Lymphedema is a chronic, progressive abnormal accumulation of fluid in the subcutaneous (below the skin) tissue resulting from inadequate transport capacity of the lymphatic system that leads to disfigurement of one or more body part(s) involved.  It can affect the limbs, the trunk, the genitalia,   and the head and neck.  Edema is the more acute swelling of any body part caused by so many factors.  Edema of more than 3 months’ duration is termed chronic edema.

All chronic edema is lymphedema as by this time, cumulative damage to the lymphatic system may have transpired which would be responsible for the various signs of volume changes,   range of motion deficits, strength impairments, abnormal cutaneous alterations as well as for the symptoms of heaviness, pain/discomfort, and tightness in the body part(s) involved that pose varying levels of functional mobility limitations,   increase risk for infection, and cause quality of life to deteriorate.

                            Adapted from Avis Hospital Images

                  Adapted from The Vein Institute @ SSA

The lymphatic system is primarily responsible for the body’s immune function.  It also plays a major role in the body’ fluid balance.  In the past decade, with the revision of the Starling principle, now known as the Michel-Weinbaum Glycocalyx Model or the Revised Starling Hypothesis for Microvascular Fluid Exchange,   the lymphatic capillaries (not just the venous capillaries) have been found to subsequently reabsorb up to 100% of the fluid and proteins from the interstitial space (space outside of the cells) before it is transported back to the right side of the heart via the four lymphovenous valves located in the junction of the internal and external jugular vein with the subclavian vein. 

Therefore, any affectation to this system can cause interstitial fluid overload, damaged lymph flow, reactive inflammation and fibrosis, and connective tissue derangements that give lymphedema its characteristic signs/symptoms.

According to the World health Organization and to some European studies made in the last ten years,  there are an estimated 250 million worldwide living with lymphedema of which 10 million Americans are afflicted,  which is more than HIV, ALS,  Parkinson’s Disease, Multiple Sclerosis, and ALS combined.  Currently, there is only one certified lymphedema therapist available for every 1,000 Americans struggling with this disease, increasing burden of care.  30% of cancer survivors have lymphedema.  American veterans suffering from trauma, injuries, infection, and those with burn pit exposure are at risk for lymphedema. 

Lymphedema staging is based on its manifestations.  In Stage O/subclinical stage, the lymph system is injured but still works well enough to manage the flow of lymph. There is no swelling but you may have early signs of numbness, tingling or fullness.

In Stage I,   swelling is mildly visible as the lymph fluid begins to accumulate, characterized by pitting edema.  Patient can test for pitting edema by pressing a finger firmly against the skin for a few seconds and a dent or pit is left behind on the skin.  There is no swelling in the morning, but it comes back and worsens as the day goes on.  Swelling typically goes away when the body part is elevated for a while.

Stage II lymphedema has a swelling that does not get better on its own without physical therapy.  The tissues become fibrotic where it gets hard and thicken from scar tissue formation.  The patient is at higher risk for skin problems, including cellulitis.

Stage III lymphedema makes the arm or leg engorged and movement of the limb is difficult. The skin may get very hard and scaly. Lymph fluid may leak from breaks in the skin (lymphorrea). There is a higher risk for recurrent infections and other medical problems related to lymphedema.

 Adapted from More Than Fat, A Story of Lipedema site

COMPLETE DECONGESTIVE THERAPY at DAN WYAND, PT and ASSOCIATES

Currently, there is no cure for lymphedema but a program called complete decongestive therapy or complex decongestive therapy provided by a certified lymphedema therapist trained with at least 135 hours of in-person/hands on training along with a 90-hour online theoretical framework exposure can help you with symptom amelioration and mitigation.  This program consists of manual lymphatic drainage, multi-layer short-stretch bandaging,  proper skin care, lymphedema remedial exercises, and patient education/training during the reductive phase/Phase I in the lymphedema clinic followed by maintenance phase/Phase II at home.

Lymphedema therapists work with patients and DME provider to procure needed durable medical equipment consisting of appropriately-fitting compression garments and pneumatic compression devices that can assist with the success of the maintenance phase at home.

At Dan Wyand, PT and Associates, with referral from your oncologist or your primary care provider, we ensure that these services and treatment program are provided to you.  If you or anybody you know have swelling, both acute and chronic,   ask your doctor about lymphedema to ensure that needed treatment options are offered to you.