What is Lymphoedema?
Lymphoedema is an accumulation of protein-rich fluid in the tissues. A problem with the lymphatic system can cause lymphoedema to develop in any part of the body but it mainly affects the arms or legs. Lymphoedema may develop when lymph vessels are missing or not functioning well (Primary), or after lymph nodes are removed or damaged by radiation treatment eg. breast cancer treatment (Secondary). Left untreated, lymphedema can worsen and cause severe swelling and permanent changes, such as thickening and scarring, to the tissues of the limb.
How Is Lymphoedema Treated?
Once lymphoedema has developed there are no treatment or management miracles, but it can be managed with intervention.
When you first come for treatment the Physiotherapist will carefully assess the situation and make recommendations to you about the type of treatment she feels will be of benefit to you.The treatment programme suggested will be dependent on the stage your lymphoedema is at, the issues which concern you most and the resources available to you.
Stages of Lymphoedema:
- Stage 0 (also called subclinical or latent): There are no visible changes to the limb at this point, but you may notice a difference in feeling, such as a mild tingling, unusual tiredness, or slight heaviness. You can have stage 0 lymphoedema for months or years before obvious symptoms develop.
- Stage 1 (mild): The arm, hand, trunk, breast, or other area appears mildly swollen as the protein-rich fluid starts to accumulate. When you press the skin, a temporary small dent (or pit) forms; you may see this referred to as “pitting oedema.” Such early-stage lymphoedema is considered reversible with treatment because the skin and tissues haven’t been permanently damaged. When you elevate the arm, for example, the swelling resolves.
- Stage 2 (moderate): The affected area is even more swollen. Elevating the arm or other area doesn’t help, and pressing on the skin does not leave a pit (non-pitting oedema). Some changes to the tissue under the skin are happening, such as inflammation, hardening, or thickening. Stage 2 lymphoedema can be managed with treatment, but any tissue damage can’t be reversed.
- Stage 3 (severe): This is the most advanced stage, but it is relatively rare in people with breast cancer. At stage 3, the affected limb or area of the body becomes very large and misshapen, and the skin takes on a leathery, wrinkled appearanc
- When you come for an initial assessment, the Physiotherapist will take a detailed case history asking you about any surgery/ medical treatment you have had and about how your lymphoedema has developed and how it impacts on your life. She will examine you and take careful note of the condition of your limb, including skin or tissue changes and whether the oedema affects your trunk or abdomen. The limb (s) will be carefully measured and photographed to establish a baseline volume so that any changes during treatment can be noted. If necessary Deirdre will contact your GP or Consultant to seek consent for treatment. She will outline to you the treatment regime which she feels is best for you.
- In the early stages of lymhoedema stages 0 and I compression garments alone may be enough to manage your swelling.
- In the later stages an intensive course of Combined Decongestive Therapy (CDT) may be necessary.
COMBINED DECONGESTIVE THERAPY
Treatment: According to the International Society of Lymphology, Combined Decongestive Therapy (CDT), also known as Decongestive Lymphatic Therapy (DLT), is the treatment of choice for lymphoedema. This is a proven combination of treatments aimed at reducing the volume of your limb. It involves an intensive treatment phase and a maintenance phase.
- Manual Lymphatic Drainage (MLD) to decongest the affected areas by opening up the lymphatic channels and diverting the fluid to areas with normal drainage.
- Multi layer Lymphoedema bandaging (MLLB) where layers of bandages are applied over padding to provide a compression force to the limb. This maintains the fluid reduction achieved by MLD and may result in further reduction.
- Exercises You will be given a programme of specific exercises to do while the bandages are in place. Bandages apply a compression force to the lymphatics and exercising in bandages augments the pumping force of the muscles.
- Skin Care and Hygiene– Good skin care plays an essential part in the treatment of lymphoedema. Daily washing with pH neutral cleansers and application of moisturising cream cream will help to eliminate possible bacterial and fungal growth and so minimise the possibility of repeated attacks of cellulitis.
- Breathing exercises. The thoracic duct runs upwards through the chest cavity and carries lymph back to the heart. Flow in this vessel can be improved by breathing exercises which create a suctioning effect.
The intensive phase of treatment may continue for as long as 2-4 weeks. Towards the end of this phase you will move towards the maintenance phase. You will be measured for a compression garment which may be off the shelf or custom-made. This garment is an essential element in maintaining the reduction in volume achieved in treatment. The garment style recommended will be carefully chosen with you to try to ensure it fits into your lifestyle so that it will be worn.
Longer term follow up and support will be provided as necessary and the Physio is happy to show you or a loved one how to bandage the limb if this is considered necessary.
The aim of treatment is to enable you to manage your condition in the longer term to minimise the risk of complications such as cellulitis. This document is a useful resource and may be helpful to bring to your GP if you have an infection as many doctors don’t have a great deal of expertise in dealing with lymphoedema.