessary for the establishment of rational therapy."

Once correctly diagnosed, the lymphedema patient faces a lifetime of treatment because there is no cure. Swelling can be managed through a specialized massage technique known as manual lymphatic drainage, by using compression garments and bandages daily, by engaging in regular exercise and maintaining meticulous skin and nail care.

White points out that in many cases physicians are not acquainted with treatment for the condition and patients get most of their information from massage therapists. In fact she says often patients with swelling are diagnosed by therapists. Another difficulty according to White is the failure of insurance companies to pay for therapy or compression garments.

Solutions

Although there is no cure, Dr. David Feingold told those attending the Lighthouse conference that genetics may be the answer. "How do you generate new lymphatics?" That is the question being examined by the genetic researcher. Three genes have been identified, and experiments are under way.

Until an answer is found, awareness and education are the focus of the Lighthouse Lymphedema Network. A bill has been introduced by Georgia state Rep. Debbie Buckner. The house bill provides for a pilot program to test and evaluate a system of coverage for costs associated with the prevention and treatment of lymphedema and to provide for data collection.

The Atlanta organization has also set aside Oct. 22 as Lymphedema Awareness Day in Georgia.

Although awareness is growing, White points out that it is still "an image thing" and many of those with the condition are reluctant to go public and as a result there is still a lack of emphasis.

Last night at Wal-Mart my daughter and I were on our way to the checkout lane when one of the cashiers stepped out and offered to check us out right away. I noticed that her legs were bandaged to her knees. I could tell because she was wearing pedal pusher type pants (I'm no fashionista, so I don't know the proper name for pants that aren't shorts but aren't just high-waders). I looked back to my daughter and whispered excitedly at the same tiime she was whispering to me, "She has LYMPHEDEMA!"

I've seen women with compression sleeves before, but I've never seen anyone with compression leggings or bandages on. I was just so excited to not be the only one. To see someone with Lympahdema just working and living and coping. I didn't say anything to her about it because my daughter thought it would be better not too. I guess I didn't want to be all weird and ask her some personal question that maybe she didn't feel like discussing with a perfect stranger. She made my night though. I know that I'm not the struggling alone.

I found this cool site! For anyone with lyphadema in their arms this seems like a really great way to manage it and still look "cool." They don't have anything for people with lymphedema in their lower extremeties yet, but they're working on it. I know I can't wait to see what they come up with for legs! And I love the idea of "Lymphediva" - I'm jealous I didn't think of it first! Go there and check out their awesome stuff: http://www.lymphedivas.com/

Their mission statement says: LympheDIVAs™ LLC is dedicated to creating medically correct fashion: compression apparel for the savvy and stylish breast cancer survivor with lymphedema, which will inspire her to feel beautiful, strong, and confident.

News Flash: Lymphedema Sucks!

Here's an article I ran across recently regarding aromatherapy and lymphedema. Right now I'm willing to believe almost anything. I know I haven't really discussed my own struggle with Lymphedema, mainly because I can sum it up in two words: IT SUCKS! I have primary lymphedema in both legs. I have gone for physical therapy and had the Manual Lymph Drainage massages (as much as my all knowing insurance would allow, but that's a story for another day). I currently use both the compression wrapping and I have CircAid Leggings

I've had this problem all my life, and it's slowly worsened over time. I have asked doctors about it MANY times, all of them either prescribed diuretics, which do nothing, or they have not really done anything because I don't think they've known what to do. I don't think most doctors know what lymphedema is. Anyway, I finally found a doctor who recognized it, and sent me to physical therapy this past summer.

I've now been in treatment for about 3 or 4 months and I don't feel I've made any permanent progress. The bandages help my legs to reduce, but when I take them off to shower, my legs swell right back up. I swell up so quickly that it's just discouraging. I know they tell you that you can't cure lymphedema, you can only manage it - well I guess I just don't feel that I'm managing.

The CircAids are not comfortable; the foot wrappings make my feet too big to fit into my regular shoes. I was wearing larger shoes, but they're hard to walk in and I'm always tripping and walking funny. I feel even more like a circus freak. They're hot, they're a pain in the butt to put on and take off, I had to pay almost a thousand dollars for them because my insurance doesn't cover their cost - because Lymphedema isn't recognized as a problem I guess. I don't know. I'm just feeling discouraged, miserable, and wishing that I could just sniff some tangerines and be all-better! whee...

Anyone have any better ideas?

October 17, 2007 - Irene Spedaliere usually comes out smelling like a rose — literally. The Streetsville businesswoman owns Mohani Bay, an aromatherapy store and custom blending bar that offers her customers a wide range of body washes, soaps, shampoos and scrubs made from pure essential oils extracted from plants and known for their healing properties.
An aromatherapist with a pharmaceutical background, Spedaliere recently came up with a novel way to contribute to breast cancer research. She concocted a blend of essential oils to make shampoos and conditioners, body washes and scrubs, all in support of Rethink, a Toronto-based breast cancer support group. October is national breast cancer awareness month.

The products made from that blend, also named Rethink, are available only until the end of October. Proceeds from sales go towards breast cancer research. Spedaliere said she took four blends along with some 40 essential oils to be tested by women at Rethink, and asked them to select one. She tweaked the formula a little. The final blend, chosen by the women, most of whom have been touched by cancer, was a winner. “It so happens, the blend they chose contained sweet orange and tangerine, both of which are good for the lymphatic system,”

Spedaliere said. “A lot of breast cancer patients have lymphedema, which is swelling of the lymph nodes, and these oils help with that. The blend they selected also had lavender, which is a natural anti-depressant, along with cinnamon and clove, which aid circulation and are antiseptic, so it all works well together.

“I want to promote natural, healthy living for everyone,” she added.
Spedaliere said aromatherapy can help combat both physical and mental conditions to alleviate stress.

Having spent most of her career as a pharmacy technician at Toronto's Bayview Clinic, Spedaliere saw first-hand the effects of cancer on women.

For more details, visit www.mohanibay.com.
from: The Mississauga News, written by: Radhika Panjwani

Voices of Lymphedema - the Silent Epidemic

Lymphedema, or chronic swelling due to lymphatic fluid, affects 3-5 million Americans including 20-40 percent of cancer survivors. Lymphedema is so little known -- even among doctors -- that it has been called a 'silent epidemic.' "Voices of Lymphedema" breaks this silence as patients and therapists share their experiences and their wisdom.

San Francisco, California (PRWEB) October 8, 2007 -- Lymph Notes has published an exciting new book "Voices of Lymphedema: stories, advice, and inspiration from patients and therapists" in which 80 patients and therapists share their stories and tips for living well with lymphedema.

Chronic swelling caused by lymphatic fluid, or lymphedema, affects 3-5 million Americans including 20-40 percent of cancer survivors, and yet most people have never heard of it and many doctors can't diagnosis it. Untreated lymphedema can be painful, disfiguring, disabling, and deadly. There is effective treatment that can break the cycle of repeated infections and reverse lymphedema-related disability but many doctors consider the condition to be untreatable. Medicare and other payment plans may not cover any or all of the costs of treatment.

Voices will raise the profile of lymphedema while providing practical advice and comfort for those with, or at risk for developing, this chronic condition. This book features advice on getting a diagnosis and finding treatment, solutions to common problems and practical tips on self-care, information on activities and travel, support groups and outreach to the medical community, and issues in treatment coverage and reimbursement.

Stories include: How AZ lost hundreds of pounds in his leg and regained his mobility after being bed-ridden for 30 years; How Francis was able to control her swelling, break the cycle of repeated infections and hospitalizations and return to a normal life.

"An excellent resource for lymphedema patients, therapists, and other health care practitioners. It's a book that should be required reading in all schools that turn out healthcare providers."
Kathryn McKillip Thrift, BS, CLT-LANA

Book Details
Title: Voices of Lymphedema: stories, advice, and inspiration from patients and therapists
Authors: Edited by Ann B. Ehrlich and Elizabeth McMahon, PhD, Foreword by Calina Burns
ISBN 13: 978-0-9764806-5-5
Price: $24.95 paperback

About the Editors
Ann Ehrlich and Elizabeth McMahon are coauthors of Living Well With Lymphedema (Lymph Notes 2005). Ann is a professional medical writer and breast cancer survivor with secondary lymphedema. Elizabeth is a clinical psychologist and author of Overcoming the Emotional Challenges of Lymphedema (Lymph Notes 2005).

About Lymph Notes
Lymph Notes publishes high quality health information in print and online. www.LymphNotes.com is an online information and referral resource and an online support community for those with lymphedema, their family and friends, and the healthcare professionals who treat them.

Media Contact:
Ann Ehrlich, editor
Ann@LymphNotes.com

For review copies and cover images please e-mail Sales@LymphNotes.com

Source: PRWeb: Industry Healthcare

Lymphadema Research Funded

I just found out about this campaign and I think it's awesome! I'm all about supporting research to cure breast cancer and I appreciate that they recognize Lymphadema as a separate problem that needs research focused towards it. I don't know anyone personally that sells Longaberger Products, but here's a link to their company http://www.longaberger.com

The Longaberger Basket Company announced that it has broadened its 2007 Horizon of Hope fundraising campaign by extending it through September and making Horizon of Hope products available online nationwide.

For the first time, the campaign -- which historically has run from July through August -- will continue through September 30.

Proceeds from the sale of Horizon of Hope products go to breast cancer research and awareness programs of the American Cancer Society.

Since the launch of the campaign in 1995, Longaberger, its Home Consultants and the American Cancer Society have partnered to raise more than $12 million and reach an estimated 19 million women with potentially life-saving information.

Each year, The Longaberger Company designs a special basket sold exclusively during the campaign. With every purchase of a Horizon of Hope product, $2 goes to the American Cancer Society for programs aimed at:

• Improving the quality of and access to mammography services.
• Improving breast imaging quality standards.
• Improving the quality of clinical breast examination.
• Improving the quality of life for young survivors and women with breast cancer recurrence.
• Lymphedema research. Lymphedema is a chronic and debilitating swelling of the arm caused by the destruction of the lymphatic vessels during the removal of lymph nodes or damage to them by radiation therapy. It is a possible side effect of breast cancer treatment.

Horizon of Hope was established in 1995 to raise funds for breast cancer research and education and to reach out to millions of women with helpful information about the importance of early detection. For more information about Horizon of Hope please visit http://www.HorizonOfHope.com.

To learn more about breast cancer and the importance of early detection, visit the American Cancer Society at http://www.cancer.org.

Founded in 1973, The Longaberger Company is America's premier maker of handcrafted baskets and offers a variety of other home and lifestyle products, including pottery and other tableware, wrought iron, fabric accessories, jewelry, handbags and specialty foods. There are approximately 45,000 independent Home Consultants located in all U.S. states who sell Longaberger products directly to customers.

March 6 is Lymphedema Awareness Day in NJ

New Jersey recently passed, "Three bills and a resolution sponsored by Assemblyman Eric Munoz, MD, that provide for the protection and health of New Jersey’s children and raises awareness about a debilitating condition, were signed into law Monday by Governor Jon Corzine.

Munoz, a well respected medical professional, advocates for the health and well being of student athletes and others suffering from debilitating conditions.

“With the passage of SJR-31/AJR-99, we will also shed light on the plight of those who suffer from Lymphedema, a very painful and devastating condition” said Munoz. “Those of us who enjoy good health often don’t realize the obstacles faced by individuals suffering with a debilitating condition like Lymphedema."

SJR-31 (AJR-99)-– Designates March 6th of each year as “Lymphedema Awareness Day” to raise awareness about the treatment needs and severity of lymphedema and to honor lymphedema patients. Lymphedema is a debilitating and intensely painful condition that causes swelling in the arms, legs and other areas of the body. It may result in disfigurement and has the potential to cause severe infections or loss of limbs.

Four Munoz-Sponsored Bills Signed into Law
By scmysak - August 7, 2007 - 3:51pm
http://www.politicsnj.com/four-munoz-sponsored-bills-signed-law-10810

This is really fantastic! I think we should all write to our senators and congresspeople and have March 6 declared "Lymphedema Awareness Day" in every state in the nation. If we do that, maybe the insurance companies will wake up and realize that Lymphedema is a serious medical condition. I find it frustrating right now that my insurance won't help pay for my physical therapy or compression garments, but if I lose my ability to walk, they will pay for a wheelchair! What kind of sense does that make? It's sad to see that there are people that need help but it's the insurance companies, and not necessarily their doctors, who decides what help they get! Crazy.

http://www.visi.com/juan/congress/

http://www.senate.gov/general/contact_information/senators_cfm.cfm

Don't forget to wear your blue lymphedema ribbon to raise awareness - there's a link at the bottom of the page if you need to get one.

Lymphedema Causes

First of all it’s important to know that lymphedema is one of the most misdiagnosed diseases in our world today. Because other diseases such as chronic edema have similar symptoms, many of the people who suffer from lymphedema don’t even know it. So what can cause lymphedema?

Primary Lymphedema can develop at any stage during the patient’s life. It can be present at birth (milroy’s), develop at or around puberty (praecox) or even in adulthood (tarda). Each of these instances stem from unknown causes or have been associated with vascular anomalies. Some anomalies would be hemangioma, lymphangioma, Klippel Trenaury and Port Wine Stain. Because the causes of primary lymphedema are neither exact nor fully understood, diagnosing this disease is often delayed or overlooked in the patient’s life.

Secondary Lymphedema can occur as a result of many different things. It is also referred to as acquired lymphedema because there is an event that has caused the lymphatic vessels to be damaged or impaired or the lymph nodes to be removed. Some of the causes can be but are not limited to surgery for cancer, (breast, head and neck, prostate, gynecological, bladder or colon) radiation therapy, chronic venous insufficiency, filiarisis, cellulites/lymphangitis, abdominal surgeries, joint replacements, rheumatoid arthritis, vascular surgeries and even traumatic injuries. All of these causes can either appear immediately or weeks, months and even years later.

Any part of the body or limb(s) can develop lymphedema. Remember that it is a dysfunction in the lymphatic system so any part of the lymphatic system can experience these problems and result in localized lymphedema. Recognizing lymphedema in its early stages is the best way to manage and handle the issue before it gets out of hand. Early detection and treatment will improve both the prognosis and condition. Some symptoms to look out for are persistent swelling in any limb or area of the body, tight skin in a specific area, decreased flexibility in the wrist, ankle or hand, difficulty in wearing clothing in one area of the body. It is vitally important that if you experience any or all of these symptoms you seek expert medical advice immediately. It is also a great idea to get at least one other opinion.

Manual Lymph Drainage

Manual lymph drainage is a type of light massage that uses gentle strokes (almost as light as a butterfly caress) on the skin, since the lymph vessels are right underneath the surface. The lymphatic system works with the immune system to help cleanse the body and stave off infections. Lymph originates in the spaces between the cells, consisting of interstitial fluid and waste products from cellular activities. The fluid flows to the more than 600 lymph nodes of the body for processing. The nodes filter bacteria, dead cells, along with other toxins and they also produce white blood cells. The lymphatic organs of the body, such as the thymus gland, spleen, tonsils and lymphocytes support important immunological functions. If the lymph system slows down or backs up, excess fluid may cause swelling called lymphedema, a potentially serious complication.

Manual Lymph Drainage was started in the 1930s by Dr. Emil Vodder working with his wife, Estrid, in Europe. They were both massage therapists. Many of their clients had colds and a common denominator was swollen lymph glands in their necks. The Vodders began systematically working on the nodes with success, the swelling dispersed and the colds were alleviated. Vodder was the first to coin "manual lymph drainage" and is considered the originator of the practice. His first publication appeared in Paris in 1936. He and his wife gave lectures, demonstration treatments and taught courses. Since then two other approaches to “MLD” have come about. One type was formed by an osteopathic physician, Eyal Leaderman; another style is taught through the Upledger Institute in Florida by Bruno Chickly.

Lymphatic massage helps keep the system working properly and combined with water intake makes for an effective detoxifier. MLD has an effect on the body as a whole and sessions impact can be similar to deeper kinds of massage. Quicker transport of waste and faster processing helps keep the body on guard. People have found MLD useful for inflammation, recent injuries such as an ankle sprain, sinus problems and congestive conditions. Lymph passages can be damaged and swell after surgical operations.

A mastectomy after breast cancer, where some breast tissue and the lymph nodes under the arms are removed, is one of the most common causes of lymphedema. Up to 15 percent of women are likely to get scar tissue that stalls the lymphatic flow. According to the National Lymphedema Network, a risk of lymphedema is present anywhere from hours to decades after the procedures.

Medical professionals practicing MLD are physical therapists and occupational therapists along with their assistants, massage therapists, aestheticians, nurses and medical doctors. In conjunction with MLD, compression garments, bandaging, diet control, skin care, and condition-appropriate exercise are used. Some contraindications are congestive heart failure, kidney failure, or kidney dialysis unless specifically ordered by a physician. It is vitally important that if you are having problems with lymphadema that you consult with a qualified professional who has training in lymph drainage.

Lymphadema Treatment

Treatment of Lymphedema

Although lymphedema may have different causes, the treatment for all types is the same

Unfortunately, there is no cure for lymphedema. Treatment for lymphedema focuses on minimizing the associated symptoms. When a person is afflicted lymphedema, they should speak to their doctor, who will advise the most beneficial methods of treatment. If your doctor initially is hesitant to recommend treatment, I encourage you to persist. Lymphedema is an under-recognized problem that slowly and insidiously develops into a worse and worse problem. Getting treatment as soon as possible will greatly increase your quality of life!

The following are all methods of treatment a person can pursue:

• Gentle exercise, such as squeezing the muscles, which may help fluid in the affected area dissipate,
• Bandage wrappings applied to the arm or leg promote movement of accumulated fluids away from the affected area,
• Compression stocking or sleeves, worn on the arms or legs, respectively, are another way to promote movement of accumulated fluids away from the affected area, and help reduce swelling.
• A pneumatic compression sleeve is worn on the arm or leg and connected to a pump which inflates the sleeve and puts gentle pressure on the affected limb. These pneumatic compression sleeves help encourage fluid to flow away fromfingers and toes, thereby reducing swelling in the limbs.

A massage designed specifically for those suffering from lymphedema called manual lymph drainage can help dissipate fluid in an affected limb. This massage technique may not be appropriate for everyone with lymphedema.

Decongestive therapy is designed to unblock and increase the flow of the lymphatic fluid away from the extremities. Professionals use a variety of exercise, massage and compression wraps and garments to manipulate the fluid and reduce the swelling. The massage doesn’t actually move the fluid manually it facilitates the lymphatic system so that it can pump. Complete decongestive therapy works in two phases. The first phase involves moving the lymphatic fluid out of the affected region and thus reducing the swelling, using compressive bandaging and massage to move the fluid. Once the fluid is moved, the patient is fitted with a graduated compression garments to keep the swelling at a minimum.

In rare instances where lymphedema is deemed severe, a doctor may recommend surgery to remove excessive tissue in the affected area. This procedure reduces the swelling associated with lymphedema, but cannot cure it. This course of action is usually thought to be more harmful than helpful as it can make the lymphedema worse, because it tends to strip away the lymph system that can move fluid away from the affected area. This “solution” should be carefully considered if it is recommended and I would suggest that anyone who is told to have this surgery should get a qualified second and third opinion.

Persons who have been treated for cancer should take special care of the limb or limbs involved, to reduce their risk of developing acquired, or secondary, lymphedema.

Decongestive Therapy

Massage and physical therapies have been used with variable effectiveness in treating lymphedema. Complex decongestive physiotherapy includes “Manual Lymph Drainage,” bandaging garments such as elastic wraps, and exercises. Complex decongestive physiotherapy requires therapy that is usually performed by physical therapists who specialize in lymphedema treatment, and some rehabilitation centers offer this specialty treatment.

Currently, the position paper of the International Society of Lymphology recommends complex physiotherapy by a physician, nurse, or physical therapist who has been professionally trained. It should be noted that compression bandaging, if done incorrectly, may be harmful or useless.

Complex physiotherapy treatment consists of two phases. The first phase involves preventive skin care, manual lymph drainage, range-of-motion exercises, and compression with multilayer wrapping. The second phase, which must be initiated promptly after phase one, includes use of a compression sleeve, remedial exercise, and repeated light massage as needed. Cancer patients are advised to wear the compression garments when flying because pressure changes may trigger lymphedema, even if not present before.

Note:
Pneumatic compression devices have been used for treating lymphedema, but insufficient evidence exists to support or reject this treatment. In addition, these devices are expensive and can cause cases of cellulitis or deep vein thrombosis. These devices are not recommended by most professionals.

What is Lymphadema?

Lymphedema (Lymphadema) is a medical condition that affects the body's lymph nodes and vessels (the lymphatic system). Lymph vessels transport body fluids to the lymph nodes, where the fluid is cleaned and filtered, then returned to the blood. If this system of lymph vessels and nodes is, or becomes, damaged, or if a vessel or node is removed, fluid cannot flow through the system correctly. The fluid overwhelms the damaged lymph vessels and nodes and can accumulate, causing swelling in the affected body part. Lymphedema most commonly affects the arms or legs, although it can affect any body part, and can occur in one limb to all four limbs.

A more thorough medical description of Lymphedema “is the accumulation of protein-rich interstitial fluid within the skin and subcutaneous tissue that causes chronic inflammation and reactive fibrosis of the affected tissues. Normally, lymph fluid is drained from the cells in the body and carried in the lymphatic system. Lymph is cleared through a network of thin-walled lymphatics, and ultimately empty into the venous system. The lymphatic system is part of the immune system, which carries lymphocytes throughout the body to respond to antigens and communicate responses to other parts of the body. The lymphatic system also carries excess fluid back to the venous bloodstream through a series of ducts or tubules, and empties excess fluid near the subclavian vein. Lymphedema occurs when the lymphatic ducts become blocked and a buildup of lymph fluid occurs in the fatty tissues just under the skin, resulting in swelling.”

There are two main types of lymphedema

Primary Lymphadema (Inherited): In primary lymphedema, some type of developmental abnormality exists in the lymphatic system. Congenital lymphedema accounts for 10% - 25% of all primary lymphedema cases, with females affected twice as often as males. Primary lymphedema may occur at any time in life; however, primary lymphedema is thought to be a genetically determined disease and may present at birth or shortly thereafter (Milroy disease), at puberty (referred to as lymphedema praecox), or after age 35 (lymphedema tarda) Primary lymphedema usually affects the lower extremities.

Secondary Lymphedema: Secondary lymphedema is a result of some sort of an injury to the lymphatic system caused by an obstruction or a disruption that prevents the system from draining fluid from the surrounding tissues. It may occur from infection caused by streptococci or filariasis (caused by a parasite), surgery, radiation therapy, or tumors. Lymphedema caused by infection must be treated with an antibiotic or antiparasitic agent. Secondary lymphedema may develop after surgery for malignant solid tumors, such as in breast cancer or lymphoma. It also may also develop after an axillary node dissection, breast surgery, or after radiation treatments.

Surgery or radiation treatments are the most common cause of lymphedema in the United States. Approximately 15%-20% of breast cancer patients develop lymphedema at some point, up to 20 years following treatment. With 2 million breast cancer survivors, this number translates into approximately 400,000 patients coping with lymphedema on a daily basis.

Breast cancer survivors are not the only ones at risk for lymphedema. Persons who have experienced or undergone any of the following are at an increased risk for developing secondary lymphedema:

· Treatment for one of the following cancers: breast, ovarian, uterine, colon, prostate, testicular, (all of these cancers involve treating or removing lymph nodes or vessels)

· Surgery involving blood vessels

· Liposuction

· Infection caused by parasites; (more common in tropical areas)

Women who have undergone treatment for breast cancer are at a higher risk for developing lymphedema in the arm or upper body. Men who have undergone treatment for prostate or testicular cancer are at a high risk for developing lymphedema in the lower body and groin. All persons in general who have been treated for cancer are at an increased risk for developing lymphedema.

In addition to these two main types of lymphedema, some people can develop chronic lymphedema. Swollen body parts affected by lymphedema are more susceptible to damage and injury. Almost any ordinary wound on the skin, such as a scrape, cut, or bug bite, can cause the swollen limb to become infected. These infections are severe, and recurring infections causes tissue to become susceptible to even more swelling and infection.

Symptoms and Severity

Symptoms resulting from lymphedema usually manifest themselves in obvious ways. The following are all indicators a person may be suffering from lymphedema:

· A swollen limb or area of the body, including fingers and toes,

· A heavy or tight feeling in the arm or leg,

· Restricted motion in the arm or leg,

· Aching in the affected arm or leg,

· Thick or hard skin over the affected area,

· Discolored skin over the affected area,

· A general feeling of fatigue,

· Skin infections and/or ulcers in serious cases,

· A deformity in the affected area (elephantiasis),

· The affected area may also become infected, and persons may experience emotional problems as they deal with their frequently unsightly disorder.

The severity of a case of lymphedema is gauged with a medical lymphedema scaling system.

Grade 1: Mild edema;
Grade 2: Moderate edema;
Grade 3a: Severe edema;
Grade 3b: Massive edema;
Grade 4: Gigantic edema (also known as elephantiasis).

For persons suffering from lymphedema, the emotional difficulties may be trying. The pain and swelling associated with lymphedema can make daily activities and tasks difficult. Severe lymphedema can be a tragic circumstance for the person afflicted with it. Onlookers may find the extreme swelling or associated deformities of advanced lymphedema unsightly, even frightening. Persons with lymphedema may find it beneficial to seek counseling from a professional, or to join a support group, both of which can provide helpful care.