Natural Healing LLC

  Therapeutic Massage & Lymphedema Treatment Center

LYMPHEDEMA

The basis for the information in this booklet was taken from booklets by the National Lymphedema Network and Lymphedema Services, P.C. and modified to fall within the guidelines of Natural Healing LLC's beliefs.

COPYRIGHT 1995

Natural Healing LLC

LYMPHEDEMA - AN INFORMATION BOOKLET

 WHAT IS LYMPHEDEMA?

Lymphedema is an accumulation of lymphatic fluid that causes swelling in the arms and legs.  Edema occurs when venous or lymphatic vessels or both are impaired.  When the impairment is so great that the lymph fluid exceeds the lymphatic transport capacity, an abnormal amount of protein fluid collects in the tissues of the extremity.  Untreated, this stagnant, protein-rich fluid, not only causes tissue channels to increase in size and number, but also reduces oxygen through the transport system, interferes with wound healing, and provides a culture medium for bacteria that can result in various infections.  A chronic inflammatory condition stemming from this accumulation of fluid eventually results in fibrotic tissues. 

THE NORMAL LYMPHATIC SYSTEM: A DESCRIPTION 

To understand the condition called lymphedema, we first must understand the normal lymphatic system. Consisting of lymph vessels, nodes and tissues, the lymphatic system is part of the circulatory system of veins and arteries.  The important role of the lymphatic system is to remove impurities from the circulatory system and to produce cells of the immune system (lymphocytes) that are vital in fighting bacteria and viruses.  These important lymphocytes, produced in the lymphatic system, mostly in the spleen, are a crucial part of the immune system. Lymph vessels are channels that contain colorless fluid called lymph.  The lymph comprises white blood cells and waste products from lymph tissue.  Lymph fluid passes through nodes, or valves, located in the lymph channels at 1-cm to 2-cm intervals.  As the fluid passes through the nodes, it is purified of harmful bacteria and viruses.  Networks of the lymphatic system are situated in several areas of the body: 

• The neck (supraclavicular).
• Near the intestine (abdominal).
• The armpits (axilla). 
• Behind the abdominal cavity (retroperitoneal).
• Along the windpipe (trachea).
• The pelvic area.
• Adjacent to the lung (thoracic).
• The groin (inguinal).

Lymph tissue is found in other areas of the body as well, including the tonsils, spleen, intestinal wall and bone marrow.

WHAT CAUSES LYMPHEDEMA? 

Lymphedema can occur from idiopathic, or unknown, causes.  This is called Primary Lymphedema.  Lymphedema can be present at birth either idiopathically or associated with arterial-venous abnormalities, hemangioma, or lymphangioma.  These can occur in either upper or lower extremities.  Lymphedema can occur in adolescence (lymphedema praecos), mostly in girls and usually in the lower extremities.   Lymphedema also can occur in both male and female adults (lymphedema tarda), usually between the ages of 35 and 45 years. 

Breast or abdominal surgery can result in Secondary Lymphedema.  Surgical removal of a tumor and the adjacent lymph nodes and vessels can block lymph fluid from flowing naturally through its system.  Lymphedema can occur immediately in the post-surgical period or several years later.  Other surgeries that require lymph node removal are those performed for skin cancer (melanoma), gynecological cancers, bladder or colon cancer, and prostate or testicular cancer. 

Radiation therapy, used in the treatment of various cancers and some AIDS-related diseases, can damage otherwise healthy lymph nodes by causing scar tissue to form and thus, interrupt the normal pathway of the lymphatic fluid.  Furthermore, the radiation can cause a skin burn on the area being treated, which may initiate the onset of lymphedema.  It is important to monitor the area for any skin changes, such as inflammation or blistering. 

Lymphedema can occur secondary to an infection that interrupts normal lymphatic pathway function.  A severe, traumatic injury may also trigger the onset of lymphedema. 

WHAT ARE THE SYMPTOMS OF LYMPHEDEMA? 

Lymphedema usually often begins with swelling in the hands or feet.  If you notice persistent swelling in an extremity, it is very important that you seek immediate medical advice.  Early diagnosis and treatment improves both the prognosis and the condition.  When lymphedema remains untreated, the limb becomes more edematous and the skin hardens, losing its elasticity (fibrosis).  Moreover, untreated lymphedema leads to infection and, sometimes, irreversible complications. 

HOW DOES LYMPHEDEMA CAUSE INFECTION? 

Lymph fluid is rich in albumin, or protein.  When lymphatic flow is obstructed, the Lymph fluid accumulates and becomes stagnant in the tissues of the limb closest to the obstruction.  This creates an environment favorable for the growth of bacteria and, ultimately, infection.  Low prophylactic doses of antibiotics frequently are prescribed for people who experience recurrent infections. Note:  Always carry your antibiotics or a prescription with you when you travel.

HOW CAN LYMPHEDEMA BE PREVENTED? 

If you have had lymph nodes removed surgically in either the groin or the axilla, or if you have been treated with radiation therapy, it is important that you protect the limb closest to the treatment from injury. 

Following are several suggestions to avoid developing lymphedema. 

WHAT YOU SHOULD DO 

• EXPLANATION

Wear gloves while doing housework, gardening, or other types of work that can result in even minor injuries. 

• A lesion in the skin will allow Infectious bacteria to enter the tissue.

Never allow an injection or blood drawing in the affected extremity. 

• Injections or blood drawing will pierce the skin, providing an entry for infection.

Have blood pressure checked in the unaffected extremity.

• The inflated blood pressure cuff further limits the circulation in an arm that already has poor circulation.

Avoid heavy lifting with the affected arm.  Do not carry heavy handbags with over-the-shoulder straps. 

• Lifting puts a strain on the arm with poor circulation.

Avoid vigorous, repetitive movements with the affected arm or leg (rubbing, scrubbing, pushing or pulling). 

• Physical exertion causes sudden, rapid blood flow through the muscle and tissue, further damaging an already comprised system.

Elevate the affected arm(s) or leg(s) whenever possible. (Only when un-wrapped.) 

• This will help keep swelling down when no compression is on the arm or leg.

Consult your therapist about any sports activities in which you participate, because some may aggravate the condition.  However, swimming, bike riding, walking and specially designed ballet or yoga movements are encouraged. 

• Physical exertion forces the damaged lymphatic system to try to do work that it cannot do.

Avoid extreme temperature changes in bathing, washing dishes, or sunbathing. Keep the limb protected from the sun. 

• Heat increases the blood flow through the tissues.  Sudden temperature changes cause undo stress on the weakened system.

Maintain good hygiene by keeping skin clean and dry with hypoallergenic soap, and deodorant. 

• This will protect the skin from irritation and possible infection.

Use an electric razor rather than a safety razor. 

• An electric razor will prevent puncturing the skin and subsequent infection.

Do not wear tight jewelry or elastic bands around affected fingers, arms or legs.  

• Constricting items will worsen an already compromised circulatory system.

Avoid cutting cuticles when manicuring hands or pedicuring feet. 

• Any skin puncture risks introducing infection.

Maintain your ideal weight through a well-balanced, low-salt diet; avoid smoking and alcoholic beverages. 

• Unwanted weight gain will increase swelling in the limbs.

WHAT IS THE TREATMENT FOR LYMPHEDEMA? 

Lymphedema is a serious condition. It indicates that the lymph system is unable to handle the lymph load. Treatment should be started as soon as Lymphedema is diagnosed. At present, the most effective and least invasive approach is that recommended by specialists in many European countries. This method is referred to as Complex or Complete Decongestive Physiotherapy. The length of treatment is variable and depends on the severity and duration of the Lymphedema. Our staff medical doctor supervises all treatments and our therapist is certified in CDP/MLD. As a holistic treatment center we also offer guidance on nutritional, vitamins, homeopathic, herbal and enzymatic remedies for Lymphedema. 

THE FOUR STEPS OF COMPLETE DECONGESTIVE PHYSIOTHERAPY 

1.  HYGIENE AND TOPICAL SKIN PRODUCTS: 

Meticulous hygienic care with or without antibiotics is essential. The aim of this treatment is to eliminate bacterial and fungal growth, either of which can lead to repeated attacks of cellulitis and/or lymphangitis. Meticulous skin and nail care are taught and practiced. Hydrogen peroxide and low PH all natural skin lotions are used to reduce the chance of infection.           

2.  MANUAL LYMPH DRAINAGE, MLD (a special lymphatic decompressive form of physiotherapy): 

MLD is a light form of massage that involves specific manual movements along lymphatic pathways that empty and decompress obstructed lymph vessels. Such therapy facilitates the unhindered flow of lymph fluid into the venous circulation, where it is supposed to go, and allows the limb to return to normal or near normal size. 

HISTORY OF MANUAL LYMPH DRAINAGE 

The technique of Manual Lymph Drainage has been in use for about sixty years.  It was developed by the late Dr. Emil Vodder in Cannes in the years 1932 - 1936, and has since become extremely popular in Europe.  There are Vodder schools in Austria, Germany, France, Belgium and Canada, all dedicated to the instruction and training of therapists in the theory and practice of lymphatic decompression.  Manual Lymph Drainage is superior to mechanical pneumatic pumping because it does not damage any remaining lymphatic vessels or their delicate valves, it does not empty the excessive lymph fluid into the soft tissues of the adjacent trunk and it decongests all lymphatic pathways from the swollen limb to the confluence of the lymphatic and blood systems in the neck.

3.  BANDAGING AND COMPRESSION: 

Bandaging of the affected limb follows each MLD session.  The bandages used for this purpose are minimally elastic and compensate for the diminished tissue pressure in lymphedema.  This is an important component of the therapy because it augments the diminished tissue pressure and prevents the affected limb from refilling with stagnant lymph. The bandages are worn overnight until the next MLD session is about to begin. At the end of the course of treatment when the limb is normal or close to normal, a made-to-measure elastic support garment is ordered for each patient. 

4.  REMEDIAL EXERCISES AND ELEVATION: 

Remedial exercises with the bandages in place are prescribed for every patient.  This step activates each muscle group and joint of the swollen limb and results in an increase in lymph flow and, over time, in dilation of the lymph vessels. Whenever possible, it is recommended that the patient sleep with the low elastic bandages on or with the swollen limb elevated or just above heart level. The bandaging option is more effective and is one that is most recommended. Bandaging is one of the skills taught to each patient during the treatment. Elevation is best done by means of padded, foam-rubber bolsters, which can be readily purchased. 

FOLLOW-UP MAINTENANCE 

To ensure that the results achieved by Complete Decongestive Physiotherapy are maintained at home, a lightweight sleeve or stocking is custom-made for each patient.  In addition, both patient and family receive instruction during the period of therapy on the essentials of Manual Lymph Drainage, nutrition, weight control, skin care, how to avoid infections and other related subjects. Home maintenance is simple and effective.  With proper attention to the techniques learned during therapy, the patient’s lymphedema should not recur.  Follow-up examinations are recommended every six months. 

SUMMARY OF COMPLETE DECONGESTIVE PHYSIOTHERAPY 

Complete Decongestive Physiotherapy is new to the United States.  It is the most effective and physiologic treatment of lymphedema available today.  When performed by well-trained professionals, the results are consistently superior to those achieved by surgery or pneumatic pumps.  Besides being noninvasive, Complete Decongestive Physiotherapy requires no anesthesia, no surgery and no risk to the patient. 

The uniqueness of Complete Decongestive Physiotherapy is that it decongests the whole lymph system by Manual Lymph Drainage of the trunk before any attempt is made to decompress the swollen limb. Decongesting the lymph system this way opens up alternative lymph vessels, which can then receive much more lymph fluid.  Once the whole system is decongested, the lymph fluid in the swollen arm or leg is directed gently and gradually into a circulatory system that is now ready and able to handle it. 

Over time, the situation continues to improve.  The lymph vessels dilate and carry larger and larger volumes of lymph from the affected limb.  In addition, Complete Decongestive Physiotherapy is able to soften areas of scarring and hardening that have previously developed in the limb. 

For patients willing and able to undergo this treatment, the goal of achieving and maintaining a normal or near-normal limb is both realistic and practical.  Treatment periods vary from two to four weeks. 

CONTRAINDICATIONS: 

Patients who have congestive heart failure must be monitored closely.  Patients with venous or arterial obstruction (deep-vein thrombosis) or acute infection should not be treated until the obstruction or infection has been resolved.  Patients who are receiving anticoagulant therapy should have a venous screening to rule out deep-venous thrombosis before being treated. 

DIAGNOSTIC STUDIES 

In several medical centers, a variety of diagnostic studies are being done.  Lymphangioscintigrapy, a method of using x-ray to follow a radioactive tracer protein that has been injected in the skin of the hand or foot, allows the doctor to see a major portion of the lymphatic system, to determine where in the system the blockage is located, or where there is an absence of lymphatic vessels. 

Magnetic Resonance Imaging (MRI), which does not require an injection or x-rays, also allows the doctor to see the soft tissues and lymphatics and to determine the area of blockage. 

            SOME SPECIAL WARNINGS 

AFTER A MASTECTOMY: A heavy breast prosthesis used after a mastectomy may put too much pressure on the lymph nodes above the collarbone.  This pressure risks slowing and interrupting the lymphatic pathways and prevents the fluid from flowing through the lymphatic system.  If your prosthesis is large, request that it be lightweight.  If you have questions about prostheses, you should consult your physician.  Information also is available from your representatives of the American Cancer Society Reach to Recovery, or your local breast prosthesis distributor. 

AFTER AN INSECT BITE OR OTHER MINOR INJURY:  If you receive an insect bite or sustain a minor injury on the affected extremity, clean the skin thoroughly and seek medical attention immediately.  Treatment with antibiotics is vitally important to prevent a serious infection. 

REIMBURSEMENT FOR LYMPHEDEMA TREATMENT 

When these procedures, therapies and diagnostic studies are medically necessary, some insurance companies will provide reimbursement for therapy by a physical therapist. Medicare no longer provides coverage for therapies provided by a massage therapist, or nurse. Neither will they pay for "maintenance" therapy. Private insurance companies are following Medicare's lead. Our center is now required to receive payment in cash.    

Some insurance companies cover compression garments, prescribed by a physician.  Medicare does not cover compression garments (stockings and pantyhose), compression bandages, CircAids, or Reid Sleeves at this time. 

SPECIFIC SUGGESTIONS FOR LYMPHEDEMA 

• Keep weight as close as possible to your ideal weight. This is the MAJOR factor in controlling symptoms.

• A diet high in complex carbohydrates and plant fiber, but low in calories, sodium, fat, sugar, protein and cholesterol is recommended.

• High fiber legumes (vegetables and beans) should be a major component of your daily diet. These include beans, kale, broccoli, artichoke, cabbage, Brussels sprouts, cauliflower, squash, onion, potato, etc.

• Exercise to your limitations on a consistent basis. No matter what form that exercise takes, make sure it becomes a part of your regular routine.

• Eight glasses of pure water are essential to reduce weight and help relieve swelling. Pure water is either filtered tap water, spring water or distilled water.

• Increasing potassium will help reduce fluid retention as well as limiting sodium. Foods high in potassium include: bananas, oranges, tomatoes, dandelion, fresh fruit, wheat germ, lettuce, broccoli, potatoes, celery, nuts, dried apricots, cantaloupes, flounder, chicken, haddock, etc.

• Natural diuretics will help reduce fluid retention. They are: celery seed, parsley, corn silk, dandelion and/or dandelion extract. Celery seed is an inexpensive, but tasty addition to salads. Dandelion acts as a diuretic that stimulates the liver and kidneys and absorbs toxins.

• Burdock root relieves congestion of the lymphatic system. It also cleanses the blood by eliminating uric acid and excess waste materials.

• Digestive enzymes taken on an empty stomach will help dissolve the protein and fat accumulation in the lymph system. Digestive enzymes are called pancreatic enzymes because that is where our bodies manufacture them.

• They are classified according to their action. Proteases break down protein, amylases break down sugars/starches and lipases break down fat.

• Bromelain is a specific protein-digesting enzyme that is often used to combat inflammation.

• Vitamin C supplemented with the bioflavonoid quercitin and/or rutin will help to strengthen the lymph system and reduce inflammation. This combination can be taken throughout the day.

• Anti-oxidants help strengthen cells by destroying “free radicals” that damage cells. The major anti-oxidants are vitamin C, E, beta-carotene and selenium.

• Vitamin B6 is the catalyst for hundreds of reactions that metabolize food. B6 should be added to the diet on a daily basis spread throughout the day.

• Curcumin found in turmeric is a powerful anti-inflammatory agent. Turmeric is a spice used in Indian food.

• Improving circulation is very beneficial for Lymphedema. There are many ways to accomplish this. Exercise is the best method, but some dietary additions include ginger and red pepper.

• Garlic and onions have many beneficial properties and should be added to the diet in abundance.

• Very moderate intake of alcohol is important. Alcohol is an initial stimulant that later depresses the lymphatic system which leads to fluid retention.

• Caffeine is another substance like alcohol that depresses the lymphatic system. Avoid as much as possible. This includes the caffeine in soft drinks.

For further information or to schedule an appointment, please contact:

 Natural Healing LLC