Is there treatment for lymphoedema
Lymphoedema is an ongoing condition. It can never be completely cured, but can be greatly improved with good treatment, so that you may live your life fully. Although treatment is time consuming and sometimes costly initially, it is worth making the most of the treatment offered and participating fully, which will give you the best results and give you back the control of your life. There is hope!!
It is very important that the evaluation and treatment of lymphoedema is given and performed by a therapist that has specially trained in the Management of Lymphoedema
Treatment usually consists of three to four main aspects, all of which are important, but must be tailored to your needs and situation.
- Manual Lymphatic Drainage Massage
- Compression Bandaging or Compression Garments
- Special exercises, including self massage, breathing exercises and movement.
- Skin Care and Infection Prevention
- Benzo-pyrone drugs.
Under optimal circumstances there are two phases of treatment. The first intensive phase involves frequent treatment by a qualified Lymphoedema Therapist, and is generally 4-6 weeks, but may be longer depending on the severity of the lymphoedema and it’s response to therapy. Compression in the first phase is usually compression banadaging for 24 hours a day along with MLD, exercised and skin care. Kinesiotaping may be used as needed.
It is during the second phase of treatment that the client takes greater ownership of their treatment and home programme. Therapy visits are less frequent, and the focus is on daily home management. The client is able to progress to wearing a compression stocking or sleeve in the day, and compression bandages at night. Special night compression garments are also available which are easier to apply and remove than bandages, but are also costly. Whichever night compression option is chosen, the importance of appropriate night compression must be emphasized. In the second phase the client performs self-massage and a home exercise programme when not attending therapy.
The best results are achieved with a combination of the different aspects of treatment, rather than one single aspect.
Manual Lymphatic Drainage Massage:
This is a special form of massage that should only be performed by a Lymphoedema Therapists trained in this skill. It is not the same as regular sports and soft tissue massage, which may make the Lymphoedema worse.
Manual Lymphatic Drainage (MLD) increases the uptake of excess fluid and protein from the tissues in the part of the body affected with Lymphoedema, and encourages the fluid to flow into an area with normally functioning lymphatic vessels and nodes, where it can drain away normally. It is a very gentle massage.
MLD usually starts with the neck and trunk, in order to clear these areas and allow a place for the excess lymph fluid to drain. Only then is the involved limb massaged.
Massage is usually given in conjunction with compression bandaging and then compression garments.
Multi-Layer Compression Bandaging:
Arguably the most critical aspect of successfully reducing lymphoedema (and maintaining the reduction) is compression. Multi-layer compression bandages are used continuously in the intensive phase.
These bandages are specific to the treatment of Lymphoedema, and are not the regular bandages used for general medical purposes. They are applied using a specific technique in order to create a pressure gradient which encourages fluid to move towards a path of adequate drainage. These bandages are changed and reapplied daily so that the oedema can be progressively reduced.
Apart from reducing the oedema in the affected limb, multi-layer compression bandages also restore a more normal shape to the limb. They reduce the skin changes that occur with chronic lymphoedema, eliminate lymphorrhoea (“leakage” of lymphatic fluid through the skin), soften the underlying tissue and support skin that is overstretched due to oedema.
There are different techniques to apply the bandages depending mostly on the needs of each individual client. Foam padding may be added for areas of fibrosis or thickening, or to provide padding to boney areas. In most instances the Multi Layer Compression Bandaging consists of the following layers:
- Tubular stockinette is applies as the first layer. The main function of this is absorbant, and it can be washed as it is the layer directly on the skin.
- Soft “cottonwool” padding or foam. This is used to protect the skin and boney areas, as well as to even out the pressure of the bandages.
- Short-stretch Bandages. These are usually applied in two layers over the entire limb. These short stretch bandages apply the necessary compression to reduce the oedema.
- In some instances where there is oedema of the fingers or toes, these will also require bandaging.
While the bandages are obviously bulky to wear, use of the limb in daily tasks and special exercises while bandages significantly improves their efficacy in reducing the oedema/swelling.
Multi-layer Compression Bandaging: In this case the fingers were not included in the bandaging. Compression bandages may be applied in different ways depending on the needs of the client. The bandages are not rigid, and allow for movement and use of the arm in daily tasks.
Multi-layer Compression Bandaging: In this case the toes were not included in the bandaging. Compression bandages may be applied in different ways depending on the needs of the client. The bandages are not rigid, and allow for movement and use of the leg, walking and in most cases driving.
Once the lymphoedema has successfully been treated and the limb is either equal to the other limb, or has reached a plateau in improvement, the client may then use a compression sleeve or stocking in the day. Compression garments are a critical part of the long-term management of lymphoedema, and it is therefore very important the type, fit and class of compression are correct.
There are a variety of styles available for both sleeves and stocking. Some include the thumb and hand, while others only reach the wrist. Some have silicone beads around the top cuff in order to minimize slippage of the garment when the client uses their arm/ leg in daily life. Some lower limb garments may be made like pantyhose, while others may be knee high. Some have open toes, while others have closed toes. Despite all these (and more) options, some clients still require their garments to be custom-made to fit. Indications for this are usually because the shape of the limb is unusual, but may also be related to the severity of lymphoedema.
Different types and grades of lymphoedema may require different levels of compression. This will be assessed by a practitioner specially skilled in the Management of Lymphoedema.
There is no internationally accepted classification for the classes/ grades of compression of garments, and these tend to vary in different countries and with different manufacturers of garments. It is therefore important for the practitioner to correctly select the class of compression for the garment required.
Lower classes of compression are used for early and mild lymphoedema, while higher classes are used for more severe and chronic oedema. Lymphoedema of the lower limb generally requires a higher class of compression than lymphoedema in the arm.
A correctly fitting garment requires that the clients limb is carefully measured by a practitioner. It is strongly recommended that a person with lymphoedema is specially measured and fitted with the correct garment, rather than purchasing a product at the local pharmacy or store. An incorrectly fitting or an incorrect class of compression can make lymphoedema worse and results in other complications. A correctly fitted garment with the correct class of compression maximizes the gains achieved in the intensive phase of treatment and maintains these gains over the long-term.
A specially designed Compression Sleeve is used towards the end of the intensive phase of treatment. Some sleeves may be purchased “off the shelf” while some clients may need sleeves to be custom made for them. There are different types and grades of compression sleeve, and your therapist will guide you regarding the best sleeve for you. These sleeves are only worn during the day.
Compression garments are usually only worn in the day. In many instances compression of some sort will continue to be required at night. This may be continued use of the multi-layer compression bandages, however various other night time compression garments are available that can be used instead of multi-layer compression bandages, once good reductions have been achieved or progress has reached a plateau. These are usually custom made for a client.
There are a variety of styles of compression stocking for the lower limb, depending on the needs of the client. It is vital that the correct level of compression is selected, as well as the correct size and type. A trained lymphoedema therapist can advise a client on the correct stocking to purchase. The client must be carefully measured to ensure the correct size is fitted. Incorrectly fitting garments lead to poor results, possible worsening lymphoedema, and poor compliance with the wearing schedule
As part of your therapy you should be given an exercise programme of specific exercises that enhance lymphatic drainage. These include breathing exercises, stretching exercises and strengthening exercises. These exercises are best done with your compression garment on. Exercises should never be overdone. Start slowly, and progress gradually. You and your therapist should plan your exercise programme together, according to your specific needs.
Exercises for Lymphoedema:
A self-massage programme will also be taught, so that you can continue to redirect lymphatic fluid into areas that drain normally, even after the intensive first phase of therapy is complete.
Skin Care and Infection Prevention:
Infection is one of the most significant factors causing a worsening of lymphoedema and may also trigger the onset of lymphoedema in people who are at risk. It is therefore critically important to minimise the possibility to getting an infection.
Skin problems are common in people with lymphoedema. Most often seen are bacterial and fungal infections, especially in skin folds, between the toes and between the fingers. However, many different skin conditions may occur. Compromised lymphatic function, as in the case of lymphoedema, increases the risk of infection and other skin changes. It is vital that all infections be treated immediately
It may be obvious to suggest that one avoids cuts, skin breakdown, trauma, and insect bites. However in many of our daily lives (including our occupation, sports and hobbies and household responsibilities) we are frequently exposed to this possibility. It is therefore important to manage these instances to minimise the risk of infection.
Skin should be kept moist and supple using hypoallergenic, and preferably fragrance free moisturizers. Soaps and other skin care products should preferably be pH neutral or mildly acidic. This applies specifically to the area affected by lymphoedema and not necessarily the whole body.
In the event of a cut or graze, the wound should be cleaned immediately. If the wound might be contaminated or dirty an antibiotic ointment should then be applied. If the wound becomes more red or inflamed than expected, or if it appears infected, then medical attention should be sought immediately. Do not delay.
This is a special type of non-medicated tape that is applied to the skin to help direct lymphatic fluid to normally draining areas, and away from areas of lymphatic congestion. It can be used for most types of swelling and not only for lymphoedema. In lymphoedema it is used in conjunction with the other aspects of treatment, and is not used in isolation.
There are currently no drugs available that successfully treat lymphoedema. Previous attempts at drug therapy have either been unsuccessful or had unacceptable side effects.
It is important to note that Diuretics (water pills) should not be used for the treatment of lymphoedema. However, some people have other medical problems for which the use of diuretic is important. These are prescribed by your doctor.
Many people find living with Lymphoedema a significant challenge.
The emotional discomfort of living with Lymphoedema can be as significant as the physical discomfort and should never be overlooked. When looking at wellness, we need to consider not only our physical wellbeing, but also our emotional and spiritual wellbeing. Various other practices may also be incorporated (and may play a very important role) in how you manage your Lymphoedema. These may include (but are not limited to) counseling, lymphoedema support groups, prayer, relaxation and meditation.