Lymphedema
Denver Lymphedema Treatment
We are excited to offer comprehensive care for patients with lymphedema. At Avicenna Lymphedema Care, we provide lymphedema prevention education, lymphedema screening, and lymphedema treatment. Toward the end of your treatment course, we will recommend and measure you for adequate garment solutions to provide ongoing care.
What is Lymphedema?
When a person has lymphedema, the ability of the lymphatic system to transport fluid has been compromised. This results in an accumulation of protein rich-fluid in the tissue spaces that cannot move back effectively through the lymph vessels. The excess swelling decreases the oxygenation of the tissues and interferes with normal cell function.
Initially, lymphedema is most often experienced as swelling or tightness of one limb. This does not always mean that the patient has a visible increase in the size of a limb. At times patients notice that clothing fits tighter around one limb or that jewelry does not fit anymore or leaves deep imprints. These symptoms are significant for the beginning stage of lymphedema.
Some patients complain about a variety of discomforts, including the sensation of pins and needles, tightness or tenderness in the elbow or behind the knee, leaking of lymph fluid from the skin, and/or heaviness of the affected limb. If left untreated those symptoms will progressively become worse and subsequently lead to a noticeable increase in swelling, as well as changes of the skin. Those changes typically manifest as roughness, dryness, and hardening of the skin.
In the later stages of lymphedema, the affected limb may become grossly enlarged and distorted in contour with exaggerated skin creases, folds, and lobules. The late stages of lymphedema can ABSOLUTELY be avoided by treatment and care from a lymphedema specialist!
Factors that May Contribute to the Development of Lymphedema
Obesity
Long Airplane Travel
Infections (from an insect bite or cat scratch, for example.)
Lifting or Pushing Heavy Objects
Repetitive Motions that Over-Strain the Limb(s)
Taking Repeated Blood Pressure and Blood
Causes of Lymphedema
Lymphatic dysfunction may be related to a malformation of the lymphatic system from birth. This is considered primary or congenital lymphedema. It most commonly manifests in females, and only one limb is typically affected. In primary lymphedema, the lymph vessels are inadequate to transport fluid efficiently. This condition can appear at birth, at puberty, or later in life.
The leading cause of lymphedema in the United States today is cancer and its treatments.
Lymphedema that is caused by factors listed below is considered secondary lymphedema
Surgery
Radiation Therapy
Chemotherapy
Accidental Trauma
Parasites
Most common in tropical countries.
Chronic Venous Insufficiency
Repeated Infections in a Limb
Postoperative Infection
Diagnosis of Lymphedema
Most MD’s base a secondary lymphedema diagnosis solely on your medical history and the onset of symptoms. If you had lymph nodes removed in the past and your swelling occurs in the vicinity of lymph node removal, you are likely to be diagnosed with lymphedema. Very often the initial onset happens in conjunction with other factors, e.g. long distance airplane travel, an insect bite in the affected limb, or inflammation of the skin (cellulite).
The diagnosis of primary lymphedema is usually more tricky and requires extensive testing. It is based on the absence of other diseases. Patients will undergo a multitude of tests to rule out other conditions. Most often this includes extensive vascular testing and screening for cancer. You should be aware that many doctors and therapists have never heard of primary lymphedema.
At this point, there is no cure for lymphedema. With early intervention it can be successfully managed. Diagnosis may require an evaluation by a physician with expertise in lymphedema.
Lymphedema After Breast Cancer Treatment
There are more than 2.4 million breast cancer survivors in the US with approximately 189,000 new breast cancer diagnoses every year. One common and feared negative side effect of breast cancer treatment is lymphedema.
The goal of curative breast cancer treatment is to remove all cancer cells from the body. These treatments generally include surgery, radiotherapy, and various drug therapies. The two types of curative therapies most closely linked to lymphedema risk are surgery and radiotherapy (commonly known as radiation). As the number of lymph nodes surgically removed increases, so does the likelihood that the survivor will develop lymphedema. Lymphedema is characterized by swelling of the hand, arm, breast, or torso on the affected side. It is considered the most problematic and dreaded concern after treatment for breast cancer. Conservative estimates suggest that 20-30% of breast cancer survivors will experience lymphedema.
A surgical procedure called sentinel lymph node biopsy has decreased the incidence of lymphedema compared with the full axillary dissections because this approach removes fewer nodes. There is evidence that the risk of lymphedema may be increased by as much as 48% among women who undergo radiotherapy.
Physical changes with lymphedema are associated with skin changes, loss of sensation and limb function, and pain of varying intensity and frequency. Breast cancer survivors find lymphedema more distressing than a mastectomy, as it is more difficult to hide the physical manifestation.Breast lymphedema will increase your risk of skin infection in that area. If you notice unusual redness, tenderness, and swelling of the breast, please contact your physician.
Lymphedema Treatment
The only effective long-term treatment and the international standard of care for lymphedema is Complete Decongestive Therapy (CDT). It consists of five major components: Manual Lymphatic Drainage (MLD), compression bandaging, exercise, skin care, and ultimately providing adequate elastic lymphedema compression garments.
A good lymphedema therapist will treat and educate you in all the above areas. The length of treatment depends on the severity and duration of the lymphedema.
The primary goals of CDT are listed below
Decrease Edema
Increase Lymph Drainage
Improve Skin Condition
Enhance Patient's Functioning
Develop Independent Self-Care Program
Control Lymphedema at all Times
Lymphedema Treatment Methods
Manual Lymph Drainage (MLD)
MLD is a gentle, hands-on technique that stimulates the activity of the lymph vessels and manually moves lymph fluid. Even though most patients refer to MLD as “massage,” it should be performed by therapists who are specially trained in this technique. A series of MLD treatments will generally decrease the volume of the affected extremity to normal or near normal size. MLD can be very effective in the treatment of facial, limb, trunk and genital edema. The sequence of MLD will change depending on the location of the lymphedema. Treatments usually take 45 minutes to one hour.
Compression Bandaging
Bandaging follows MLD treatments. Low stretch bandages prevent re-accumulation of lymph fluid in the tissues. Bandages are worn overnight or until the next MLD session. Most patients learn to self-bandage within one or two treatments. At Avicenna Lymphedema Care, we are happy to teach your significant other or caregiver how to bandage correctly. At the end of the treatment course, a ready-made or custom-measured garment is ordered.
Lymphedema Compression Garments
There are many solutions for compression garments. These options should be discussed with your lymphedema therapist or a practitioner who is specialized in fitting patients with lymphedema.
Daytime compression garments are essential to maintaining the reduced limb size after finishing your therapy. They replace the bandages that are used earlier in treatment. They are worn during the day while you are active. The compression garment assists your muscle pump in moving lymph fluid towards the middle of the body. Properly fitted garments are crucial for long term control and management of lymphedema. Garment style and compression strength should be discussed and prescribed by your lymphedema therapist.
Nighttime compression garments can replace bandaging at nighttime. They are bulkier than daytime garments and usually more expensive. Nighttime compression is not always necessary, but it is something to discuss with your lymphedema healthcare professional.
Avicenna Lymphedema Clinic is licensed to measure and fit you for custom and off the shelf garments with all the big name brands in the lymphedema industry. Brands we provide include, Jobst, Juzio, Mediven, and Solairs.
Petra Schalk OTR/L, CLT is one of the few therapists in Colorado who provides garment fitting. She is a specialized fitter, well known and recruited to the University Hospital of Colorado, Aurora frequently to advise other therapist and their patients in expert fitting.
Exercise
Exercises need to be performed while the limb is bandaged. At Avicenna, Petra Schalk, OTR/L, CLT will teach you individual exercise routines and recommend certain types of activities that are beneficial for the reduction of lymphedema.
Skin Care
You will be provided with information about skin care to avoid bacterial and fungal growth in the affected area. This is especially important for all patients with skin changes and/or lymphedema in the foot and leg.
Maintenance
During the intensive phase of treatment, you will be taught all elements of CDT. You should continue your treatments independently at home daily. Follow-up visits are recommended every month at first, and after that every 3-6 months depending on your condition.