Treating Lymphedema

Lymphedema is swelling, most often in the arms or legs. It happens when the lymphatic system does not drain properly. The fluid cannot be moved out of the arm or leg efficiently, causing swelling. Lymphedema may affect just one arm or leg, or it may occur in both arms or both legs. The lymph fluid is full of protein, which makes lymphedema hard to treat. The protein acts as a magnet for more fluid, which causes more swelling. This static swelling encourages infection.

There are two types of lymphedema: Primary and Secondary.

• People are born with primary lymphedema. It may be seen at birth or later during puberty or adulthood.
• Secondary lymphedema is more common and is caused by an injury or disease. For example, surgery or radiation therapy may injure the lymphatic system.

Lymphedema often happens after surgery when lymph nodes are removed or after radiation therapy. It can appear weeks, months or even years after the surgery. It is not always clear why some people have swelling while others do not.

The lymphatic system is a major part of the immune system, which fights disease and infection in the body. The lymphatic system makes and moves lymph fluid around the body. The lymphatic system has three jobs:

• Remove extra fluid from body tissues.
• Absorb fat and move it to the blood.
• Defend the body against disease by making white blood cells.

The physical therapist will evaluate you and create a treatment plan. It may include one or more of the following:

Skin care
Avoid injury and infection. Practice good hygiene, and put on moisturizing lotion. We will teach you how to care for your skin.

Massage
Two basic types of massage are used to treat lymphedema:

• Manual lymph draining is a precise and gentle form of massage that helps move the fluid to other parts of the body.

• Soft tissue mobilization (or myofascial release) is a type of massage used to loosen scar tissue and other tightness that might contribute to the swelling. Sometimes massage is taught to patients or family members to do at home.

Exercise
You may be referred to Baptist MD Anderson’s Rehabilitation Services. They can teach you how to do stretching exercises to loosen up the tissues in the area or special exercises to help move the fluid. You will get written instructions for these exercises.

Bandaging
Cotton, low-stretch bandages apply constant pressure on the limb. Bandaging is usually combined with other methods of treatment.

Compression garments
Elastic fabric garments, similar to a girdle or support stocking, put pressure on the arm or leg to help move fluid and keep new fluid from collecting.

Medicine
Sometimes doctors prescribe antibiotics or other medicines as part of the treatment plan.

Surgery
For many patients, surgery may help treat lymphedema.

Although there are cases when lymphedema has suddenly gone away and not come back, most patients always have it and need long-term management.

Ask your doctor about lymphedema surgery. Patients who have had less severe lymphedema for a shorter time tend to have better results. Many patients improve; however, every patient is different. The surgery does not help every patient. Do not expect a complete cure.

Many patients improve; however, every patient is different. The surgery does not help every patient. Do not expect a complete cure.

The procedure takes about four to six hours while under general anesthesia.

The arm or leg is wrapped loosely with a bandage, which needs to be changed daily for about four weeks. There is usually little pain, and you may have to limit some of your activities or movement after the surgery. After four weeks, a compression stocking can be worn and lymphedema therapy can resume.

As with any surgery, there are risks such as infection. Your doctor will talk with you about all of the risks.

The procedure may not help the lymphedema, and you will have small, permanent scars.

The procedure may help lessen the effects of lymphedema and keep it from getting worse. You may have fewer problems with pain, heaviness and infection.

Although you may improve with surgery, continue treatment to get the best result. For example, wear the compression garment, have massages, care for your skin and exercise.