SVH Rehabilitation Services provides an evaluation and complete decongestive therapy (CDT) at the SVH Women's Health Center. CDT includes manual lymph drainage, compression therapy with bandages, decongestive exercises done by the patient at home, education regarding skin and nail care, and assisting the patient to obtain properly fitting compression garments for the involved extremity. Patients are typically seen five days per week and treatment lasts two weeks or longer based on the severity of the lymphedema. Once the volume of the extremity is reduced during treatment, the compression garments are worn daily to prevent refilling with fluid.
What is lymphedema? Lymphedema is the swelling of a body part due to an inability of the lymph system to adequately transport fluid out of an extremity. In simple terms, the amount of fluid has exceeded the transport capacity of the system. This usually occurs in the arms or legs, but may also occur in the trunk, face, or genitals.
The lymph system includes vessels and nodes which assist the body in transporting fluid filled with proteins, fat cells, waste products and even cancer cells. The lymph vessels move the fluid out of the limb, delivering it to the nodes where the fluid is filtered and unwanted material is sent to the kidneys for excretion and other fluid is recycled for the cardiovascular system.
Lymphedema is classified as either primary or secondary:
- Primary lymphedema is a condition typically caused by an underdeveloped lymph system. Primary lymphedema is more common in women than men and usually affects the legs more than arms.
- Secondary lymphedema is a result of a mechanical insufficiency of the system. Typical mechanisms of injury to the lymph system causing secondary lymphedema include trauma, surgery, cancer or cancer treatment. Trauma might include a direct injury to a leg which severs the lymph vessels leaving it incapable of bringing fluid out of a limb.
Surgical procedures like lymph node removals can also potentially put patients at risk of developing lymphedema if the system cannot keep up with system demands. Breast cancer treatment with lymph node removal increases one’s risk of later developing lymphedema in the affected arm. Due to this risk, extra care should be taken to not overwhelm the system with any potential trauma, even having blood pressures taken on that arm. Cancer can also impair lymph drainage by a tumor taking up space and obstructing the flow.
Signs that may potentially indicate the onset of lymphedema include:
- Swelling in the extremity with or without pitting edema
- Feeling of fullness or heaviness of the extremity
- Thickening/hardening of the skin (fibrosclerotic changes)
There are many other conditions which may also cause extremity swelling, including acute sprains, blood clots, congestive heart failure and infections for example. Due to this, persistent swelling should be evaluated by your physician.
Lymphedema is a disease that is managed but not cured. Early treatment interventions can prevent worsening skin conditions or development of chronic infections like cellulitis. Although medications are sometimes prescribed for fluid loss, they have limited long term control of lymphedema.
Suggestions for preventing worsening of lymphedema symptoms include good skin and nail care, avoid scratching dry skin or insect bites, keep skin well moisturized with lotion and keep jewelry and clothing loosely fit to prevent unwanted pressure or lymph vessels obstructing flow. If you had breast cancer or lymph nodes removed for an arm you should avoid blood pressure cuff or blood draws to that arm whenever possible.
For more information about this service, please contact SVH at 207.487.9293.