Lymphedema is the accumulation of lymphatic fluid in the body tissue that is characterized by swelling, most often in the arms or legs or occasionally in other body parts. Lymph fluid is very important as it flows through one-way valves with its' primary function to transport microorganisms (germs) and other undesirable products to the lymph nodes for final destruction. This fluid is filtered through thousands of bean-shaped lymph nodes clustered along the lymphatic system (road map in which this fluid flows). These unwanted products are destroyed in the nodes slowly, and are not allowed to reenter the bloodstream!

     When the lymphatic system is overloaded, an abnormal amount of this protein-rich fluid collects in the affected area or extremity. If this goes untreated, the stagnant fluid can cause these tissue channel to multiply innumber or size. This may lead to an infection call Lymphangitis. Lymphedema can be confused with other forms of edema(swelling) such as the types that occur from poor circulation, heart disease, or inflammation; which is not lymphedema. However; support stockings or specially made garments may be indicated for either case.

     What causes it?

     Primary lymphedema, can be present at birth, develop at puberty or adulthood, all from causes unknown, or it can be associated with a condition called AV malformation(arterial-venous malformation). A person just may not have enough lymph vessels to drain all of the fluid they have. Secondary lymphedema is acquired and usually is a result of surgery, radiation treatments, infection or injury. Lymphedema in an arm is very common after breast removal in the affected arm. Other operations such as: GYN, head and neck, prostate or testicle, bladder or colon cancer surgeries whereby the lymph nodes had to be removed, put the person at risk for the condition.

     Airplane flights, injury,sunburns and infection have been linked to lymphedema in post-surgery persons (decreased cabin pressure). A custom-fit compression garment can be made for one when flying is planned.

     Although rare in the U.S., an infection called filariasis can occur and cause a severe lymphedema called Elephantiasis. This disease affects those in tropical ,underdeveloped countries and is caused by the roundworm , and affects about 100 million people. The roundworm is transmitted by a mosquito and eventually the adult worm totally clogs the lymph drainage system. The legs, feet and scrotum in men get enormous, hence the name Elephantiasis!

     What are signs and symptoms?

     Watch for heavy feeling in the limb(s), a tight feeling in the skin, decreased flexibility of the hand, wrist or ankle, difficulty fitting in clothing such as shoes, and ring/watch tightness. If you notice persistent swelling , it is important that you seek medical attention from a Medical doctor at once (get a second opinion if you need to); since, early diagnosis and treatment improves the prognosis and condition of lymphedema.

     Signs and symptoms of lymphangitis: red,rash, blotchy skin, itching of extremity, discoloration, increase in swelling, increased temperature of skin, heavy sensation of limb, limb pain, high fever and chills. The treatment for this is not compression but it is antibiotics.

     What are some State-of the Art treatments for lymphedema? (This excludes heart disease and terminal cancer)?

     Depending on the severity of the condition, the recommended treatment plan should be based on the the Complex Decongestive Physiotherapy (CDP) methods which includes: 1)manual drainage (light massage technique) 2) bandage wrapping w/ special bandages 3) meticulous skin care4) compression garments- stockings, sleeves, gloves 5)exercises 6) instruction in prevention and precautions.

     Prevention is the key, and depending on the stage, lymphedema can be managed successfully especially with early recognition and treatment. If you need a comprehensive treatment approach, find a therapist with training and experience with CDP. Your doctor may or may not know that much about treating lymphedema.

     For additional information on this topic more information is available on the internet. Look up the National Lymphedema Network.

     Ms. Schwartz is a Registered Occupational Therapist at Elizabeth General Hospital in Elizabeth,N.J. She graduated from Towson University in 1983 with BS in Occupational Therapy. She also worked at Kessler Institute for Rehabilitation in New Jersey, a world renowned hospital for rehabilitation.