The lymphatic system works with the immune system and the circulatory system to carry out its important functions. It works with the immune system to fight off diseases and destroy pathogens that invade our body and boost our immunities. It works with the circulatory system to deliver nutrients, oxygen and horomones throughout our body. It also works to remove excess fluid, waste and toxins and returns fluid to maintain body fluid balance.

What is lymphedema?

Lymphedema is an abnormal swelling most often in the arm(s), leg(s) and occasionally in other parts of the body. It is due to an excessive build up of protein rich fluid called lymph. This occurs when there is damage to a part of the body’s lymphatic drainage system. If a lymph channel becomes blocked, perhaps by a tumor, lymphnode removal, or damage caused by radiotherapy, surgery or trauma, the lymph fluid is uanble to pass along the lymph vessel. Excess tissue fluid builds up and causes swelling because it is unable to drain away through the lymph vessels and back in to the circulatory system.

Lymphedema can present with mild to severe symptoms and is subdivided into differen stages. Remember, it is progressive and can worsen without the appropriate intervention.

Stage 0: Not symptomatic. There is damage to the lymphatic system but the system is still compensating and no swelling is present. There is the propensity for developing symptoms. Patient education in prevention measures is very important at this stage and could actually deter or prevent an onset of active symptoms.

Stage 1: Soft swelling. Able to cause in indent by pushing on the skin AKA “pitting edema”. It appears at the end of the day and can be resolved with elevation.

Stage 2: The limb begins to harden. Swelling persists and elevation has no effect on the swelling.

Stage 3: Can be extreme swelling with skin changes where the skin takes on an “orange peel” type texture. Skin lesions develop, large bulges can develop and it is usually painful in this stage.

Initial Symptoms of lymphedema

Some initial signs to look for can include a feeling of heaviness or full sensation in the limb(s), the skin feeling tight, a decrease in the flexibility of the limb, difficulty fitting into clothing in one specific area or jewelry tightness (wristwatch, bracelets, rings). Early intervention is important. Though the lymphatic damage cannot be reversed the symptoms or progression can be controlled with treatment.

Types of lymphedema

Primary lymphedema – is due to abnormalities of the structures within the lymphatic system usually caused by genetic factors and can present itself at birth (congenital lymphedema), during adolescence and before age 35 (lymphedeam praecox) or alter in life (lymphedema tarda).

Secondary lymphedema – is acquired due to external or environmental factors, causing damage to the lymphatic system.

Causes of lymphedema

The most common cause is damage to the lymph nodes or lymphatic system from cancer related surgery to remove lymph nodes or radiation with resultant destruction of the lymph nodes or lymph vessel. Other common causes of lymphedema can be damage to the lymphatics as a result of:

  • Trauma – fractures, crush injuries, burns
  • Various surgeries where post surgical swelling does not subside or resolve
  • Chronic venous insufficiency
  • Peripheral vascular disease
  • Late effects of deep vein thrombosis
  • Late effects of congestive heart failure
  • Late effects of renal failure
  • Chronic obesity
  • Immobility and dependency positioning of the legs due to weakness, obesity, paralysis, etc

How is lymphedema treated?

Comprehensive decongestive therapy is the “gold standard” of treatment for lymphedema and chronic edemas that covnert into lymphedema. It consists of:

  • MLB – manual lymph drainage massage
  • Compression therapy – specialized bandaging
  • Appropriate remedial exercises
  • Patient education in skin care and prevention
  • Appropriate therapy intervention
  • Compression garments after size reduction
  • Maintenance phase – where patient and/or caregivers carry out a simple for of self-MLD, exercises, use of compression garments, continued skin care and prevention methods at all times as instructed by therapist.

Goals of comprehensive decongestive therapy (CDT)

  • Decrease swelling
  • Increase lymph drainage from the congested areas
  • Improve skin thickeneing and improve skin condtion
  • Restore joint range of motion/flexibility
  • Improve patient’s functional status
  • Relieve discomfort and improve quality of life
  • Reduce the risk of infections (patients with lymphedema are more susceptible to infections)
  • Reduce the risk of wounds (patients with lymphedema are more susceptible to wounds)

Allied Services Skilled Nursing Facility

Residents may present with lymphedema in various stages as a result of the numerous medical conditions which are seen in the SNF setting and that are commonly associated with, or develop into, some form or stage of lymphedema. Also, residents required a skilled level of care are often non-ambulatory and wheelchair bound which can increase the likelihood of developing symptoms due to the associated dependent position of the legs as well as paralysis/paresis of the extremities Allied Services Integrated Health System Skilled Nursing Facility currently has on staff an occupational therapist and a physical therapist who have undergone special training and certifications and can provide the appropriate treatment for patients with lymphedema in its various stages and forms.

Helpful Resources

www.lymphnet.org
www.lymphedemapeople.com
www.lighthouselymphedema.org
www.nci.nih.org
www.oncolink.com
www.nwlymphedemacenter.org