Living with Lymphedema Can be Difficult
Disorder Can Cause Extreme Swelling in the Arms and Legs
Richard Morris was fairly active before he was diagnosed with lymphedema four years ago. He liked to walk, swim, and take weekend trips with his wife. But the swelling in his legs made it difficult to move and he couldn't get in the water anymore.
Lymphedema occurs when the lymph system doesn't function properly. The lymph system is a network of lymph nodes, lymph ducts, and lymph vessels that move two to three liters of lymph fluid each day.
"The lymph system is like a waste management system," said Tina Hammond, a physical therapist assistant who is also a certified lymphedema educator at Washington Hospital. "Every cell in the body produces waste as it goes through its normal metabolic process. The lymph system cleans the body of toxins, poisons, and other waste products."
The lymph fluid flows through the lymph system and gets pushed to the lymph nodes by normal body and muscle movements. The lymph nodes are small, oval-shaped organs that are located throughout the body and linked by the lymph vessels. They serve as filters and are an important part of the immune system.
Hammond said about 80 to 90 percent of the lymph vessels are just below the surface of the skin, above the muscle and fat. When the lymph system is not functioning properly, it backs up, just like a sewer system, and the lymph can seep through the pores of the skin.
"The fluids in my body would come out the pores of my leg," Morris said. "My leg was so swollen. It was twice the size of my other leg."
While his lymphedema was caused by a wound on his leg, a common cause is removal of the lymph nodes, generally for cancer treatment.
"If your lymph nodes are destroyed by radiation treatment or removed, you can develop lymphedema," Hammond said. "You can also be born with it."
Primary lymphedema can be present at birth or develop at the onset of puberty or in adulthood, and has no known cause, she explained. Secondary lymphedema, or acquired lymphedema, can develop as a result of surgery, radiation, infection, or trauma. It is most often linked with breast cancer treatment, according to Hammond.
There is no cure for lymphedema or even medication that can be taken to reduce the symptoms. Treatments include massage, manual drainage, skin care, and compression. In very extreme cases, surgery may be needed to remove some of the abnormal lymph tissue.
"It is a life-changing condition that requires maintenance," Hammond said. "While it can't be cured, it can be improved and managed through a number of techniques."
Massage therapy by someone like Hammond who is specifically trained for lymphedema can help to reduce the swelling. If done correctly, massage can help to move lymph fluid out of the swollen area into an area with working lymph nodes and vessels or where it can be drained. Patients can be taught to do this type of massage therapy themselves.
A compression device that wraps around the arm or leg and applies pressure in intervals can be effective. The pumping action helps to move the lymph fluid through the lymph vessels and prevent it from building up in the arm or leg. Compression garments that are made of fabric that puts a controlled amount of pressure on an area can also help.
Bandaging an area that has been drained can help to keep it from refilling with fluid. Skin care techniques help to prevent infection and keep skin from drying and cracking.
Diet and exercise can also help, although Hammond cautions that vigorous exercise can cause inflammation, which exacerbates lymphedema.
"I did the massage and compression," Morris said. "Now the swelling is down, so I just go in twice a week to get my bandages changed."
Hammond works with patients like Morris on a regular basis helping them to control their symptoms through a combination of treatments.
"It's important for people with lymphedema to learn as much as they can about controlling their condition," she said. "It can affect your appearance and self-image, your sense of identity, even your ability to work. It can be very disabling, so proper management is essential."
Hammond teaches the free Lymphedema Education Series at Washington Hospital twice a month. It is open to anyone who is interested in learning more about the lymph system and lymphedema. The class is held on the second and fourth Tuesday of every month, from 3 to 5 p.m., and covers general information about the anatomy and function of the lymph system. It is held in the Washington Women's Center Conference Room at 2500 Mowry Avenue (Washington West).
To learn more about the education series or lymphedema services offered at Washington Hospital, visit www.whhs.com/cancer/lymphedema/