Lymphedema Treatment

Management of limb lymphedema

2012-02-13T08:07:00.000-08:00

Management of limb lymphedema.

Jan 2012

[Article in French]

Vignes S.

Source

Unité de lymphologie, centre national de référence des maladies vasculaires rares, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.

Abstract

Keywords:
Lymphedema;
Treatment;
Physiotherapy;
Low stretch bandage;
Compression

Lymphedema results from impaired lymphatic transport with increased limb volume. Cellulitis is the main complication, but psychological or functional discomfort may occur throughout the course of lymphedema. Lymphedema management is based on complete decongestive physiotherapy (multilayer low stretch bandage, manual lymph drainage, skin care, exercises). First phase of treatment leads to a reduction of lymphedema volume. The second phase stabilizes the volume and is based on elastic compression. Resection surgery is a useful tool in external genitalia lymphedema.

Elsevier

Comprehensive decongestive therapy in postmastectomy lymphedema

2012-02-09T05:19:00.000-08:00

Comprehensive decongestive therapy in postmastectomy lymphedema: An Indian perspective.

Oct 2011

Randheer S, Kadambari D, Srinivasan K, Bhuvaneswari V, Bhanumathy M, Salaja R.

Source

Department of Surgery, JIPMER, Puducherry, India.

Abstract

Background: Lymphedema following breast cancer treatment is one of the most morbid conditions affecting breast cancer survivors. Currently, no therapy completely cures this condition. Comprehensive Decongestive Therapy (CDT), a novel physiotherapeutic method offers promising results in managing this condition. This therapy is being widely used in the West. Till date, there are no studies evaluating the effectiveness and feasibility of this therapy in the east.

Materials and Methods: The therapeutic responses of 25 patients with postmastectomy lymphedema were analyzed prospectively in this study. Each patient received an intensive phase of therapy for eight days from trained physiotherapists, which included manual lymphatic drainage, multi layered compression bandaging, exercises, and skin care. Instruction in self management techniques were given to the patients on completion of intensive therapy. The patients were followed up for three months. Changes in the volume of the edematous limb were assessed with a geometric approximation derived from serial circumference measurements of the limb and by water displacement volumetry. Changes in skin and sub cutis thickness were assessed using high frequency ultrasound.

Results: The reduction in limb volume observed after therapy was 32.3% and 42% of the excess, by measurement and volumetry, respectively. The maximum reduction was obtained after the intensive phase. The reduction in skin and subcutis thickness of the edematous limb followed the same pattern as volume reduction. Patients could maintain the reduction obtained by strictly following the protocols of the maintenance phase.

Conclusions: CDT combined with long-term self management is effective in treating post mastectomy lymphedema. The tropical climate is a major factor limiting the regular use of bandages by the patients.

Pub Med

2010 Georgia Lymphedema Education and Awareness Program

2010-06-05T04:06:00.000-07:00

2010 Georgia Lymphedema Education and Awareness Program

13th State of Georgia Lymphedema Education and Awareness Program, October 16,
2010, Decatur, GA.

View and Print out Brochure to Register (vertical menu item)

The LLN Brochure also includes much information about our not-for-profit
organization in Georgia and can be printed out (vertical menu item) or click
here

The program is entitled:

SHEDDING LIGHT ON LYMPHEDEMA

and is sponsored by The Lighthouse Lymphedema Network

Don't Forget - Mark Your Calenders - See You There!!!

Baby Kayden in Oklahoma

2009-11-04T01:10:00.000-08:00

Baby Kayden in Oklahoma

Good Morning Everyone

I wanted to bring this to everyone’s attention and encourage anyone who can to help this little baby.

Kayden has vascular Lymphedema and was just born on August 18, 2009…he’s got a long road ahead of him so let’s do anything we can for him and his family:

Baby Kayden

He’s a real little doll too!

Thanks Everyone!!!!!!!!!!!!!!!!!!!!

Pat

Understanding the Lymph System

2009-10-28T08:23:00.000-07:00

Understanding the Lymph System

I thought it would be helpful for readers to understand the lymph system, the anatomy, what it does, and how it helps with immunity.

Listed below are information pages that should be quite helpful and each page has many additional links for more a more in depth study.

Anatomy of the Lymph System

Lymphatic System Functions

Lymphatic System and Immunity

Pathology of the Lymph Nodes and Lymphoma

Lymph Nodes

Lymph Fluid

12th State of Georgia Lymphedema Awareness Program

2009-10-17T03:50:00.000-07:00

12th State of Georgia Lymphedema Awareness Program

Lighthouse Lymphedema Network

THERE IS STILL TIME TO GET THOSE REGISTRATIONS IN

An educational and awareness conference for patients, caregivers and professionals!

Where?

Saint Joseph Hospital Auditorium 5665 Peachtree Dunwoody Road, NE Atlanta, GA 30342

When?

Saturday, October 24, 2009 7:30 am - 5:00 pm

Click here for Registration Form

Schedule

7:30-8:15am Registration – Continental Breakfast – Exhibits 8:15-8:30am Welcome .

Plenary Session:

8:30-10:00am Moderator: Elaine Gunter, MT (ASCP)

Nicole Stout, PT, MPT, CLT-LANA Will discuss her studies on early intervention for breast cancer including the anatomy, reconstruction, breast cancer surgeries, truncal and other upper extremity lymphedema

10:00-10:30am Break Exhibits

10:30-12:00 Charles McGarvey, PT, DPT, MS, FAPTA

Lymphedema Secondary to Pelvic Cancer Treatment: A Review of Literature and Clinical Practice

12:00 – 1:30pm Lunch Exhibits

1:00-2:15pm Teen (only) Networking -Parent Networking (parents of children with lymphedema)

Separate sessions

Plenary Session:

1:30-2:15pm Daniel Beless, MD, Director of Wound Care at Saint Joseph Hospital Wound Care and the lymphedema patient

2:15-3:00pm DeCourcy Squire, PT, CLT-LANA

Research updates from the International Society of Lymphology of Lymphedema Diagnosis and Treatment

3:00-3:30pm Break Exhibits

3:30-4:30pm Panel Discussion

All speakers will participate in this question and answer discussion

4:30-5:00pm Closing Remarks

Lymphedema and the Use of Diuretics

2009-10-14T08:27:00.000-07:00

Lymphedema and the Use of Diuretics

Because of the incredible lack of awareness and/or knowledge of lymphedema in the medical community, it is very common to hear of lymphedema patients speak of being prescribed diuretics (water pils) by their physcians in attempting to treat this condition.

It is important to understand not only that diuretics are not for lymphedema, but to understand why.

The long term use of diuretics will eventually lead to a serious worsening of lymphedema and will help set the stage for increased complications such as tissue fibrosis.

Hopefully, this page will clear up questions regarding this and will help patients better manage their lymphedema.

Pat

Diuretics Definition

A class of drugs or other substance that promotes the formation and release of urine. Diuretics are used to decease the fluid volume in the treatment of many underlying medical conditions. Most people commonly call diuretics a “water pill.”

Anything that promotes the formation of urine by the kidney. (The word “diuretic” comes from a combination of the Greek “dia-”, thoroughly + “ourein”, to urinate = to urinate thoroughly).

Diuresis may be due to a huge number of causes including metabolic conditions such as diabetes mellitus (in which the increased glucose level in the blood causes water to be lost in the urine); substances in food and drink (such as coffee, tea, and alcoholic beverages); and specific diuretic drugs.

All diuretic drugs – which are usually called, more simply, diuretics – cause a person to “lose water” but they do so by diverse means, including:

Inhibiting the kidney's ability to reabsorb sodium, thus enhancing the loss of sodium in the urine. And when sodium is lost in the urine, water goes with it. (This type of diuretic is called a high-ceiling diuretic or a loop diuretic).

Enhancing the excretion of both sodium and chloride in the urine so that water is excreted with them. This is how the thiazide diuretics work. Blocking the exchange of sodium for potassium, resulting in excretion of sodium and potassium but relatively little loss of potassium. These diuretics are therefore termed potassium sparing diuretics. Some diuretics work by still other mechanisms. And some diuretics have other effects and uses such as in treating hypertension. (3)

Lymphedema or Edema?

To understand why these agents are not recommended for the treatment of lymphedema we must first start with a basic definition of edema and lymphedema.

Edema: Abnormal pooling or build up of fluid in tissues. Generally caused by underlying medical conditions such as hypertension, varicose veins, thrombophlebitis, congestive heart failure, kidney failure, steroid therapy, inflammatory reactions, or injury or trauma.

Diuretics are used to assist in the correction of the base problem causing the edema.

Lymphedema: A disorder in which “lymph” collects usually in a limb as a result of a congenital, hereditary malformation of the lymphatic system, or is a result secondary conditions such as node removal for biopsies, damage to the lymphatics from radiation, injury or trauma or by parasitic infection. Diuretics cannot help the underlying condition of lymphedema.

Why not use diuretics for lymphedema?

Perhaps the single most important consideration is in the composition of the lymph fluid caused by lymphedema. The fluid i a protein-rich substance that provides a breeding and nourishment center for bacteria. This has to be removed to lesson the risks of cellulitis and lymphangitis.

This fluid also has to be removed so as to prevent the formation and progression of fibrosis as lymphedema advances through the various stages.

Diuretics remove none of this waste fluid as it is a heavier molecule fluid then just water itself..

Diuretics and Lymphedema

A question that came up is whether diuretics should be used in the treatment of lymphedema. In my opinion, the answer is usually no. There are some exceptions and I will explain.

Diuretics are one of the best treatments for patients suffering from edema of the legs due to congestive heart failure. When the right side of the heart does not work efficiently, the pressure in the venous system increases and this, in turn, results in increased pressure in the tissues and edema results. The edema is not from the lymphatic system and is not lymphedema.

Diuretics, such as lasix, cause the kidney to eliminate water from the blood. This in turn reduces the pressure in the venous system and allows the edema to drain into the venous system. Unfortunately, when someone drinks additional water the fluid and edema returns and so many patients require fluid and salt restriction to have the best results. Diuretics must be given regularly to eliminate as much water from the blood system as possible and control the edema. In some case, even when high doses of diuretics are given, the edema cannot be controlled by drugs alone and compression garments can be of additional benefit for these patients. The lymphatic system can be completely normal and patients will still develop edema due to congestive heart failure.

The lymphatic system drains through the lymph nodes and lymphedema generally arises due to an obstruction in the lymphatic system. This can occur due to surgery, radiation or trauma. Decreasing the pressure in the venous system by removing water from the venous system does not help reduce lymphedema. In fact, patients with normal cardiac function do not have excess tissue edema. As a result, fluid removed by diuretics must be replaced by oral intake to maintain a normal fluid balance and any reduction in fluid due to diuretics in normal people is temporary. Diuretics have no value for the treatment of lymphedema in patients who do not have edema due to congestive heart failure or other similar conditions.

A patient could have a mixed condition where lymphedema is complicated by edema due to congestive heart failure. These patients may benefit from treatment with diuretics because of the mixed condition. Check with your doctor to see if you have some component of edema.

Dr. Mortimer addressed this question in a recent publication in Angiology 48:87-91, 1997. He said,

“Lymphedema, regardless of etiology, is essentially incurable but different therapy approaches exist which serve to contain swelling. The objectives of treatment are to reduce swelling, restore shape, and prevent inflammatory episodes, eg, recurrent cellulitis. There are essentially three main approaches to lymphedema treatment: physical therapy, drug therapy, and surgery. Any edema arises from an imbalance between capillary filtration and lymph drainage. The principle of physical therapy is to a) reduce excessive capillary filtration and b) improve drainage of interstitial fluid and macromolecules from congested regions to normally draining lymph node sites. This is achieved through a combination of compression, exercise, and if possible, massage. Control of recurrent inflammatory episodes can only be achieved through diabetic type skin care, a reduction in swelling, and if necessary, prophylactic antibiotics. Drug therapy comprises diuretics or the coumarin/flavonoid group of drugs. The use of diuretics for pure lymphedema is physiologically unsound but may be of use in edema of mixed origin and in palliative (cancer) circumstances.”

Tony Reid MD Ph.D

Penninsula Medical Diuretics Page

Acknowledgment

Penninsula Medical - “The Reidsleeve People”

New Lymphedema Treatment Clinic - Myrtle beach, Souther Carolina

2009-10-14T08:23:00.000-07:00

It gives me great pleasure to announce a new lymphedema treatment clinic in the Myrtle Beach, Souther Carolina area:

Tom Kincheloe, OTR/L, CLT
Founder/Clinical Director
RIVERTOWN LYMPHEDEMA CLINIC AND REHAB, LLC.
100 Prather Park Drive, Suite A
Myrtle Beach, SC 29588-7910
Bus. Phone: (843) 742-5701
Bus. Fax: (843) 742-5704
Cell: (843) 957-2422
Email: erivertownlymph@sc.rr.com

I know Tom personally and two things strike me about him.

First, is his real concern/compassion for his patients.

Secondly is his knowledge of lymphedema.

A winning combination! So if you live in his area and are looking for lymphedema help, give him a call.

Pat

Lymphedema Awareness Atlanta Georgia

2009-09-29T03:08:00.000-07:00

Lighthouse Lymphedema Network

11th Annual Lymphedema Education & Awareness Program

An educational and awareness conference for patients, caregivers and professionals!

at Piedmont Hospital

Richard H. Rich Auditorium

1968 Peachtree Road, NW, Building 77

Atlanta, Georgia

Saturday, October 18, 2008

7:30 am - 5:30 pm

Program includes:

What to expect of tissue after radiation? What is the physiology response of radiation? What does radiation do to the lymph nodes? - Peter Rossi, MD

How does vascular flow affect the lymphatics? - Ken Harper, MD

Expectations of surgery. - Christopher Hart, MD, FACS

The Lymphatic System, Wound Care, Infections and Treatment - Paula Stewart, MD

Parent Networking

Aquatic Exercises

The Connection of obesity and increased swelling in people with lymphedema and lipedema.

And more.

Additional information and registration form:

Lighthouse Lymphedema Network

2009-09-29T03:02:00.000-07:00

I wanted to make a special announcement that the Lighthouse Lymphedema Network
is now on Facebook.

You can join by going to: Lighthouse Facebook

There is also an area where you can post and participate.

AND - don't forget our upcoming program in October.

see the details for that at:

Lighthouse Lymphedema Network

**yes, I'm on it too :-)

Pat

Finding a Lymhedema Therapist

2009-09-21T23:20:00.000-07:00

Finding a Lymhedema Therapist

How To Find a Lymphedema Therapist

It is important for the lymphedema patient to understand that there is an important difference between what we know of as massage therapy and the type of decongestive therapy that is the protocol treatment for lymphedema

Traditional massage therapy is not treatment for lymphedema.

This page will

1.) Explain the difference
2.) Link you to pages wherein you can locate a certified and properly trained lymphedema therapist in your area.

Pat

Schools of lymphedema therapy

To locate a therapists click on URL of school
From here you can locate locate and link to therapists all over the US, Canada, the United Kingdom, Ireland, Greece, Australia, New Zealand and Singapore

VODDER SCHOOL
Home Page: Therapist Finder:

Dr. Vodder School - North America PO Box 5701 Victoria, British Columbia, V8R 6S8 Tel: (250) 598-9862 Fax: (250) 598-9841

KLOSE TRAINING AND CONSULTING
LYMPHEDEMA THERAPY CERTIFICATION

Home Page:
Find a Therapist

Complex Lymphatic Therapy Courses - Casley-Smith Method

Home page:
CLT Courses 115 Leyden Street Decatur, GA 30030
Phone: 678-596-1785
CLTcourses@cs.com

ACADEMY OF LYMPHATIC STUDIES
Home Page:
Find a Therapist:

Norton School of Lymphatic Therapy
Home Page

Find a Therapist

Coast to Coast School of Lymphedema Management
Home Page
Find a Therapist
e-Mail: Information@lymphedemamanagement.com

Lymphology Association of North America
Home page:
Find a Therapist:

nATIONAL lYMPHEDEMA nETWORK
National Lymphedema Network
Find a Therapist

MLD UK
Manual Lymphatic Drainage in the United Kingdom
http://www.mlduk.org.uk/ Email: admin@mlduk.org.uk

CASLEY-SMITH-Australia

Home Page:
List of Therapists

Complex Lymphatic Therapy Courses US
http://www.casley-smith-lymphedema-courses.org/index.html

Traditional Massage Therapy in the Treatment and Management of Lymphedema
By Joachim Zuther, MT, PT

Editor's note: Joachim Zuther is the founder and director of the Academy of Lymphatic Studies in Sebastian, Florida. Mr. Zuther received his massage therapy degree in 1982 and his physical therapist degree in 1984, both from the School for Physical Therapy and Massage in Ulm, Germany.

Lymphedema is a common condition caused by a reduction in the transport capacity of the lymphatic system. The lymphatic system in the affected area is unable to respond to an increase in lymphatic loads. Massage therapy increases the amount of lymphatic load and can have negative effects on lymphedema if applied incorrectly. This article discusses the differences between massage therapy and the techniques known as manual lymph drainage (Vodder Technique) and the proper application of massage therapy when lymphedema is present.

Lymphedema is defined as high-protein edema - an accumulation of water and protein in the tissues, caused by a decrease in the transport capacity of the lymphatic system. Lymphedema may be mild, moderate or severe; most often, it affects the extremities, but can also be present in other parts of the body.

Lymphedema can be classified as primary or secondary. In primary lymphedema, transport capacity is reduced as the result of a congenital malformation in the lymphatic system.6 Primary lymphedema may be present at birth, but more often develops later in life, with or without obvious cause. Secondary lymphedema is more common, and is caused by surgical interventions involving the lymphatic system. Lymph node dissections, radiation therapy, or incisions that disrupt the natural pathways of the lymphatic system affect the ability of the lymphatics to drain lymphatic loads out of the affected extremity. Secondary lymphedema may arise immediately after surgery or years later.

What Are Lymphatic Loads?

The lymphatic system is not a closed circulatory system; it works according to the one-way principle. Its main purpose is to drain from the interstitium substances that cannot be absorbed by the venous end of the blood capillaries. These substances, called lymphatic loads, consist of water, protein, cells and fat.5

What Is the Transport Capacity of the Lymphatic System?

Transport capacity is the highest possible lymph flow per unit of time.4 The relation of the physiological resting lymph flow to the transport capacity of a healthy lymphatic system is approximately 1:10.7 This means that the lymphatic system is able to transport 10 times the volume of the normal amount of lymphatic loads. When primary or secondary lymphedema is present, the transport capacity of the lymphatic system falls below the physiological level of water and protein load (mechanical insufficiency).

Massage Therapy vs. Manual Lymph Drainage (MLD)

The term massage means “to knead” (Gr: massain) and is used to describe forms of “classical” or “Swedish” massage.10 The word is often misused to describe the techniques of manual lymph drainage, which is a gentle, manual treatment technique used in combination with compression therapy, skin care and decongestive exercises. The techniques of MLD are used to effectively treat primary and secondary lymphedema1 and postsurgical and posttraumatic swelling. Migraine headache, chronic venous insufficiencies and edema of other genesis present additional indications. MLD also has a detoxifying effect.

If applied correctly, MLD increases the activity of lymph vessels and moves interstitial fluid; it exerts little pressure on the skin3 and does not cause any increase in local arterial blood flow.

Effects of Massage Therapy on the Skin

The basic strokes used in massage (e.g., petrissage, effleurage, tapotement, vibration and friction) are generally applied with more pressure than manual lymph drainage techniques. The effects of massage strokes are not limited to suprafascial tissues (e.g., the skin), but also cause reactions in subfascial areas such as muscles, tendons and ligaments. Massage strokes can increase local arterial blood flow and venous and lymphatic return, and can also loosen subcutaneous adhesions.

Many massage therapy publications list edema as one of the indications for these techniques.8 This statement, while correct, is often misleading if the distinction between edema and lymphedema is not established. Edema is suprafascial tissues can be caused by various problems, including inflammation or impaired venous return (valvular insufficiency, pregnancy, or prolonged sitting and/or standing). With edema, the lymphatic system remains intact but is overloaded. This condition, called dynamic insufficiency, results in the accumulation of water in the tissues. Massage therapy may be beneficial for some forms of edema, but is contraindicated for others. It should not be applied without prior consultation with a physician.

On the other hand, lymphedema is always caused by mechanical insufficiency of the lymphatic system; water and protein accumulates in the tissues. As discussed earlier, in the case of mechanical insufficiency, the transport capacity of the lymphatic system falls below the physiological level of water and protein load and is not able to appropriately respond to an increase in lymphatic loads.

Negative Effects of Massage Therapy on Lymphedema

Most massage strokes cause an increase in arterial blood flow (active hyperemia) in skin areas where such techniques are applied. Active hyperemia is accompanied by an increase in blood capillary pressure and subsequent increase in ultrafiltration of water in the area of the blood capillaries. This process results in more water accumulating in the interstitial spaces. Water represents a lymphatic load. Due to mechanical insufficiency, the lymphatic system will not be able to manage this additional water load. If massage therapy to lymphedemateous tissues, an increase in swelling may result.

Additionally, superficial lymphatics are extremely vulnerable to external pressure. Traditional massage techniques can cause focal damage to anchoring filaments and the endothelial lining of lymph vessels.2 This possible damage to lymphatics, and the potential increase in arterial blood flow, must be avoided.

Conclusions

If lymphedema is present, the application of massage therapy is contraindicated in the affected extremity and the trunkal area bordering the extremity (ipsilateral trunkal quadrant). Massage therapy is also contraindicated in these areas in patients who have undergone surgery involving the lymphatic system, but when lymphedema is not yet present (latency stage of lymphedema).

This is often the case in postmastectomy/lumpectomy patients who have also undergone removal or radiation of the axillary lymph nodes. The absence of visible lymphedema in these patients indicates that, although reduced by the surgical procedure, the transport capacity of the lymphatic system is still sufficient enough to remove water and protein from the tissues. The balance between the reduced transport capacity of the lymphatic system and the lymphatic loads may be fragile, and any additional disturbance may trigger the onset of lymphedema.
As previously discussed, massage therapy increases the lymphatic load of water (and often cells), and may further decrease the transport capacity of the lymphatic system by causing additional damage to those lymphatics still intact following surgical procedures.

In patients with primary lymphedema affecting one leg, massage therapy should not be applied to the contralateral extremity, since malformation of the lymphatic system may also be present in this leg.5

The application of massage techniques (those discussed, and any technique that may cause an increase in arterial blood flow) in lymphedemateous limbs and bordering trunkal quadrants may trigger the onset of lymphedema or worsen existing lymphedema.
In instances of upper-extremity lymphedema, massage therapy may be applied safely to the lumbar/gluteal area and to the lower extremities. Negative effects on lymphedema may result if massage strokes are apllied to the neck/upper trapezius area. Likewise, neck, thorax and upper-extremities may be treated with massage when lower-extremity lymphedema is present; the lumbar and gluteal areas on the opposite side, and the unaffected lower extremity, present areas “at risk” and should be treated with caution.

References
1. Consensus document of the International Society of Lymphology Executive Committee: The diagnosis and treatment of peripheral lymphedema. Lymphology 1995:28, pp113-117. 2. Eliska O, Eliska M. Are peripheral lymphatics damaged by high-pressure manual massage? Lymphology 1995:28, pp21-30. 3. Földi E. Massage and damage to lymphatics. Lymphology 1995:28, pp1-3. 4. Földi E, Földi M, Clodius L. The lymphedema chaos. Ann Plast Surg:22, pp505-15. 5. Földi M, Kubik S. Lehrbuch der Lymphologie. Gustav Fischer Verlag, Germany 1999. 6. Greenlee R, Hoyme H, Witte M, et al. Developmental disorders of the lymphatic system. Lymphology 1993:26, pp156-68. 7. Olszewski W. Peripheral Lymph: Formation and Immune Function. CRC Press, Boca Raton, FL 1985. 8. Tappan F. Healing Massage Techniques. Appleton and Lange 1988. 9. Weissleder H, Schuchhardt C. Lymphedema Diagnosis and Therapy. Kagerer Kommunikation, Bonn 1997. 10. Zuther J. Treatment of lymphedema with complete decongestive physiotherapy. NLN Newsletter 1999:11(2).

Lymphedema Compression Pumps

2009-09-17T07:15:00.000-07:00

Put a crowd of lymphedema patients, therapists and doctors together and nothing will start a heated debate like the topic of using pneumatic compression pumps for the treatment of lymphedema.

Compression pumps were at one time a standard of treatment for lymphedema. These older types referred to simply as compression pumps consist of an inflatable garment for the arm, leg, or foot and an electrical pneumatic pump that fills the garment with compressed air. The garment is intermittently inflated and deflated with cycle times and pressures that vary between devices. These antiquated devices have been replaced by intermittent/ sequential pumps which consist of numerous chambers that inflate one at a time while moving up the arm or leg. Due to complications such as genital lymphedema and possible further damage to existing superficial lymphatics, many patients and medical professionals are no longer in favor of using compression pumps to treat lymphedema.

Time for a new dialogue and re-evaluation?

Today, however, there is a new generation of compression devices coming in to the market that offer the possibilities of a safe and effective addition to our treatment arsenal.

My hat is off to two companies in this regard.

First, Tactile Systems for their Flexitouch Device and BioCompression for its development of pneumatic compression therapy that uses the Reid Sleeve Optiflow insert which has been demonstrated to not damage the superficial lymphatics.

Factors for Consideration in Using a Compression Pump

The question about compression pumps is not whether they are effective in the movement of fluid. This has been clearly demonstrated and without a doubt they are extremely effective. The central problems are the possible complications. The clinically demonstrated complications as mentioned above are (1) genital lymphedema because devices have not cleared the abdominal lymphatics before use of the pump and (2) damage to the superficial lymphatics. It is also my personal opinion that the use of pneumatic compression devices must not be marketed as a replacement for manual decongestive therapy by a certified lymphedema therapist or for a substitution in the use of compression bandaging… Rather, it should be used as adjunct for maintenance and should be included in the overall patient self-care program.

It is also important to understand the difference between treatment for arm lymphedema versus leg lymphedema. It is my utmost desire to provide important and independent information for patients as they decide whether or not to use a compression device.

Compression Pumps for Arm Lymphedema

It has been substantially demonstrated through various studies that the best treatment for arm lymphedema is actually a combination of manual decongestive therapy, compression bandages and the use of a compression pump.

In my personal opinion, I have no problem recommending this treatment modality.

Compression Pumps for Leg Lymphedema

The complications listed above have centered around the use of compression pumps for the leg lymphedema. Hopefully, the two new devices manufactured by Tactile and by BioCompression will resolve these issues.

Those of us with leg lymphedema desperately need some time of additional treatment option that not only helps but that we can feel totally safe using.

Contraindications for the use of a compression pump

A compression pump should not be used if:

You have an active infection
You have a blood clot or deep venous thrombosis
You have kidney or renal failure
You have congestive heart failure
You have body-wide edema
You have plueral effusions (lung fluid)
You have episodes of pulmonary embolism
You have Thrombophlibitis

Should I use a Sequential Pump?

Opinion Article - From a Certified Lymphedema Treatment Therapist

While there have been clinicians, therapists, and patients who have not had good results with pumps and do not recommend their use, hundreds of people have experienced great results with the proper use of the right pumps. Pumps are not for everyone, and success does depend on which pump is used, and the proper application of pumps. Pumps, like prescription drugs, or even like driving a car, if not used properly can cause damage, or will not achieve results. In providing lymphedema therapy for thirteen years, helping hundreds of people, I have never seen some of the problems some people are reporting. Many of the people I have worked with have successfully used their pump for five to ten years with no complications.

THE KEY IS USING THE RIGHT PUMP, THE RIGHT WAY.

Some therapists may tell you that pumps are a waste of money, that they do not work, that they do not help in opening up lymphatic flow, or that pumps make edema worse. Only part of this is true. When any clinician gives you information on clinical treatment, ask to see scientific clinic studies. Many “opinions” have been published, but no scientific clinical studies have been conducted or published that will back up these statements. There are however, many many scientific, clinical, published studies that prove the efficacy of pumps. Pumps also do not assist in opening up the lymphatics, nor were they designed to, nor are the recommended as such. Pumps are to be used as an alternative for bandaging, and MLD is applied to open up the lymphatic system. It is not appropriate for any clinician or patient to deprive you of any treatment that may really help you, by providing you with misinformation. If your disease is not properly treated and managed, serious health complications can occur. If a pump will assist you in accomplishing effective disease management, and your are given misinformation regarding their effectiveness, this is call for serious concern. Pumps have been clinically proven, beyond opinion, to help hundreds of thousands of people worldwide, but it is important to make sure you are a candidate, make sure you use the right pump, and make sure you use your pump correctly. It is not complicated, and I will review pump information below.

When reviewing pumps, look for a pump that contains ten or more chambers, operates on a short thirty-second cycle time, and applies graduated compression. The body operates on a pressure gradient system, so it is essential to obtain a gradient or graduated compression pump. Gradient or graduated means the pressure at the feet or hand is greater than the thigh or shoulder. Pressure starts at 60mmHg, and is about 1.5% less each chamber as compression moves proximal or towards the thigh or shoulder. Pumps that contain more chambers, and operate on a thirty second cycle versus sixty second cycle more closely mimics massage, and do not over compress the superficial lymphatics. Pumps that are not gradient, operate on a sixty second cycle and contain less than ten chambers can cause a reflux of fluid in the distal veins, and damage the superficial lymphatics. This has been proven upon review of pump compression during Doppler Ultrasonography. The result of this is pain, and edema that does not reduce but actually gets worse. Also, pressures should not be set higher than 60mmHg.

Doppler Ultrasonography shows that when external pressures are applied above 60mmHg, venous flow decreases rather than increases. The goal is to increase venous return in order to remove excess edema causing fluid. When venous return decreases, so does lymphatic flow.

Unless you have no other alternative, do not accept a pump from a supplier who is going to ship it to you or drop it off at your door step. Pumps should be set up in your home, and the provider should properly educate you on the proper use of the pump. If your health insurance company requires you to use an in-network provider who will not provide home set-up, have your physician include “home-set-up and patient education”, in his written prescription for your pump.

Pumps should not be applied over compression bandaging or compression stockings. They should be applied for about two hours in the morning, and two hours at night during treatment, and then as needed for continued edema reduction. Pumps should not be used during sleep over night, unless you are hospitalized, and your physician is directly monitoring treatment. I recommend the use of a Reid Optiflow, Jovi-Pak or Tribute for use with sequential pumps. These foam compression binders can be very effective in protecting the superficial lymphatics, and assisting the direction of lymphatic flow. Manual lymph drainage should also be applied either before and after pump therapy, or during pump therapy. If you have genital edema, or edema in the hips waist and abdomen, the LymphaPress pump has a bodysuit appliance that applies compression from the feet to the chest area. This has assisted my patients in significant abdominal reduction of edema.

You should not use a pump if you have edema throughout your entire body, if you have a blood clot, if you have an active infection, if you have (kidney)renal failure, if you have active cancer, if you have congestive heart failure, or if you are not applying manual lymph drainage. Pumps are also not normally recommended for babies, or children under age six.

For further study, information and lists of manufacturers please see:

Compression Pumps for Lymphedema Treatment

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)

2009-06-08T08:13:00.000-07:00

Related Terms: Manual Lymphatic Drainage, MLD, Comprehensive Decongestive Therapy, CDT, Complete Decongestive Therapy, Complex Decongestive Physiotherapy, CDP, Simple Lymph Drainage

Manual Lymphatic Drainage (MLD): is a unique, therapeutic method of stimulating the movement of fluids in the tissues. The gentle, rhythmic, pumping, massage movements follow the direction of lymph flow and produce rapid results. It assists the cutaneous lymphatics in picking up and removing not just fluids, but all the waste products, protein particles and debris from our system. It also is successful in breaking fibrosis and fibrotic areas of a lymphodemous limb.

This treatment was created and developed Danish therapists Dr. Emil Vodder and his wife, Estrid, in the 1930's and was introduced in Paris in 1936. They are also credit with creating a specialty of medicine called Lymphology.

First brought to North America in 1982, the school is located in Victoria, British Columbia, Canada. Before it was introduced the standard treatment course in North American was either a surgery called debulking or the use of compression machines wherein the limb was literally squeezed by pneumatic air pressure.

The sessions generally last about one hour and will continue for a duration of four to six weeks.

Comprehensive Decongestive Therapy (CDT) is used primarily in the treatment of lymphedema and venous insufficiency edema. It is a combination of MLD, bandaging exercises and skin care. CDT may also involve breathing exercises, compressive garments and dietary measures. A frequent indication for CDT is lymphedema caused by irradiation or surgery due to cancer. It can relieve edema, fibrosis and the accompanying pain and discomfort.

Also known as Complete Decongestive Physiotherapy (CDP), this treatment therapy was pioneered in the United States by Dr. Robert Lerner.

From a recent post I made on a lymphedema board 07/14/04

DECONGESTIVE THERAPY

I received an email request to describe what decongestive therapy is since I have mentioned it so many times. It is the treatment of choice presently used for lymphedema.

To understand how and why decongestive therapy works, first you need to undersand exactly how the lymph system is made up. We generally think of the lymph system as these “channels” the go throughout our body and are connected by lymph nodes. However, it is also comprised of an unblievable network of lymph capillaries that network under and through the skin layers our of body. This almost microscopic network collects fluids and channels it into the lymph veins to be filtered through the lymph nodes and eventually carried out of the body. In lymphedema, because of an impaired lymph system, fluid collects in the interstitial areas (tissues) between cells. This fluid is composed of proteins and electrolytes and even includes the liquid of blood plasma. You normally have about 15 quarts of this fluid in your system. With our condition, this liquid doesn't move as it should and eventually the affected areas swells from the excess fluid, the whole system becomes “clogged.”

Decongestive therapy is a massage technique that helps unclog the system. It gently moves this fluid, in the direction of normal body flow so that it can be eliminated. In unclogging the system, the tiny network of lymph capillaries are able to help move the fluid.

There are two basic types of decongestive therapy.

Also known as Complete Decongestive Physiotherapy (CDP) or Complex Decongestive Therapy (CDT).

After each session, your limb will be wrapped in compression bandages to prevent reswelling until the next session. Once the limb is down to the desired size, you will be measure for a custom made compression hosiery type garment and pressure sleeve.

WHAT HAPPENS WHEN LYMPHEDEMA IS NOT TREATED?

I sound like a broken record on urging everyone to get decongestive therapy, because for me, it came too late. By the time I had heard of this treatment my left leg (the worse one) was already beyond treatment. I have had three lymphedema therapists tell me that there was nothing that even this treatment could do.

Like most hereditary/primary lymhpedema patients (Milroy's Syndrome) my legs are not as large as lot I have seen. They are about twice the normal size. But, the left one is totally fibrotic, literally as hard as a rock. It is the hardest and most grotesque leg you would ever NOT want to have or see. As such, the infections, which have been plentiful and furious, especially during the past two years can only be controlled through months of IV antibiotics. Sometimes, I have even had to use a combination of Unasyn and Gentimycin.

It is also where the first of my two lymphomas appeared. I am now also loosing venous flow to my left foot because of the fibrosis. On my left ankle, I have an ominous and rapidly growing purplish nodular growth (soon to be biopsied). The change in this leg has been more dramatic and intense during the past year than all the other 50 years I have had lymphedema. What ever you do…get that lymphedema diagnosed early and get treatment immediately. I wish with all my heart that none of you have to experience the complications I now face.

TREATMENT FOR LYMPHEDEMA

Complex Decongestive Physiotherapy, (CDP) or Complete Decongestive Therapy (CDT) Manual Lymphatic Drainage

This treatment is a gentle light touch massage. This prevents damage to the tissues. It promotes lymph flow through the collateral (superficial) lymph vessels to channel the lymph into the abdominal area ( the “watershed”) and into normal functioning lymphatic vessels and nodes. These collateral lymph vessels are usually working normally and the problem lies in the deeper vessels which were damaged and scarred.

Bandaging

The therapist places compression bandaging around the limb. Often foam chip pads are placed under the bandaging to increase pressure on fibrotic area to break down scar tissue. These bandages stay on 24 hours a day throughout the treatment period. They come off only to shower, do skin care, assess the swelling reduction and to do the MLD.

Skin Care

Use a soap with a low pH., unscented and not antibacterial soaps. A good liquid soap is Cetaphil. The skin must be moisturized after bathing. Use a lotion like Eucerin or Nivea. If there are any irritations use an antibacterial cream. Always dry the area very well, and gently, after washing.

Exercises

An individualized exercise program will be given by the therapist to each patient. They will improve muscular contractions and joint mobility. There will also be strengthening exercises for the limb that will reduce muscle atrophy. Muscular contractions along with the low-stretch bandages provide constant counter pressure to keep the lymph fluid moving.

MANUAL LYMPHATIC DRAINAGE

Dr Vodder's Manual Lymphatic Drainage (MLD) is an advanced therapy in which the practitioner uses a range of specialized and gentle rhythmic pumping techniques to move the skin in the direction of lymph flow.

This stimulates the lymphatic vessels which carry substances vital to the defense of the body and removes waste products.

The first visit will include a consultation and the therapist will outline the number and frequency of sessions. Each session will last approximately one hour.

Where appropriate the therapist will work in conjunction with your medical practitioner.

THE HISTORY OF MANUAL LYMPHATIC DRAINAGE (MLD)

During the early 1930's Dr Emil Vodder created a unique range of movements which brought relief from chronic conditions such as sinus congestion and catarrh.

Since Vodder's pioneering work, Manual Lymphatic Drainage has spread world-wide and has become a popular treatment in many European hospitals and clinics.

MLD is now beginning to gain acceptance in the U.K. as a component in the treatment and control of lymphoedema.

The Benefits Of Manual Lymphatic Drainage

Manual Lymphatic Drainage:

is both preventative and remedial and can enhance your well-being is deeply relaxing

promotes the healing of fractures, torn ligaments, sprains and lessens the pain

can improve many chronic conditions: sinusitis, rheumatoid arthritis,scleroderma, acne and
other skin conditions.

may strengthen the immune system

relieves fluid congestion: swollen ankles, tired puffy eyes and swollen legs due to pregnancy

is an effective component of the treatment and control of lymphoedema and assists in conditions arising from venous insufficiency

promotes healing of wounds and burns and improves the appearance of old scars minimizes or reduces stretch marks

Antibiotic Preventative Therapy for LE Related Cellulitis

2009-05-19T07:22:00.000-07:00

Antibiotic Preventative Therapy for LE Related Cellulitis
May 11, 2009

The protocol I use and recommend comes directly from all my doctors over thelast forty years including infectious disease doctors, so it isn't just alayman's suggestion. It is also supported by several of our well known LEdoctors that I have discussed it with.You can not treat cellulitis in an individual as if it was just a simpleinfection. One must remember

(1) A lymphedema limb is a immuno-compromised limb.

(2) As such any infection must be treat immediately to prevent spread anddditional lymphatic damage and complications such as gangrene and/or sepsis. Because of the limb being immuno-compromised the infection WILL spread rapidlywithout immediate care.

(3.) When you do go to the doc, they will look at the leg and prescribe sometype of antiibiotic. And...guess what????? When they do so, they don't have aclue as to the specific bacteria that is causing the infection.

There are only two ways you can tell the specifics. First, if you took anactual biopsy/culture of the infected area. This is almost never done anymore and is absolutely not what a LE patient needs to have - an open wound in the midst of infected tissue.

The second way is to do a blood culture. But, the only way you can identify thebacterium in a blood culture is if you are already septic or rather if theinfection has become systemic. You must in no uncertain terms wait for this tohappen.

Finally, time is absolutely essential here. Here's the scenario about waitingthat so many have expressed.

You call your doctor. Generally, they will/might say that can't see you today -perhaps tomorrow - perhaps whenever. To wait is not acceptable.

Or - they do tell you to come in and they prescribe an antibiotic as I saidpreviously without identifying the bacteria.

Or - they will say go to the ER. Here's the problem with that. In a leadingCanadian hospital, they found that cellulitis was incorrectly diagnosed andimproperly treated in 30% of the ER cases in their distinguished hospital. Thisis just my opinion - but that isn't a record I frankly would want to put my lifeon the line for.

Then you wait, possible again for hours. Then, more and more they give you abag of cancomycin and send you home.

This is bad for two reasons:

(1) Vanco should be used as a last line antibacterial defense. Use of it as animmediate frontline med is what is truely helping create the super duper bugs.

Bacterial infections fall into two broad groups. What is called gram-positive or what isreferred to as gram-negative. What most doctors would do is presribe a longer term broad spectrum antibiotic that is capable of hitting both types of bacteria.

(2) Giving you one bag of Vanco and sending you home very well could be aprescription for disaster. Most cellulitis is simply not going to be eliminatedby one bag of super antibiotic.Why? Well, first if you have fibrosis, this is going to make it very very hardfor the antibiotic to penetrate to areas where the bacterial may be hiding. One"hit" may not do the job.Secondly, we are talking about limbs that are greatly enlarged with a lot ofextra fluid - greatly diluting the antibiotic.

Lymphedema Treatment

Management of limb lymphedema

Management of limb lymphedema.

Source

Abstract

Keywords: Lymphedema; Treatment; Physiotherapy; Low stretch bandage; Compression

Comprehensive decongestive therapy in postmastectomy lymphedema

Comprehensive decongestive therapy in postmastectomy lymphedema: An Indian perspective.

Source

Abstract

2010 Georgia Lymphedema Education and Awareness Program

Baby Kayden in Oklahoma

Understanding the Lymph System

12th State of Georgia Lymphedema Awareness Program

Lymphedema and the Use of Diuretics

Diuretics Definition

Lymphedema or Edema?

Why not use diuretics for lymphedema?

Diuretics and Lymphedema

New Lymphedema Treatment Clinic - Myrtle beach, Souther Carolina

Lymphedema Awareness Atlanta Georgia

Lighthouse Lymphedema Network

Finding a Lymhedema Therapist

Lymphedema Compression Pumps

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)

Antibiotic Preventative Therapy for LE Related Cellulitis

Keywords:
Lymphedema;
Treatment;
Physiotherapy;
Low stretch bandage;
Compression