Living Well with Lymphoedema
The Lymphatic system acts as a compensatory system when the venous system is failing to return all the blood that it should to the heart. The resulting accumulation of fluid (oedema) in the tissues is drained by lymph vessels. The system has a major role in fighting infection. Lymph nodes are often checked for cancer spread, which suggests that lymph nodes have a role in trapping abnormal cells and microscopic foreign bodies.
The lymphatic system consists of collector vessels, lymph nodes, the thymus gland, the adenoids and the tonsils. Lymphoedema occurs when the system's compensatory mechanisms fail and there is accumulation of protein reach fluid in the tissues.
There are several reasons for this to happen. There could be poor circulation, abnormality from birth, or it could arise as a reply of cancer or cancer treatment where removal of lymph nodes literally obstruct drainage. There could be parasitic infestation which damages the lymph channels. This is the commonest cause of lymphoedema in the world, but is not known to be present in Jamaica.
In Jamaica, we see lymphoedema arising primarily from cancer treatment and from poor circulation resulting in swollen legs. Poor circulation, refers to faults in the veins returning blood to the heart. These faults include damaged valves and often follow blood clots.
By far, the most effective treatment for lymphoedema is complete decongestive therapy (CDT). This treatment consists of manual lymph drainage, followed by compression bandaging to keep the swelling from recurring. Education on skincare and exercise plays a vital role in the success of this approach.
A trained lymphoedema therapist with a detailed understanding of the lymphatic system uses the hands to gently direct fluid through clear pathways to rid the area of accumulated swelling. This is immediately followed by special bandages and paddings which are applied to enhance the reduction of swelling. These bandages are worn continually and are refreshed daily until the desired reduction is achieved.
The contraction of muscles against the external compression of bandages aids the lymphatic vessels to also contract, causing the lymph to flow and drain away swelling faster. During CDT, therapists teach patients a series of exercises that can be done while wearing the bandages.
When the swelling is reduced, compression garments are fitted to preserve the reduction rather than to reduce the swelling. Exercise and general activity is encouraged to help the lymph flow. Water exercise is particularly useful, as water provides pressure against the skin. Otherwise, when doing dryland exercises such as cycling, walking or weight training, exercise should be performed with the compression garment on.
Special precautions can help to reduce the risk of swelling. These include the avoidance of heat, which seems to promote swelling. Infection should be avoided by keeping the skin clean and properly moisturised using a low pH balanced lotion. Any sign of infection should be addressed with urgency to reduce the more serious infection called cellulitis.
CDT has helped to improve the quality of life of lymphoedema patients. If a consumer received treatment purported to be Complete Decongestive Physiotherapy (CDP) and did not improve, it was probably because the treatment was not derived from an accredited school of training. Alternatively, the consumer may have discontinued the components of the maintenance phase of self-management which could easily be addressed by restoring the routine necessary to achieve change.
Lymphoedema is a chronic, incurable condition resulting from inadequate lymph drainage. It is usually found in an arm or a leg. If you have been diagnosed with Lymphoedema or feel that you might be showing early signs, it is a good idea to begin CDP as soon as possible because CDP works best when it is started early. CDP takes a very determined, motivated patient to use this treatment to its greatest advantage to live well with lymphoedema.
- Dr Bernadette Bryan-Frankson is a doctor of Physical Therapy and a US Certified Lymphoedema Therapist with experience in addressing lymphoedema of the arms, legs and head and neck regions.