Lymphoedema is out there and yet so few healthcare professional know that much about it. I have to say that I myself had a very poor understanding of the condition and its associated issues before I trained as a Manual Lymph Drainage therapist. I used to think sure” your arm is only a little swollen, there’s no need to worry, iIt will only become an issue when it gets bigger”. However this is not the correct approach. We should be trying to react proactively instead of reactively about that little bit of swelling.
Even in the latency stage of lymphoedema, this is the sub-clinical stage, there was changes taking place in the body. The damaged lymphatic system due to surgery or lymph node removal, does not have the transport capacity for protein, water and cells which set the stage for overload of the lymphatic system. The symptoms of this stage can be a feeling of fullness in the affected limb, discomfort and feeling that jewellery or clothes feel a little tighter. At this stage lymphoedema is easily treatable and reversible.
Sometimes it can be difficult for patients to notice latency stage and they may present with Stage 1 lymphoedema, which is reversible. This stage presents as pitting oedema and the swelling builds up during the day and reverses at night time. Again if treatment is started at Stage 1 the outcome is better for the patients.
Stage 2 presents as oedema or swelling which does not resolve spontaneously, does not go down over night or on elevation. The oedema is non-pitting at this stage. Fibrous or hardening of the tissues begin as the protein is unable to be removed from the tissues. The limb feels heavier, the skin is hard to touch. Patients may experience severed discomfort or even pain . This stage responds to treatment and it is vital that treatment is start as soon as possible so that the damage is minimised.
Should treatment not happen at this point, Stage 3 can occur. This is when skin changes occur. The appearance of the skin is hard and known as elephantiasis. The oedema is irreversible now. This stage is very uncomfortable, patients quality of life is greatly affected and they can have difficulty do everyday tasks for themselves.
For all lymphoedema patients infection is a risk. Good skin care is vital, if they cut themselves or damage the skin of the affected limb they need to wash the area thoroughly, apply antiseptic cream and cover the area immediately. Should they notice that the area is becoming red and hot to touch and/ or they feel unwell, medical assistance should be sought again immediately. Compression garments need to be removed and not worn till advised by a healthcare professional or your MLD therapist. Infection or cellulitis can spread rapidly and correct treatment needs to start straight away. An episode of infection can cause the oedema to increase and changes to occur so it is important that after an episode of infection that lymphoedema patients contact their MLD therapist for an assessment.
Lymphoedma is often associated with cancer patients, especially if they have had lymph node removal. However this cohort of patients only make up a percentage of lymphoedema suffers. Obesity, vascular issues, infection, post surgery or trauma to the affected area can be other causes of lymphoedema.
There is treatment and help out there for patients with early detection being vital. Awareness needs to happen as it is difficult for healthcare professionals to know everything about every condition. If you or any of your patients/clients have any questions about lymphoedema please get in touch.
