Aug 24, 2007

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

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.

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.

Aug 23, 2007

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.

Aug 22, 2007

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.

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.