LYMPHEDEMA & EDEMA MANAGEMENT

What is lymphedema?

Lymphedema is a pathological condition in which the lymphatic system (lymph vessels or lymph nodes) does not function effectively. This makes the system’s transport capacity insufficient to remove the normal lymphatic load (mechanical insufficiency).

This usually leads to fluid and protein loading into the intercellular space, resulting in the clinical signs of lymphedema, i.e. swelling of the area and accumulation of lymph. If lymphedema occurs in the intestinal wall, the removal of long-chain fats in the intestinal lymphatics is disrupted.

Practically, edema, which is due to some insufficiency of the lymphatic system, has been experienced by all of us at some point in our lives, and it is nothing more than “swelling” after an injury or other pathological condition. However, a healthy lymphatic system manages to reverse the situation in a few days, restoring the normal picture again, as it manages the lymphatic load successfully. When this restoration to normality is not possible, we have pathological and chronic lymphedema.

Lymphedema, as mentioned above, is due to some abnormality in the normal form, quantity and function of the lymphatic vessels or lymph nodes. Such an abnormality occurs in 2 cases, which are also the categories of lymphedema.

A) Primary lymphedema: In this case, the lymphatic system is congenitally anatomically unique or malformed. For genetic reasons, a person may have fewer or dysfunctional lymph vessels/lymph nodes in one or more areas.

The result is that at some point in a person's life, the lymphatic network becomes inadequate in managing the lymphatic load, resulting in the appearance of persistent edema, which becomes chronic and is now characterized as lymphedema.

If primary lymphedema occurs in children or adolescents and manifests itself at ages up to 35 years, it is called early, while if it occurs in people older than 35 years, it is called late primary. It is characteristic that most of the time the onset of lymphedema occurs after a minor injury or even simple mosquito bites.

B) Secondary lymphedema: Secondary lymphedema occurs in adults after a serious injury to some part of the lymphatic system.

The concept of injury also includes the most common cause, which is none other than the surgical removal of neoplastic lymph nodes (lymph node dissection) or their irradiation as part of a treatment plan for cancer patients.

Of course, the above does not rule out the occurrence of lymphedema after a serious accident, where a large part of the lymphatic network may have been extensively or irreparably injured.

In any case, we must mention that lymphedema can appear from 2-3 to 20 or 30 years after a process of injury to part of the lymphatic vascular system.

Lymphedema can occur anywhere there are lymph vessels. In other words, it can occur literally anywhere in the body. Of course, the greatest frequency is in the lower extremities, followed by the upper extremities, while it is not uncommon for us to have swelling in the trunk and genitals.

The symptoms of lymphedema depend on the stage of the swelling.

First of all, it can be generalized (e.g. the entire lower limb) or local (e.g. only the foot).

The early stages of lymphedema are characterized by a soft, easily movable, palpable swelling. However, the presence of swelling alone is not enough to make the diagnosis. There are several diagnostic tests, such as the Stemmer sign, palpation, and observation, which will give us a reliable characterization of lymphedema.

Other symptoms of lymphedema, which exist for a longer period of time, are the proliferation of connective tissue resulting in the gradual hardening of the edema, hyperkeratosis and epitheliomatosis.

We may also have thickening of the skin, excessive increase in the volume of the affected limb (elephantiasis), lymphorrhea, melanocytosis, lipid deposition, etc.

Lymphedema, if not treated effectively or even worse if neglected, goes through all the stages, sometimes ending in the 3rd stage of elephantiasis. Thus, a 1st stage lymphedema with a soft and easily treated swelling, can easily become a hard, fibrous, oversized brownish and difficult to manage swelling.

There are many problems associated with the development of lymphedema. To begin with, we will mention the most dangerous ones, which are summarized in the fact that the area with the edema has significantly reduced immune defense against possible infections.

Thus, a simple scratch on already sensitive skin can very quickly result in an erysipelas-type infection or inflammatory cellulitis, conditions that are painful and dangerous for the person's overall health.

However, neglected lymphedema also has an impact on appearance, which has both physical and psychological implications. A severely swollen leg or arm can be a reason for a person to start avoiding social exposure. Even worse, a lymphedema condition in the genitals, an area sensitive in all respects, can become the cause of serious problems in the sexual self-confidence and psyche of the patient.

Finally, we should not forget that as lymphedema progresses through its stages of development, it also causes various problems in the person's daily life.

In the 2nd and 3rd stages, it becomes increasingly difficult for the individual to choose clothing and footwear, as the problem of unevenness between the 2 sides of the body must be addressed, especially in localized lymphedema.

Lymphedema and the treatment process

Lymphedema is a completely manageable condition. Even neglected lymphedema can, with appropriate treatment, return to a relatively normal state, restoring normality to the individual’s daily life. Obviously, the earlier the treatment plan begins, the better the prognosis for the development of the edema.

Biofeedback applies the model of Comprehensive Decongestant Therapy (CDT) and Lymphatic Drainage (MLD).

The Lymphedema manager of our center, Mr. Triantafyllou Evripides, is a professor of the integrated method in Greece on behalf of the largest seminar center, Epimorfosis.

The therapeutic process includes the following steps:

  • Update process

During this first meeting with the lymphedema specialist, you will receive a detailed presentation and explanation of your condition. Through a history taking, detailed evaluation, and physical examination, the picture of your lymphedema becomes clear to you.

At the same time, during this first appointment, the treatment plan will be drawn up, its cost will be calculated, and any possible questions you may have will be answered. This way, you will know from the start what will be done, how much it will cost, how long it will last, and what you should expect from this process.

  • What does a typical session include?

Lymphedema management sessions first include assessment and reassessment. In short, the therapist assesses the initial condition and systematically monitors the course of treatment with various measurements and clinical tests.

Then follows the purely therapeutic part. With specialized techniques and a special method, the excess lymphatic load is removed from the area, enabling the lymphatic system to function and create collateral circulation for lymph management.

The lymphatic drainage process is (and should be) gentle and painless, so as not to cause spasm of the lymphatic vessels. Also, the therapist must have excellent knowledge of the lymphatic network in order to drain the lymph in the right direction.

Finally, in each session, a compression bandage is applied to maintain the result until the next session. Using special materials and a specialized method, the therapist creates a graduated compression to drain the lymph, combined with muscle activation.

  • How long does a treatment plan last?

The duration depends on the clinical picture of the lymphedema.

While stage 1st lymphedema can return to normal levels in just 3-4 sessions, advanced lymphedema will require 10-12 treatments before it is ready to accept compression garments.

Possible complications, such as an infection or inflammation, may lengthen the overall duration of treatment.

  • Compression garment

After the end of the therapeutic process, a specialized graduated compression garment should be measured and manufactured, which the patient should place according to the therapist’s instructions.

The placement of the compression garment and annual therapeutic maintenance of the area with lymphatic insufficiency will maintain the results of the initial treatment, facilitate the lymphatic system to return to proper function, and allow the individual to return to the normal daily routine and functionality they had before the lymphedema appeared.

LIPOEDEMA

Lipedema is a chronic form of symmetrical disorder of the distribution of adipose tissue.

It occurs mainly in women and between the pelvis and ankles. It usually has a “saddle” shape in the leg area near the pelvis.

Its treatment, especially in the case of pure lipedema, consists of the systematic use of high-compression compression material (usually in the form of tights), combined with exercise.

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