Edema is a symptom. Lymphedema is a disease. What does this mean for you?
Lymphedema is an abnormal accumulation of water and protein (swelling) in the superficial tissues of the body. The most common cause of lymphedema is surgical interventions that involve the lymphatic system, i.e. breast cancer surgery and removal of lymph nodes. However, this can also occur early in life, during and after treatment for other types of cancer, after trauma, or after a blood clot. Lymphedema is also common in developing countries because of parasites carried by different types of mosquitoes. This swelling will progress if not treated. Currently there is no cure for lymphedema.
Research shows that 1 in 8 women will develop breast cancer during the course of their lives. 75% of these women will seek traditional treatment, including surgery, chemotherapy, and/or radiation. Of this percentage of women, 42% will develop some degree of lymphedema at 1-year post-treatment and 50-75% at 5-years. The incidence of lymphedema is 140-250 million worldwide and 2-3 million in the US.
Lymphedema is treated with Complete Decongestive Therapy (CDT) and involves 4 components: Skin Care, Manual Lymph Drainage, Compression, and Decongestive Exercise.
Good skin care and overall hygiene is essential because it reduces the chance of bacterial or fungal growth. It is important to bathe daily and moisturize the skin. Dry skin can lead to cracking, which results in increased risk of infection. Low pH lotions, such as Eucerin or Curel, are recommended.
A manual therapy technique called Manual Lymph Drainage (MLD) allows for re-routing of the flow of excessive lymph fluid . This technique feels like a massage and is performed during physical therapy treatment sessions. This can also be taught for self-performance at home
Compression is used after manual lymph drainage to maintain the reduction of edema that occurred during the treatment, prevent re-accumulation of fluid, and to break down scar tissue. Short stretch bandages give strong support while the patient is active. Once reduction of lymph fluid is maintained, the patient will transition to compression garments, which the patient will wear daily. These can be purchased off-the-shelf or custom sized to the patient.
Decongestive exercise is performed to improve circulation of lymph fluid. Range of motion exercises will be performed initially and may be progressed to more aggressive strengthening exercises prior to discharge from physical therapy services. Deep breathing is also important for the flow of lymph fluid.
The key to the success of Complete Decongestive Therapy for the treatment of lymphedema is patient compliance. Lymphedema requires lifetime management. It is important to develop a relationship with a physical therapist trained in lymphedema management. If you think you have edema as described above and would benefit from evaluation, talk to your physician about a referral to a lymphedema trained physical therapist, such as those at Jersey Shore Hospital and Tiadaghton Health Services.
Susan Smith, PT, is a Physical Therapist at Tiadaghton Health Services. Susan can be reached by calling 570-748-8034.