Lymphedema

Lymphedema is a swelling caused by the abnormal collection of lymph under the skin. The lymph is fluid from the tissues in your body that travels in the lymphatic system. This system is part of the immune system that includes lymph nodes and vessels. The lymph vessels collect and carry the excess fluid, fats, proteins, and wastes from the tissues of the body to the bloodstream. This system also works to clean and remove bacteria and waste products from the body.

Lymphedema occurs when the lymphatic system is blocked. When the lymph vessels or lymph nodes are blocked or damaged, lymph does not drain properly. This causes abnormal build up of lymph. This leads to swelling in the arms or legs. Lymphedema cannot be cured by medicines. But the swelling can be reduced by physical methods.

CAUSES

There are two types of Lymphedema. Primary lymphedema is caused by the absence or abnormality of the lymph vessel at birth. It is also known as inherited lymphedema, which occurs rarely. Secondary or acquired lymphedema occurs when the lymph vessel is damaged or blocked. The causes of lymph vessel blockage are:

  • Skin infection like cellulites.

  • Infection by parasites (filariasis).

  • Injury.

  • Cancer.

  • Radiation therapy.

  • Formation of scar tissue.

  • Surgery.

SYMPTOMS

The symptoms of lymphedema are:

  • Abnormal swelling of the arm or leg.

  • Heavy or tight feeling in your arm or leg.

  • Tight-fitting shoes or rings.

  • Redness of skin over the affected area.

  • Limited movement of the affected limb.

  • Some patients complain about sensitivity to touch and discomfort in the limb(s) affected.

You may not have these symptoms immediately following injury. They usually appear within a few days or even years after injury. Inform your caregiver, if you have any of these symptoms. Early treatment can avoid further problems.

DIAGNOSIS

First, your caregiver will inquire about any surgery you have had or medicines you are taking. He will then examine you. Your caregiver may order special imaging tests, such as:

  • Lymphoscintigraphy (a test in which a low dose of radioactive substance is injected to trace the flow of lymph through the lymph vessels).

  • MRI (imaging tests using sound waves).

  • Computed tomography (test using special cross-sectional X-rays).

  • Duplex ultrasound (test using high-frequency sound waves to show the vessels and the blood flow on a screen).

  • Lymphangiography (special X-ray taken after injecting a contrast dye into the lymph vessel). It is now rarely done.

TREATMENT

Lymphedema can be treated in different ways. Your caregiver will decide the type of treatment depending on the cause. Treatment may include:

  • Exercise: Special exercises will help fluid move out easily from the affected part. This should be done as per your caregiver's advice.

  • Manual lymph drainage: Gentle massage of the affected limb makes the fluid to move out more freely.

  • Compression: Compression stockings or external pump apply pressure over the affected limb. This helps the fluid to move out from the arm or leg. Bandaging can also help to move the fluid out from the affected part.

Your caregiver will decide the method that suits you the most.

  • Medicines: Your caregiver may prescribe antibiotics, if you have infection.

  • Surgery: Your caregiver may advise surgery for severe lymphedema. It is reserved for special cases when the patient has difficulty moving. Your surgeon may remove excess tissue from the arm or leg. This will help to ease your movement. Physical therapy may have to be continued after surgery.

HOME CARE INSTRUCTIONS

  • Eat a healthy diet.

  • Exercise regularly as per advice.

  • Keep the affected area clean and dry.

  • Use gloves while cooking or gardening.

  • Protect your skin from cuts.

  • Use electric razor to shave the affected area.

  • Keep affected limb elevated.

  • Do not wear tight clothes, shoes, or jewels as it may cause the tissue to be strangled.

  • Do not use heat pads over the affected area.

  • Do not sit with cross legs.

  • Do not walk barefoot.

  • Do not carry weight on the affected arm.

  • Avoid having blood pressure checked on the affected limb.

  • The area is very fragile and is predisposed to injury and infection.

SEEK MEDICAL CARE IF:

You continue to have swelling in your limb.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have high fever.

  • You have skin rash.

  • You have chills or sweats.

  • You have pain or redness.

  • You have a cut that does not heal.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.