Ginger-K Center - Lymphedema Therapy, Skin and Cancer Care

What is Lymphedema and Who Develops It?

Lymphedema is an excessive accumulation of lymph — a fluid that originates
in the spaces between body cells. It shows itself as a visable and palpable swelling
of a body part — usually an arm or leg — and occurs when blocked, damaged,
or missing lymphatic vessels fail to adequately move fluid and protein
resulting in an accumulation of fluids in the affected area.
Even though lymphedema is more often seen in an arm or leg, it can
affect any part of the body.

There are two forms of lymphedema, the symptoms and treatments of both being similar:

Secondary lymphedema, the most common form, is an acquired condition as a result
of surgery, radiation, lymph node dissection, severe trauma or infection.

Primary lymphedema, a congenital or familial condition, occurs when lymph vessels are
underdeveloped or malformed.

Signs and Symptoms of Lymphedema

Lymphedema can develop in any part of the body. When Lymphedema begins
to develop, the signs to watch out for are:

Prickly, burning, or itchy sensations in the area.
A heavy or achey feeling; skin feeling tight and full
A ring, watch, or bracelet tightness at wrist
Clothes not fitting in a certain area
Increased swelling in an area that sometimes recedes at night
but returns as the body is vertical for a long period of time.
Persistent swelling
Decreased flexibility, especially in the knee, elbow, ankle, or wrist.

Stages of Lymphedema

LATENT: Showing no symptoms, though factors may be present.
Stage 1: (MILD), "pitting" edema, when tissue is pressed there is
a finger impression in the skin that stays. Usually in the morning
upon rising the affected area is about normal size and the edema has receded.
Stage 2: (MODERATE), "non pitting", tissue is spongy; the tissue
bounces back when pressed without indentation.
Stage 3: (SEVERE), swelling is irreversible and the limb or area
becomes very large. The tissue is hard (fibroti›.

If lymphedema is left untreated, the limb or area will continue to swell with
areas of stagnated lymph that isn't moving. This stagnation leads to fibrosis
(an accumulation of stagnated lymph that doesn't move and becomes hardened).
Because this fluid is protein-rich, it is a perfect medium for growth of bacteria.
The area or limb becomes highly susceptible to infection (cellulitis). Furthermore, severe
swelling and: fibrosis leads to loss of mobility, other chronic infections and
sometimes irreversible complications.

Any break in the skin can open the way for bacteria to enter. It is very important
to maintain good healthy skin by: keeping it clean, soft and supple, and safeguarding
against any cuts, bites, etc.

Problems from Untreated Lymphedema

When lymphedema is untreated, this protein-rich fluid stagnates in the tissues of the affected
part resulting in an overload of the lymph drainage system in that area. Serious problems can arise:

Infection requiring treatment with antibiotics and possible hospitalization for repeated occurrences.
Hardening of tissue that further interrupts lymphatic flow and causes discomfort, pain, and fibrosis.
Impaired movement or inability to walk; difficulty with activities of daily living.
Cosmetic deformity and an altered lifestyle.

Treatment - Hands-On-Therapy

Treatment depends upon the stage and severity of the lymphedema. The key is
to begin treatment as early as possible, by focusing on reducing swelling and
re-channeling lymph into functioning lymphatic vessels. The GOAL is to decongest,
reduce, and in some instances, re-contour the affected area.

Treatment includes:

Treatment of underlying infections
Intensive skin care
Manual Lymph Draining (MLD) Therapy
Gradient sequential pump — used only in conjunction with MLD therapy
Circumferencial measurements of affected limb/limbs
Compression bandaging to prevent re-accumulation of lymph fluid.
Therapeutic exercises
Compression garments
Patient education for independent, long-term management
Wound care - Dressing and gradient bandaging

How Does Therapy Work?

MLD is a gentle, specific MASSAGE technique performed by certified MLD therapists to
increase the flow of lymph fluid from the affected region and open new channels in nearby
healthy tissue into which the lymph can flow. Compression bandages or garments are
then applied to prevent re-accumulation of fluids.

In conjunction with therapy, the patient receives instructions in a long-term, home management program.

Since lymphedema is a chronic condition, it requires proper treatment and maintenance to
control swelling and increase quality of life.

Patient Precautions

LYMPHEDEMA can occur immediately post-operatively, within a few months, a couple of
years, or 20 or more years after cancer therapy.

With proper education and care, LYMPHEDEMA can be avoided or, if it develops, kept under control.

FOLLOW THESE INSTRUCITONS:

Don't ignore any slight swelling. Consult your physician immediately.
Never allow injections, IV's, blood pressure, or other invasive therapy in the affected arm or area.
Keep the area "at risk" clean and healthy by applying good skin care including lotions.
Avoid vigorous, repetitive movements against resistance with the affected limb, eg. scrubbing, pushing, pulling.
Avoid heavy lifting or wearing shoulder bags over the affected area.
Don't wear tight jewelry or bands around affected areas. Including rings, bracelets, belts, and in the case of breast surgery, check the bra straps and band for pressure points.
Avoid extreme temperature changes - hot and cold.
Avoid any type of trauma, eg. bruises, cuts, animal scratches, bites, sunburn or burns. Wear gloves when doing house and/or garden work to avoid any trauma to the skin or dirt/bacteria invading the tissue.
Keep nails trimmed but avoid cutting the cuticles unless done by a professional.
Exercise is important, but don't overtire an affected area. EVERYTHING IS DONE IN MODERATION. Recommended exercises: walking, swimming, light aerobics, cycling, and specially designed ballet or yoga. DON'T LIFT OVER 12 POUNDS.
When travelling by air, wear a compression garment and in most instances, reinforce it with compression bandages and/or a higher class compression garment. This is the time to increase fluid intake especially water.
Wear a well-fitted bra, and if a breast form is being worn, make sure it is light weight.
When removing hair from the body, use an electric razor instead of a blade.
Wear a well-fitted compression garment during waking hours. At least every 4-6 months check with a lymphedema therapist to see if it is compatible with your lymphedema.
WARNING - If a rash, blistering, redness, fever, or increase in temperature in the affected area occurs, consult your physician immediately. These are signs of an impending infection and could mean a worsening of lymphedema.

** To avoid infection, practice meticulous skin care and guard against any breaks in the skin.

Additional Services for Lymphedema, Cancer and Wound Care

Consultation and Evaluation of Lymphedema
Combined Decongestive Physiotherapy (CDP) - Treatment for Lymphedema
Measure and fitting of gradient compression garments for Lymphedema and venus insufficiency.
Designing specialty compression systems for problematic lymphedemas and venous conditions.
Skin and Wound care to treat the effects of chemotherapy, surgery and radiation.
Fitting post-mastectomy bras and prostheses.
Teaching self-care and planning home care regimens for maintenance.
Complete supply of bandages, compression systems, skin care and wound care needs.

Lymphedema Therapy Cost Schedule

The following document is available as a PDF file. To view or print PDF files, you need
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press "Reload" in your browser and the document should appear.

Lymphedema Therapy Cost Schedule PDF File (January 2005, 1 page)

Insurance Information

Insurance carriers may offer full or partial coverage for therapy. Consult a Case
Manager within your insurance company to determine the benefits available to you.

Our staff will assist you with any questions or concerns you may have.

Support Group

Lymphedema Information Support Group LISG.
The 3rd Lymphedema Care Forum will be held on Saturday, October 22, 2005. It will
be held at the Fourth Street Banquet Facility located at Fourth St and San Fernando in San Jose.
The Forum will run from 8:00 AM to 5:00 PM.
More information can be found at LISG as it becomes available.

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