Lymphedema is an accumulation of protein rich fluid in the interstitial tissue of the skin caused by an insufficiency in the lymphatic system. This condition occurs when there is impairment in the normal lymphatic flow. It can be caused by deficiencies in the lymph vessels or nodes during fetal development. This type of lymphedema is called Primary Lymphedema.
Secondary lymphedema can be the result of an external cause such as lymph node dissection, radiation treatment, obstruction, (such as malignant disease), trauma or injury to the lymph vessels. An example of secondary lymphedema would be after treatment for breast cancer when patients undergo lymph node dissection, surgery and radiation treatment; swelling in the arm, chest wall, and/or trunk may develop. Damage, blockage or absence of lymph vessels leads to a reduced transport capacity of the lymph vessel system. Fluid and proteins may not be removed properly and may start to accumulate in the tissues especially in the skin where many lymph vessels are found. Accumulating proteins exert an attraction force for water (colloid osmotic pressure) and more water is attracted from the blood stream into the tissues. At the same time, less fluid is able to leave the tissues because of the problems in the lymph vessel system. As a result, the tissue starts to swell.
When does the swelling occur? Primary Lymphedema: Lymphedema can occur at any time. Some babies are born with this condition if they do not have a sufficiently intact lymph system (Milroy’s Syndrome). Adolescents may develop lymphedema in teenage years (Lymphedema Praecox). Adults that develop lymphedema after age 35 are considered to have Lymphedema Tardum.
Secondary Lymphedema: Lymphedema may develop after trauma, cancer, surgery and/or radiation treatment.
Can Lymphedema occur with other diseases? Lymphedema can be associated with conditions such as chronic venous insufficiency, resulting in phlebo-lymphedema. It can also be associated with lipedema. Lipedema is a genetic condition that effects mostly women and is characterized by abnormal fatty deposits located below the skin of the hips, legs and down to the ankles. Those with lipedema complain of sensitivity to touch in their legs, and bruise easily. They may also note increased swelling as the day goes on, which may decrease during sleep. Lipedema patients often benefit from manual lymph drainage with reduction of pain as stimulated lymphatic vessels move fluid out of the tissue. As MLD treatment is continued, reduction of pain and hypersensitivity is noted. Lipedema may cause compression of the superficial lymphatic vessels and can evolve in later stages into a lymphedema (lipolymphedema).
The Importance of the Lymphatic System: A well-functioning lymphatic system is imperative to maintaining one’s health by removing wastes, pathogens, as well as balancing fluids in the body. The lymph vessel system carries excess water, proteins and wastes from the connective tissue back to the blood stream. During the transportation process the lymph is cleaned, filtered and concentrated. Many immune reactions occur in the lymph nodes. If the pathways become congested, blocked, damaged or severed, then fluids can build up in the connective tissue leading to edema and fibrosis. If there is damage in the connective tissue (e.g. burns, chronic inflammation, ulceration, hematoma), then the lymph vessel system must transport the damaged cells, inflammatory products and toxins away from the area. The quicker this can happen, the faster recovery.
Combined Decongestive Therapy (CDT) is a successful method of treating lymphedema. It must be adapted to the specific requirements of each patient. A fully qualified therapist who understands, not only the pathology, but also the most appropriate treatment for their particular condition, should attempt treatment. Combined Decongestive Therapy (CDT) is a combination of Manual Lymph Drainage (MLD), remedial exercise therapy, compression bandaging (or compression garments in the maintenance phase) and therapeutic skin care. It may also include breathing and aquatic exercises, adjunct therapies and dietary measures. Treatment also includes education of self-care techniques; self-massage, self-compression bandaging, home exercise program and skin care. Lymphedema is a chronic condition that can be successfully managed with on-going maintenance CDT. At present there is no cure for lymphedema
If intensive treatment is required, or if treatment sessions could be covered under an individual’s health insurance plan, Dorie can assist in meeting the clients’ goals by referring out to her extensive network of healthcare professionals.
Professional Compression Garment Measuring and Fitting: Dorie is certified by Juzo, Jobst and Mediven companies to measure/order both ready-made and custom-made garments. She is also experienced in measuring for Reid Sleeves and Jovi Paks for night-time compression. Dorie works in conjunction with Durable Medical Equipment Specialist (DME) to help provide compression garments/devices for lymphedema. The DME will assist in determining coverage for lymphedema medical products from insurance companies, insurance billing if applicable, and follow up for reorders.
Lymphedma Caregiver Support: For those who are taking care of someone with lymphedema, or assist in their home management of lymphedema, Dorie is available to help educate caregivers in the manual lymph drainage massage, compression bandaging, donning/doffing compression garments and devices and overall guidance that is often requested or needed in regular home management of their lymphedema.
Lymphedma Self-Care Review: Dorie can provide review sessions of self- care techniques after someone with lymphedema has already gone through their intensive CDT treatment and are no longer covered under insurance for ongoing therapy. Regular maintenance manual lymph drainage sessions are available to assist in overall management of their lymphedema.