Lymphedema is an accumulation of protein-rich lymph fluid in soft tissues in one or more areas of your body due to a direct problem with the Lymphatic system, or associated with other medical concerns negatively affecting the Lymphatic system.
The lymphatic system consists of a series of lymph nodes and vessels throughout your body responsible for filtering Lymphatic fluid. Lymph fluid is regular body waste products that your circulation system does not handle including: protein, water, fats, and cell debris. Lymph vessels distributed throughout your body carry this fluid to your lymph nodes. Lymph nodes filter these waste products and ultimately return the fluid to the vascular system at drainage points under the collarbones.
If your lymphatic system is somehow damaged or impaired, this lymph fluid may accumulate and cause Lymphedema. Some of the signs and symptoms you may experience include:
- Sensation of: “Tightness,” “Heaviness,” “Discomfort,” “Throbbing”, “Aching pain;”
- Weakness, decreased endurance, fatigue, and decreased strength with use of the affected extremity(s);
- Swelling that may come and go. The swelling may progressively worsen over time;
- Problems with returning to functional activities in your daily life: return to work, home activities, leisure activities;
- “Anger”, “worry”, “anxiety” over development of this condition;
- Decreased quality of life.
The Normal Lymphatic System
The normal lymphatic system consists of lymph vessels, nodes and tissue which collect, transport and filter approximately 10% of our body’s waste fluids back to the heart. The lymphatic system also plays a vital role in our body’s immune system producing lymphocytes to kill bacteria, helping the body prevent and fight infection.
Lymphatic vessels are channels that contain lymph fluid. The lymph fluid is comprised of white blood cells, protein, water and waste products from tissue.
Lymph nodes are the “filtering stations” of the lymph system. All lymph fluid passes through these nodes which act as waste purifiers. Lymph nodes are primarily located at the base of the neck, armpits, groin and deep in the abdomen. The lymph nodes and vessels are interconnected creating a system. The filtered fluid is returned to the venous system just above the heart under the collarbones.
Lymph tissue is also found in the tonsils, thymus, spleen, intestinal wall and bone marrow.
What Causes Lymphedema?
Primary Lymphedema is a defect in the lymphatic system at birth. There are two types of primary Lymphedema:
● Hereditary (familial / genetic)
● Sporadic (non-familial)
The majority of Primary Lymphedema’s appear before the age of 35. A primary Lymphedema may develop at any point in life and occurs most often in the lower extremities.
Secondary Lymphedema may develop as a result of surgery, radiation, infection, chronic wounds, cancer or trauma. Lymphedema is seen after specific surgeries including: breast, gynecological, head and neck, prostate, testicular, bladder or colon cancers. Secondary Lymphedema may also develop in individuals with other medical concerns including: chronic venous insufficiency, infections, fractures, various traumatic injuries, and parasitic infections. Parasitic infections may develop in Canadians who travel abroad and are infected by Filariasis.
Often in Cancer-related surgeries, lymph node removal disrupts lymphatic flow in the areas associated with the surgery. For instance, breast cancer surgeries may affect the arm and chest wall on the surgical side. Research suggests risk of Lymphedema in Breast cancer survivors with an auxiliary node dissection is approximately 20-40%. Sentinel node procedures is a more recent surgical development, where less lymph nodes are removed, causing less damage to the lymphatic system. Recent research suggests risk of Lymphedema is reduced to <5% from this procedure. Risk of Lymphedema is not exclusively associated with Breast Cancer care. For instance, in prostate or gynecological cancer, the leg and pelvis on the surgical side is at risk.
Secondary Lymphedema can develop immediately post-operatively or weeks, months or even years later. If Lymphedema occurs it should be considered a chronic medical condition, which will likely require ongoing self-management.
What are the Symptoms of Lymphedema?
Some of the signs and symptoms you may experience include:
- Feeling of: “Tightness,” “Heaviness,” “Discomfort,” “Throbbing”, “Aching pain;” in one or more areas of the body. Your skin may feel tight which in turn may affect your flexibility or mobility of the body part.
- Weakness, decreased endurance, fatigue, and decreased strength with use of the affected extremity(s). You may notice your affected extremity does not have the strength to complete activities you did before, or your may notice your affected extremity(s) fatigue quicker with activity then the unaffected side. This could impact your ability to complete work activities, exercise and leisure pursuits, to activities around the home.
- Swelling that may come and go or swelling may progressively worsen over time. You may notice your veins may not be as visible when your affected region swells.
- Problems with returning to functional activities in your daily life: return to work, home activities, and leisure activities. You may notice your jewelry worn on the affected extremity becomes too tight. It may be more difficult to fit a shirt or blouse.
- “Anger”, “worry”, “anxiety, or “sadness” over development of this condition. Many clients who develop Lymphedema report significant psycho-social concerns that need to be addressed.
- Decreased sense of quality of life.
Stages of Lymphedema
Lymphedema develops in a number of stages, from mild to severe. The International Society of Lymphology (PDF article) identifies Lymphedema in 3 main stages:
Stage 1: Reversible
Tissue is still at the “pitting” stage which means that when pressed by fingertips, the area indents and hold the indentation. Usually the swelling decreases with rest, and the affected extremity is often at or near normal upon waking in the morning. Elevating the limb typically reduces the swelling.
Stage 2: Spontaneously Irreversible
The tissue now has a spongy consistency and is “non-pitting”, meaning the tissue now bounces back instead of leaving an indent. This is called fibrosis and typically goes along with an increase in volume of the limb. There is an increased risk of infection.
Stage 3: Lymphostatic Elephantiasis
This stage marks an extreme increase in size. Tissue continues to harden and become increasingly fibrotic. Clients are at even further risk of recurrent infection.
How Does Lymphedema Cause Infection?
Lymph fluid is rich in albumin, a thick, colorless, viscous (sticky) protein substance. When lymphatic fluid is trapped and flow impaired, the protein-rich fluid leaks and becomes stagnant in surrounding tissues causing Lymphedema to develop or worsen. This protein-rich fluid is a favorable environment for the growth of bacteria and ultimately increases risk of infection. An infection may develop due to a break in the skin, which allows an avenue for bacteria to enter the limb.
Signs and symptoms of infection include: redness, pain, rash, increased temperature and localized swelling. These symptoms may occur suddenly over a matter of hours and may be accompanied by flu like symptoms such as fever, reduced energy and aches / pains. If you suspect an infection you should see a physician immediately for assessment and treatment. Oral antibiotics or intravenous antibiotics may be necessary to combat the infection.
The risk of infection does not go away once you have Lymphedema. Vigilance to maintain healthy skin integrity is extremely important to reduce the risk. Active treatment of an underlying Lymphedema is also extremely important to reduce risk of infection.
Lymphedema Treatment
Lymphedema is treated by Complete/Combined Decongestive therapy (CDT). CDT incorporates the following:
- Manual lymphatic drainage;
- Graduated compression bandaging;
- Home exercise/activity program;
- Skin care education;
- Lymphedema garment fitting services;
- Client self-management with follow-up as indicated.
Manual lymphatic drainage (MLD) is a gentle, hands-on, manual therapy to facilitate lymphatic drainage and softening of tissue by gentle mechanical stimulation of lymphatic flow. Your therapist will focus on decongesting the limb through manually stimulating lymphatic fluid flow to adjacent regions of your body where the lymphatic system is otherwise unaffected. MLD can assist with reducing tissue pressure helping to reduce discomfort or pain that may occur in Lymphedema.
 Graduated compression bandaging involves using a series of padding materials in conjunction with medical bandages to stimulate lymphatic flow, prevent re-accumulation of lymphatic fluid, and soften tissues. The graduated bandaging provides an incremental change in compression to encourage lymphatic fluid drainage. These bandages are worn on the affected extremity(s) between sessions for up to 24 consecutive hours before being re-bandaged. Your affected extremity(s) will be bulky with your extremity(s) bandaged, but our clients are often pleasantly surprised by the mobility the bandages allow for the affected extremity. Clients are encouraged to wear loose fitting clothing during acute treatment to allow for bandages to be worn under clothes.
Home exercise/activity program is designed to stimulate lymphatic drainage and decongest the affected extremity(s) through activity in combination with graduated compression therapy. The goal is to activate the muscle pump through targeted exercise and encourage fluid decongestion. An activity program can assist with stress management, weight management, improved strength, endurance, and mobility. Your therapist will develop a program to meet your medical, physical, and functional restrictions. Your therapist will work with you to develop a plan to gradually return you to your leisure activities.
It is important to include a fitness program to assist in Lymphedema management. A routine walking program of 3-4 walks per week for at least 15-20 minutes encourages improved lymphatic flow and improved cardiovascular fitness. Aquatic exercise program is another opportunity for our clients. A water based program offers a unique opportunity to utilize the natural physiological principles of water to stimulate lymphatic decongestion. Our therapists will encourage a fitness program around activities our clients enjoy.
All of our client’s should receive medical clearance prior to starting a new exercise program.
Skin care education focuses on promoting good skin integrity to reduce risk of skin breakdown and infection. Lymphedema can apply stress and pressure to the overlying skin tissue, resulting in loss of elasticity and increased risk of skin breakdown. Your therapist will work with you to reverse this process through diligent care and management.
Lymphedema garment fitting services involves measuring and fitting our clients with appropriate compression garments to help with long-term Lymphedema management. Compression garments include consideration of both daytime and night-time compression needs. For more information on Compression garments.
Client self-management and follow-up is the most important part of treatment! As Lymphedema is a chronic medical condition, it is extremely important for our clients to learn self-management techniques. A self-management plan needs to be designed to meet your specific needs! A self-management plan may include: education on self-bandaging, exercise, manual lymphatic drainage, skin care, compression garment use and care, activity modification, and steps to prevent flare-up. You are the most important person in this process! Our team will work with you to develop a treatment and management plan that will meet your needs in daily life. Clients are strongly encouraged to follow-up with our team to ensure long-term management of this condition. Once our clients have established a file with our clinic, our team is available as needed to assist you in any issues that arise with your Lymphedema.
What happens with Lymphedema over time? As in many medical conditions, the condition is different in some way for each and every client we work with. Some of our clients develop Lymphedema many years after surgery, while others develop Lymphedema within weeks of surgery. Some of our clients find their affected extremity(s) worsens very rapidly, while others see it as a minor issue or somewhat of a nuisance. Compression garments become an intricate part of long-term management of Lymphedema. Our clients may incorporate an exercise program or bandaging to help with management. Our therapists will help our clients modify daily activities that may be flaring up the condition through assessing the activity and making adjustments to how our client participates in the activity.
The most important part of managing Lymphedema is your ability to return to your activities in daily life.
Is Calgary Lymphedema Rehabilitation and Consulting Services a medical clinic?
No. Our clinic is a rehabilitation clinic staffed with therapists and a surgical garment fitter. We do not have physicians on staff, and therefore, do not diagnose Lymphedema. We will work in collaboration with your physician to provide you with treatment for your lymphatic-related concerns. Our therapists do request your permission to contact your physician as needed during program.
How do I schedule an appointment or if I have further questions?
Our clinic works on an appointment basis only! We do not accept walk-ins! To schedule an appointment, please contact us. An appointment can usually be scheduled within a couple of days.
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