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Lymphedema

Lymphedema

For some people, varicose veins are little more than a cosmetic issue. For others, varicose veins cause a variety of troubling and often uncomfortable symptoms. The same symptoms associated with varicose veins can also be attributed to other conditions, which require professional assessment and diagnosis so the appropriate treatment can be administered. Please contact us today at the Vein Care Center, serving the residents of Lima, Celina and the surrounding areas of Auglaize County, OH, to discuss your symptoms. We’re here to help!

What Is the Lymphatic System?

The lymphatic system is a necessary part of the immune system consisting of lymph nodes, vessels and organs that work together to move lymph fluid throughout the body. This fluid is crucial for your general health because it contains proteins, salts, water and white blood cells. Together, these elements help your body fight off foreign invaders, nourish tissues and maintain appropriate fluid levels. Lymph moves in only one direction — upward toward the neck, where it re-enters the circulatory system. Most lymphatic vessels have one-way valves that work with the body’s muscles to ensure lymph never flows backward in the wrong direction.

The lymphatic system also contains lymph nodes. Lymph nodes filter out foreign particles, infectious organisms, damaged cells and cancer cells. They are located in many parts of the body, including the neck, chest, groin, abdomen, armpits and abdomen.

What Is Lymphedema?

Lymphedema, also known as lymphatic obstruction, occurs when fluid builds up in the soft tissue because of dysfunction within the lymphatic system. This system is responsible for supporting the immune system in removing toxins and foreign substances from the body. Lymph vessels carry excess fluid to the lymph nodes, where the harmful substances are filtered out, and the clean fluid can be recirculated through the bloodstream. When the lymph nodes or vessels become damaged or are removed due to cancer treatment, it can lead to a fluid buildup. This process can occur within days after injury to the lymphatic system or develop months or even years after the injury.

Lymphedema can become present at any time throughout a person’s lifetime, and the medical community has yet to pinpoint the exact cause. However, known risk factors exist that are associated with this condition, which should be explored as a part of the diagnostic process. For example, people who have been through cancer treatment are much more likely to develop lymphedema due to how the therapy impacts the lymphatic system.

What Are the Risk Factors for Leg Swelling/Lymphedema?

A previous cancer diagnosis and treatment have already been cited as a risk factor for lymphedema. However, it is not the only one. Genetics may also pose a risk as the condition may run in families. It might also explain in some part why the disorder is occasionally present at birth. Two hereditary diseases might contribute to the onset of lymphedema. One of those is Milroy disease, which causes the structures of the lymphatic system to develop abnormally. The other is Meige disease, although the genetic link for this condition has not yet been identified.

Beyond these factors, you could be more prone to lymphedema if you are:

  • In the middle to later years of life
  • Very overweight or obese
  • Diagnosed with psoriatic or rheumatoid arthritis

Primary vs. Secondary Lymphedema

There are two types of lymphedema:

  • Primary or hereditary lymphedema occurs because of missing or lymphatic vessels at birth. It is a much less common form of lymphedema and may be linked to a family history of the disorder or a history of Milroy or Meige disease.
  • Secondary lymphedema is frequently attributed to damage to the lymph nodes or vessels due to cancer treatment, scar tissue after cancer treatment or infection. Secondary lymphedema commonly occurs after breast cancer, when the patient undergoes a mastectomy and possible additional treatments like radiation or chemotherapy.

Lymphedema Symptoms

The symptoms of lymphedema will vary somewhat, based on the severity of the condition. Some of the symptoms you might notice include:

  • Swollen limb or portion of the limb
  • Feeling of heaviness or tightness in the arm or leg
  • Restricted range of motion in the affected limb
  • Deformity of the limb in severe cases
  • Aching, tingling or discomfort in the affected limb
  • Swelling in other areas, including the head and neck
  • Changes in the skin including hardening and discoloration
  • Recurring skin infections
  • Significant fatigue that affects your daily function

These symptoms might appear soon after the lymphatic system has been affected by injury or other factors. However, it is just as common to see symptoms develop many months or years after the initial event. For people who have undergone cancer treatment, this means that lymphedema is an ongoing concern throughout their lives.

Lymphedema and Venous Insufficiency

Although leg swelling (edema) can be a sign of both lymphedema and venous insufficiency, the two conditions are entirely separate. Lymphedema may be associated with vascular abnormalities. However, it is more frequently the result of poorly developed or missing lymph nodes. In some cases, untreated venous insufficiency can progress into a combination of a venous and lymphatic disorder, which is typically treated in the same way as lymphedema.

Phlebolymphedema results from a combination of venous and lymphatic insufficiency that causes inflammation and lymphedema in the lower legs and feet. It typically begins with chronic venous insufficiency (CVI), in which weakened one-way valves in the veins of the lower legs lose the ability to seal completely closed, and the backward flow of blood produces swelling in the calves, ankles and feet. As CVI becomes more advanced, it overloads the lymphatic system and becomes phlebolymphedema.

Diagnosing Lymphedema

The diagnosis of lymphedema is a process that begins with a physical examination and a discussion of your medical history. Imaging tests using a contrast dye may also be ordered to detect any disruptions or abnormalities in the lymphatic system. Once the condition is diagnosed, it may also be classified based on its severity. This classification will help us to know which treatment is needed to resolve the swelling and manage the symptoms. The classification includes the following stages:

Stage 0 – also known as the latent stage, there may be few symptoms in this early phase other than some aching or tightness in the limb

Stage 1 – this mild stage of lymphedema might include swelling that comes and goes, as well as some early changes in the tissue you might notice if you press down on the area

Stage 2 – persistent swelling characterizes the moderate stage, and tissue that feels spongy and inflammation of the skin

Stage 3 – during the severe phase, you will see ongoing fluid retention, permanent skin changes and loss of motion in the limb

Potential Lymphedema Complications

In addition to the general discomfort and potential debility caused by lymphedema, people with this condition need to be aware of possible complications that can occur. One of the most concerning is the propensity for infection if the skin is injured in even the slightest way. A painful and sometimes dangerous skin infection known as cellulitis is common in individuals with lymphedema. Infection can also originate within the lymphatic system, which can spread and lead to cellulitis or a blood infection known as sepsis.

It is critical for people with lymphedema to avoid injury to the limb as much as possible. Patients may be advised to always wear shoes to prevent cuts to the feet or gloves when cooking, cutting or gardening. It is also critical to avoid constriction of the area, such as tight clothing, to avoid exacerbating the fluid retention.

Reducing Your Risk for Lymphedema

If you’re going to undergo or have undergone cancer surgery, and it has affected your lymph nodes and lymph vessels, you can take steps to minimize the risk of developing lymphedema. These steps include:

  • Rest your arm or leg after surgery. While exercise and stretching are essential for continuing a healthy life after cancer surgery, it’s best to avoid any strenuous activity until you’re fully recovered.
  • Avoid extremes of hot and cold. Do not apply things such as heating pads or ice packs to your affected limb. While it may be tempting to help mitigate pain, extreme heat or coldness can trigger fluid buildup in areas where it is applied.
  • Protect your affected limb. Do your best to shield the limb from cuts, scrapes or burns. These injuries can lead to infection and, in turn, fluid buildup in the lymphatic system.
  • Don’t wear tight clothing. The lymph nodes and vessels of an affected limb can become constricted in clothing that is overly tight. For the same reason, individuals who need to have their blood pressure taken should have the blood pressure cuff put on their unaffected arm.

Dr. Aggarwal will thoroughly review these steps and additional recommendations for preventing lymphedema with you after your treatment to prevent the condition from recurring.

Treatment Options for Lymphedema

Your treatment plan will be based on the severity of the swelling and the degree of fibrosis (thickening and scarring of your connective tissue). You will likely need to follow a daily regimen of treatment to resolve swelling in the limb and manage other symptoms. Treatment typically involves a combination of the following:

  • Compression stockings or bandaging to promote movement of lymph fluid out of an affected limb. Dr. Aggarwal will perform a fitting on you to ensure you have the right size. 
  • Exercising is an excellent way to improve the symptoms of lymphedema. Light exercises that cause gentle contractions of the muscles can help with lymph fluid drainage. Dr. Aggarwal can recommend exercises that’ll specifically target the draining of lymph fluid.
  • Pneumatic compression, which applies pressure and a pumping action to move the fluid out of the affected area. Pneumatic compression is achieved with a sleeve that intermittently inflates. When put on a limb, it moves lymph fluids away from either the hand or foot.
  • Manual lymph drainage (MLD), in which a trained specialist uses a gentle massage therapy technique to move lymph fluid out of the limb. Manual lymph drainage should be performed by an expert, as it requires many hours of training and differs from the typical, rigorous massage. Instead, MLD is a very gentle massage method that feels as though the skin is being brushed, and effectively moves lymph fluid back through the lymph vessels.
  • Complete decongestive therapy (CDT), which is a therapy that involves changing your lifestyle. CDT is essentially a combination of all treatments, and it is the most effective approach for anyone who has progressed past stage 1 lymphedema. If Dr. Aggarwal recommends CDT, you can expect to do such things as exercising while wearing a compression garment or learning in great depth the signs of infection associated with lymphedema.

The goal of all these therapies is to move lymph fluid back into the bloodstream, where it can circulate normally once again. Because the lymphatic system doesn’t have a way to pump fluid like the heart pumps blood, it must be initiated manually through a combination of the steps listed above.

Common Questions About Lymphedema

There are many options available to help you get your lymphedema under control. However, you may have questions about the long-term outlook for your lymphedema after you have started treatment. With expert care, your concerns can be thoroughly addressed. Some questions you might have include:

Will I always have lymphedema?

For patients in stage 0 or 1, lymphedema can be reversed because it has yet to cause significant damage to soft tissues. Patients in stage 1 can still be at risk for developing lymphedema again, so it’s best to consistently check for signs of swelling or infection. Patients in the later stages of lymphedema may see their condition worsen. This is because the tissues beneath the skin have sustained more damage. Despite this, patients with stage 2 or 3 lymphedema can have the appearance of any part of their body affected by lymphedema improved with consistent treatment.

Will I need treatment for my lymphedema for the rest of my life?

This depends on the stage of your lymphedema and how well your body responds to treatment. Patients with milder lymphedema may experience the occasional flare-up, which will require periodic treatment. Patients with more severe lymphedema may need active treatment for the rest of their life. For most individuals, lymphedema is a condition that changes over time, meaning you can go from requiring active treatment to needing just periodic treatment. While it can be troubling to consider that you may need lymphedema treatment indefinitely, recognizing the issue and taking the necessary steps to improve it can ensure the condition does not prevent you from enjoying a happy, normal life.

Lymphedema Treatment at The Vein Care Center

Lymphedema is a complicated issue to come to terms with. It can affect your appearance, your confidence, your lifestyle and your general sense of self. Fortunately, there are treatments available to help improve the issue. Treating vein disease and related conditions early can prevent more severe complications in the future. Let the caring and knowledgeable staff at the Vein Care Center help you look and feel your best. Under the expert guidance of Dr. Aggarwal, a treatment plan can be devised that’s customized for your unique needs.

Knowing that it is possible to get the issue under control is the crucial first step in treating your lymphedema. To schedule an appointment, please give us a call at 419-227-4472 or visit our contact page, so we can help you find relief from this uncomfortable condition.

* This information about the lymphedema treatment page was reviewed by Dr. Manu B. Aggarwal. If you have any questions, please reach out using our contact form below.

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