Lymphedema Myths Realities - Hope

Transcription

1 Lymphedema Myths Realities - Hope Texas Health Presbyterian Hospital of Dallas Lymphedema Therapy Department

2 Lymphatic System Divided into sections - watersheds Lymph nodes act as filtration stations nodes throughout body 1/3 in neck/axilla 1/3 in groin/abdomen 1/3 dispersed

3 What is Lymphedema? A breakdown in lymphatic flow Not water weight Thick & viscous fluid Chronic, progressive, incurable Two main categories Primary born with it Secondary - acquired

4 Myths about Lymphedema It will just go away (wrong!) You will not get it if you do not have lots of lymph nodes removed (wrong!) You do not have to wear a sleeve after one year (wrong!) Lymphedema can spread all over your body (usually wrong!)

5 Secondary Lymphedema Acquired 86% of those with lymphedema (in U.S.) have secondary lymphedema, not primary Usually from surgery or injury The swelling may show up days or years after the surgery or injury There is probably a genetic predisposition for it

6 Secondary Lymphedema causes Obesity Invasive surgery Cancer surgery lymph node removal Injury Severe Infections/cellulitis Genetic predisposition

7 Cancer related lymphedema Often difficult to differentiate post-surgical swelling from lymphedema Incidence of postmastectomy lymphedema is going down but since more people now survive breast cancer, we are seeing more and more patients.

8 Types of Cancers associated with Lymphedema Breast Cancer (most common) Endometrial Vulvar Head and Neck Prostate Melanoma Sarcoma

9 Risk Factors for Developing lymphedema after breast cancer Tumor located in upper outer quadrant Post-op problems (infection, injury, hematoma, seroma) Lymph node removal Axillary/breast radiation Overweight/Obese Sarcoma Large number of nodes removed

10 Incidence of Lymphedema in Breast Cancer 0-3% 8% - 28% 11% - 42% 17-44% Lumpectomy alone Lumpectomy with SLNP and breast/axillary radiation lumpectomy with ALND and breast/axillary radiation MRM with ALND and radiation Cervical Cancer = 21% to 49%

11 Reality Notes There is no cure for Lymphedema Once you have it, you have it. However, the swelling can go down and stay down for years Lymphedema progresses through stages

12 Stages of Lymphedema Stage 0 = no swelling but molecular changes start to occur, patient may feel heaviness Stage I = intermittent, soft edema, resolves with elevation (easier to manage) Stage II = constant edema, does not resolve with elevation, fibrosis forms, pitting Stage III = elephantiasis, hard, non-pitting, papillomas/weeping of skin

13 Treatment for Lymphedema Combined Decongestive Therapy (CDT) the gold standard Fitting for compression garments Must wear daily Lifetime compliance is the key

14 Manual Lymphatic Drainage Based on known lymphatic drainage pathways Creates an alternate route when normal pathway is disrupted Usually requires visits NOT a Massage!

15 Contraindications to MLD Do not get MLD if you have: Untreated malignancies/cancer Untreated infection (OK after antibiotic treatment > hours) Recent blood clot in limb Kidney Failure (end stage) Relative Contraindication Congestive Heart Failure

16 Bandaging Multi-layer compression bandaging Specialized technique Not the same as wrapping a sprained ankle Different type of bandages used Should only be done by a trained therapist!!

17 Garments Should be worn all day/every day should be fitted by an experienced fitter Must be replaced every six months Especially important during exercise and housework

18 Hope L-Dex A diagnostic tool Finds lymphedema, before the swelling. Painless, noninvasive Covered by some insurance

19 Hope Lymph Node Transplants Very new micro-surgery Not a cure, but may be helpful You still have to wear your compression sleeve after surgery Controversial do your research

20 The Facts: No cure for lymphedema, but it is highly manageable MLD alone will rarely provide long-term management of edema If you do not wear a good compression garment, the swelling will return

21 Basic lymphedema precautions for patients to follow Wear compression garments every day No injections / blood draws / blood pressure measurements on affected limb Avoid trauma (bruising, cuts, burns, sprains, pet scratches) Avoid infection at all cost in your affected limb (often leads to cellulitis) Maintain excellent skin integrity (lotion, cuticle oil, no sunburn)

22 Exercise Precautions Exercise is good, sprains are not good Always wear compression garment during exercise Do not sprain or strain a muscle in the affected limb Avoid external pressure on limb (BP cuff) Supervised program is recommended

23 Precautions What NOT to do if you have lymphedema No deep-tissue massage Do not try to bandage without training No hot/cold contrast baths Do not remove garment when exercising No heavy weights or forced range of motion

24 Risks of not managing lymphedema Decreased tissue healing ability High susceptibility to infection Increase in girth size from 2 cm to elephantiasis Brawny edema - which makes tissue hard and tight Nerve impingement from pressure Lymphangiosarcoma a complication in approx. 5% of severe lymphedema cases

25 Before and After

26 Before and After