Edema is a well-known synonym for swelling. Lymphedema is a term used to describe “swelling” that is comprised of lymphatic fluid (protein-rich edema). Typically lymphedema affects the extremities, but can also be present in the face, neck, abdomen and genitals. It can be a result of cancer therapy (described below).
Who is at risk for development of Lymphedema?
Anyone who has had an insult to their lymphatic system. These include: radiation, surgery removing lymph nodes or lymphatic vascular compromise. If you have had treatment for cancer related illness and have had surgery or radiation, you are at a life time risk of developing lymphedema. The amount of risk depends on several factors including: number of lymph nodes removed, amount of radiation received, overall health of the person, scar tissue or fibrosis impeding lymphatic fluid mobility.
Signs or symptoms of lymphedema:
- Heaviness of the extremity involved
- Physical increase in girth- usually noted around the wrist, fingers, ankles or toes
- An increase in pain that can extend into the arm or forearm
- “Pitting” found in the extremity involved
- Skin becomes stretched or even shiny
Who can help me?
A Physical Therapist who is specifically trained to manage lymphedema. They usually have a certification that requires 135 hours of training before certification. If you are searching for this type of therapist, they will have the letters CLT behind their name indicating they are a certified lymphatic therapist.
What is the gold standard of care for lymphedema?
Ideally, a patient is seen prior to lymphedema occurring. Gold standard of care would be to see these patients within 2 weeks of their surgery to provide education regarding lymphedema and how to manage it before it progresses. There is a common myth that if a patient only has 1 lymph node harvested (sentinel node biopsy) they will not acquire lymphedema. This unfortunately is a myth. Even with 1 lymph node harvested, the patient is at risk for the development of lymphedema and should have an evaluation and education session with a trained physical therapist.
If lymphedema is present, gold standard of care for management is Complete Decongestive Therapy (CDT). Phase I includes reduction of the limb. This can be done by manual lymphatic drainage (MLD) or by bandaging by a PT. Phase II would include containment of the results from phase I. This would likely include a compression garment (sleeve for the arm or stocking for the leg). During this phase it is also important that the patient exercise and take care of their limb by ongoing self-administered MLD which would be taught to the patient by the Physical Therapist.