Last month we addressed what lymphedema is, being primary or secondary lymphedema. We discussed the lymphatic system, and the factors that contribute to lymphedema.  (Please click here to go to the prior Leg Health News).This issue we would like to discuss avoiding lymphedema and keeping it in check should you have already developed.

Avoid Temperature ExtremesThe temperature of your surroundings is very important.  You should avoid temperatures extremes such as hot baths or shower, extended time in the sun, or travel into colder or hotter climates. You should also avoid infestations or blunt trauma.  Infection causing events include insect bites, manicures, pedicures, pet scratches.  Trauma includes avoiding lifting heavy objects, blood pressure cuffs on the effected limb, tight clothing, tennis or golf.Eat A Balanced Diet to Avoid obesity in Lymphedema

 A diet plentiful in fruits and vegetables for a balanced diet is suggested.  This will also help avoid obesity.  Alcohol and nicotine should be kept to a minimum, if at all.  Meticulous skin and nail care is very important.  Sleeping with the affected limb elevated and/or wrapped is helpful. Of course, a little time spent in exercising, walking, swimming, etc will be of great benefit.  If you see any changes to the coloration or size of the effected limb or if you are concerned with changes to the body always seek medical attention.

 All of the above suggestions are to help prevent the lymphedema or keep it in check. Once lymphedema has developed, many times Manual Lymph Drainage and Complete Decongestive Therapy (MLD/CDT) are required to return the affected limb to a normal or near normal size.

 There are for steps of complete decongestive therapy

1. Hygiene and Topical Skin Products

Meticulous hygiene with or without antibiotics is essential. The goal is to eliminate bacteria or fungus on the skin which can lead to repeated attacks of erysipelas (an acute streptococcus bacterial infection of the dermis, resulting in inflammation and characteristically extending into underlying fat tissue) and/or lymphangitis (an inflammation of the lymphatic channels themselves that occurs as a result of infection at a site distal to the channel).

2. Manual Lymph Drainage, MLD

A special lymphatic decompressive massage is given for one hour once or twice a day. This involves specific manual movements along lymphatic pathways that empty and decompress obstructed lymph vessels. Such therapy facilitates the unhindered flow of lymph fluid into the venous circulation, where it is suppose to go, and allows the limb to return to normal or near normal size. Accomplished by utilizing subcutaneous lymph vessels, existing lymphovenous system and other segments of the lymphatic network which cross the midline of the body, go around the back, over the top of the shoulder

3. Application of compression dressing

Bandaging of the affected limb follows each MLD session. The bandages used for this are short stretch bandages (not ace bandages) and compensate for the diminished tissue pressure in lymphedema. This is an important component of the MLD therapy in that it augments the diminished tissue pressure and prevents the affected limb from refilling with evacuated lymph. The bandages are worn overnight until the next MLD session is about to begin. At the end of the course of treatment when the limb is normal or close to normal, a compression garment is ordered. Many times this is a custom garment which is made especially for you.

4. Remedial Exercises and ElevationExercise with Bandages in Place

Remedial exercises with the bandages in place are prescribed. This step activates each muscle group and joint of the swollen limb and results in an increase in lymph flow and, over time, in dilation of the lymph vessels. Whenever possible, it is recommended that the patient sleep with the swollen limb elevated to or just above the heart. Bandaging is one of the skills taught to each patient during treatment. When elevation is required, it is best done by using foam pad bolsters which can be readily purchased.

The effects of compression are to control the lymphedema. Compression from bandaging or stockings raises the tissue (interstitial) pressure and thereby reduces the effective ultra filtration pressure which results in less lymph fluid accumulation and less fluid having to be removed from the tissue spaces. Compression improves the efficiency of the muscle and joint pumps. As the lymph is being propelled through the lymph vessels by muscular activity, by the contraction of the vessels themselves, and by movements of the diaphragm (breathing), compression assists in the rapid flow of the lymph.

 After the course of therapy is completed is not uncommon for it to become necessary to wrap in the evening as a “tune-up” and wear the compression garments during the day. If you wrap in the evening make certain your bandages are smooth and even. When you get up in the morning make certain to don your support stockings or sleeve. After four or five months of use, be certain to purchase a new garment as they loose their compression after extended use. When you wash your garments be certain to wash in hot water (about 105 temperature) and be certain to wash after every use.