Leg Edema

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Leg Edema

Postby patoco » Fri Jun 22, 2007 10:25 am

Leg Edema

Related Terms:

Edema, Oedema, Fluid Retention, Water Retention, Swollen Leg, Lymphedema, Lymphoedema

Leg Swelling

Leg swelling is not uncommon and has been experienced by many many people. Usually, this swelling is temporary and goes away after the underlying condition is healed.

Temporary Leg Swelling

This temporary leg swelling may be caused by an infection, burn or sunburn, insect bites, an injury to the leg such as a sprain, surgery, or even medications such a hormone drugs, steroids, blood pressure drugs. This may also be an part of the inflammatory response your body goes through it trying to protect and heal the leg from the cause of the trauma.

Long Term Leg Swelling.

Long term leg swelling is referred to as edema. This is usually related to specific medical conditions. These conditions may include diabetes, congestive heart failure, blood clot, varicose veins, kidney failure, liver failure or a number of cardio-vascular problems.

Treatment for this long term swelling is in conjunction with the treatment for the condition that caused it. Usually diuretics are also used to relieve the swelling or water-retention.

Permanent Leg Swelling

****In the situation of any permanent leg swelling whether the cause is known or unknown, the diagnoses of lymphedema must be considered****

There are several groups of people who experience leg swelling from known causes, but it doesn't go away or unknown causes where the swelling can actually get worse as time goes by.

Group One

This group includes those who have had the injuries, infections, insect bites, trauma to the leg, surgeries or reaction to a medication. When this swelling does not go away, and becomes permanent it is called secondary lymphedema.

Group Two

Another extremely large group that experiences permanent leg swelling are cancer patients, people who are morbidly obese, or those with the condition called lepedema. What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body's waste fluid.

In cancer patients this is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries.

This is also referred to as secondary lymphedema.

Group Three

Group three consists of people who have leg swelling from seemingly unknown reasons. There may be no injury, no cancer, no trauma, but for some reason the leg simply is swollen all the time.

The swelling may start at birth, it may begin at puberty, or may begin in the 3rd, 4th or even 5th decade of life or sometimes later.

This type of leg swelling is called primary lymphedema. It can be caused by a genetic defect, malformation or damage to the lymph system while in the womb or at birth or be part of another birth condition that also effects the lymph system.

This is an extremely serious medical condition that must be diagnosed early, and treated quickly so as to avoid painful, debilitating and even life threatening complications. Treatment should NOT include the use of diuretics.

What is Lymphedema?

Lymphedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg. The accumulation of fluid causes the permanent swelling caused by a defective lymph system.

A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphedema and two to three million with secondary lymphedema.

How is Lymphedema Treated?

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment.

It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.

With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.

What are the symptoms of Lymphedema?

If you are an at risk person for leg lymphedema there are early warning signs you should be aware of. If you experience any or several of these symptoms, you should immediately make your physician aware of them.

1.) Unexplained aching, hurting or pain in the leg.

2.) Experiencing "fleeting lymphedema." This is where the limb may swell, even slightly, then return to normal. This may be a precursor to full blown leg lymphedema.

3.) Localized swelling of any area. Sometimes lymphedema may start as swelling in one area, for example the foot, or between the ankle and knee. This is an indication of early lymphatic malfunction.

4.) Any arm inflammation, redness or infection.

5.) You may experience a feeling of tightness, heaviness or weakness of the leg.

What are some of the complications of lymphedema?

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immuno-deficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

Can lymphedema be cured?

No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided. Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.

For extensive information on lymphedema, please visit our home page:

Lymphedema People

http://www.lymphedemapeople.com

(c) Copyright 2005 by Pat O'Connor and Lymphedema People. Use of this information for educational purpose is encouraged and permitted. It must be available free and without charge and not used for financial renumeration or gain. Please include an acknowledgement to the author and a link to Lymphedema People.

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Foot, leg, and ankle swelling

Alternative names

Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral, Peripheral edema

Definition

Abnormal buildup of fluid in the ankles, feet, and legs is called peripheral edema.

Considerations

Painless swelling of the feet and ankles is a common problem, particularly in older people. It may affect both legs and may include the calves or even the thighs. Because of the effect of gravity, swelling is particularly noticeable in these locations.

Common Causes

Foot, leg, and ankle swelling is common with the following situations:

Prolonged standing
Long airplane flights or automobile rides
Menstrual periods (for some women)
Pregnancy -- excessive swelling may be a sign of pre-eclampsia (a serious condition that includes high blood pressure and swelling; sometimes called toxemia)
Being overweight
Increased age
Injury or trauma to your ankle or foot
Swollen legs may be a sign of heart failure, kidney failure, or liver failure. In these conditions, there is too much fluid in your body.

Other conditions that can cause swelling to one or both legs include:

Blood clot
Leg infection
Venous insufficiency (when the veins in your legs are unable to adequately pump blood back to the heart)
Varicose veins
Burns including sunburn
Insect bite or sting
Starvation or malnutrition
Surgery to your leg or foot
Certain medications may also cause your legs to swell:

Hormones like estrogen (in birth control pills or hormone replacement therapy) and testosterone
A group of blood pressure lowering drugs called calcium channel blockers (such as nifedipine, amlodipine, diltiazem, felodipine, and verapamil)
Steroids
Antidepressants, including MAO inhibitors (such as phenelzine and tranylcypromine) and tricyclics (such as nortriptyline, desipramine, and amitriptyline)

Home Care

Elevate your legs above your heart while lying down.
Exercise your legs. This helps pump fluid from your legs back to your heart.
Wear support stockings (sold at most drug and medical supply stores).
Try to follow a low-salt diet, which may reduce fluid retention and swelling.
Call your health care provider if Return to top

Call 911 if:

You feel short of breath.
You have chest pain, especially if it feels like pressure or tightness.

Call your doctor right away if:

You have decreased urine output.
You have a history of liver disease and now have swelling in your legs or abdomen.
Your swollen foot or leg is red or warm to the touch.
You have a fever.
You are pregnant and have more than just mild swelling or have a sudden increase in swelling.
Also call your doctor if self care measures do not help or swelling worsens.

What to expect at your health care provider's office Return to top

Your doctor will take a medical history and conduct a thorough physical examination, with special attention to your heart, lungs, abdomen, legs, and feet.

Your doctor will ask questions like the following:

What specific body parts swell? Your ankles, feet, legs? Above the knee or below?
Do you have swelling at all times or is it worse in the morning or the evening?
What makes your swelling better?
What makes your swelling worse?
Does the swelling get better when you elevate your legs?
What other symptoms do you have?
Diagnostic tests that may be performed include the following:

Blood tests such as a CBC or blood chemistry
ECG
Chest x-ray or extremity x-ray
Urinalysis

The specific treatment will be directed at whatever underlying cause is found. Diuretics may be prescribed. These are effective in reducing the swelling but have some side effects. Home treatment for benign causes of leg swelling should be tried before drug therapy under medical supervision.

Prevention

Avoid sitting or standing without moving for prolonged periods of time. When flying, stretch your legs often and get up to walk when possible. When driving, stop to stretch and walk every hour or so. Avoid wearing restrictive clothing or garters around your thighs. Exercise regularly. Lose weight if you need to.
Update Date: 9/21/2003

http://www.nlm.nih.gov/medlineplus/ency ... 003104.htm

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Swelling

Alternative names:

pitting edema; dependent edema; generalized swelling; edema; anasarca

Definition:

Excessive build-up of fluid in the tissues, or an increase in tissue mass. Swelling can occur throughout the body (generalized swelling) or swelling can be limited to a specific part of the body.

See also:

ankle, feet, and leg swelling
angioedema
swollen gums
swollen glands
facial swelling
swelling in the abdomen
breast enlargement
scrotal swelling
joint swelling

Considerations:

This document primarily discusses overall swelling. See the specific documents listed in the definition for information that is specific to swelling in a specific location.

Slight edema of the legs commonly occurs in warm summer months.

Generalized swelling or massive edema (also called anasarca) is a common sign in severely ill people. While slight edema may be difficult to detect, especially in an overweight person, massive edema is very obvious.

Very often, widespread edema is both long-term and progressive and the causes vary significantly.

Edema may be pitting (when pressing a finger against a swollen area for 10 seconds and then quickly removing it, an indentation is left that fills slowly) or nonpitting (when pressing a finger against a swollen area for 10 seconds and then quickly removing it, no indentation is left in the skin).

Common causes:

too much salt or sodium
burns
sunburn
too little albumin in the blood (hypoalbuminemia)
malnutrition
pregnancy
drugs
androgenic and anabolic steroids
antihypertensives
corticosteroids such as prednisone (causes sodium retention)
estrogens
anti-inflammatory drugs (see NSAIDs)
intravenous saline administration or tube feedings
nephrotic syndrome
acute glomerulonephritis

Note: There may be other causes of swelling. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as location, quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for swelling, occurring alone or in combination with other problems.

Home care:

Follow prescribed therapy to treat the underlying cause of the edema. Discuss with your health care provider the options to prevent skin breakdown (for chronic edema) such as a pressure mattress, lamb's wool pad, or flotation ring.

Maintain everyday activities. Walk rather than stand. Stand or lie rather than sit. When lying down, keep limbs above the heart level, if possible, to facilitate drainage. Do not do this if shortness of breath results.

Massage swollen areas regularly, particularly if edema has formed around the hip, buttocks, or back.

Reduced sodium (salt) in the diet may be recommended.

Call your health care provider if:

there is any unexplained swelling.

What to expect at your health care provider's office:

Except in emergency situations (such as cardiac failure or pulmonary congestion), the medical history will be obtained and a physical examination performed.

Medical history questions documenting swelling in detail may include:
time pattern
When did you first notice this?
Is it present all the time?
Does it come and go?
quality

How much swelling is there?

When you poke the area with a finger, does the dent remain?
location

Is it overall or in a specific area (localized)?

If swelling is in a specific area, what is that area?
other

What seems to make the swelling better?
What seems to make the swelling worse?
What other symptoms are also present?

Diagnostic tests that may be performed include:

albumin levels measured
ECG
echocardiography
serum electrolyte tests
urinalysis
X-rays

Intervention:

Treatment may include fluid and sodium restriction, diuretics, digoxin, and (rarely) intravenous albumin administration. In some cases corticosteroids such as prednisone or immunosuppressive medications may be given. Fluid intake and output should be monitored and the patient should be weighed daily.

Avoid alcohol if liver disease (such as cirrhosis and hepatitis) is the problem. Vascular support hose (TED hose) may be advised.

After seeing your health care provider:

You may want to add a diagnosis related to swelling to your personal medical record.

http://www.healthcentral.com/mhc/top/003103.cfm

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Symptom: Swelling symptoms

Swelling symptoms: Symptoms causing swelling or enlargement.
Introduction: Parts of the body may swell in response to injury, infection or disease, or because of an underlying lump. Swelling can also occur if the body is not circulating fluid well (especially ankle swelling). Generalized swelling from fluid retention is called edema. Lymph nodes may swell in response to infection (see swollen lymph nodes). Any type of swelling symptom needs prompt professional medical diagnosis

Detailed cause information for symptom: Swelling symptoms:

Possible causes of symptom: Swelling symptoms (63 conditions)
Medical conditions causing symptom: Swelling symptoms (281 conditions)
Medical conditions causing complication: Swelling symptoms (24 conditions

Medical articles on symptoms: These general reference articles may be of interest:

Symptoms of the Silent Killer Diseases
Symptoms and Medical Malpractice
Types of Swelling symptoms: abdominal swelling (70), swollen spleen (36), eyelid swelling (11), swollen lymph nodes (56), neck swelling (30), breast swelling (11), joint swelling (22), leg swelling (37), knee swelling (11), ankle swelling (22), hand swelling (16), face swelling (17), swollen testes (8), jaw swelling (7), swollen glands (56), brain swelling (22)
Symptoms: symptom center, symptom groups

Causes of symptom: Swelling symptoms: The following medical conditions are some of the possible causes of Swelling symptoms as a symptom. There are likely to be other possible causes, so ask your doctor about your symptoms.

General possible causes of localized swelling:

Injury
Infection
Skin swelling (see Skin symptoms) - see causes of skin swelling
Dependent edema
Lymphatic obstruction
Venous thrombosis
Some possible causes of skin swelling include:
Skin trauma
Skin infection (type of Skin conditions)
Cellulitis
Contact dermatitis
Eczema
Hives
Allergic reaction (type of Adverse reaction)
Insect bite
Insect sting
Causes of generalized swelling (edema) or water retention:
Edema
Premenstrual syndrome
Pregnancy
Preeclampsia
Heart failure
Congestive heart failure
Kidney conditions
Nephritis
Glomerulonephritis
Nephrotic syndrome
Kidney failure
Liver condition
Cirrhosis of the liver
Chronic hepatitis (type of Hepatitis)
Varicose veins
Lymphedema - see also causes of Lymphedema
Lymphatic obstruction
Filariasis
Protein deficiency (type of Nutritional deficiency)
Thyroid condition
Malabsorption
Celiac disease
Ulcerative colitis
Malnutrition
Beri-beri
Certain medications
Excessive IV fluid
See also edema and causes of edema
Some possible causes of a swollen limb include:

Swollen ankles - see the many causes of swollen ankles
Venous thrombosis
Lymphatic obstruction
Allergic reaction (type of Adverse reaction)
Cancer
Bone cancer
Causes of swelling depend on the type of swelling
See also causes of ankle swelling, facial swelling
Detailed cause information for symptom: Swelling symptoms:

Possible causes of symptom: Swelling symptoms (63 conditions)
Medical conditions causing symptom: Swelling symptoms (281 conditions)
Medical conditions causing complication: Swelling symptoms (24 conditions)

http://www.wrongdiagnosis.com/sym/swell ... m#possible

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Pub Med - Links to Articles on Leg Swelling

http://www.ncbi.nlm.nih.gov/entrez/quer ... &DB=PubMed

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Cause of leg swelling

http://www.eurorad.org/case.cfm?uid=2871

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Leg Pain and Swelling

http://www.embbs.com/aem/leg.html

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Lymphedema

WHAT IS IT?

Lymphedema is a buildup of a fluid called lymph and protein in the tissues under the skin. Lymph accumulates when there is an obstruction to normal flow causing swelling, usually in an arm or leg. The lymph system is similar to the blood system in its network of vessels that carry lymph fluid throughout the body.

Trauma to lymphatic tissue by surgery or radiotherapy is the main cause of lymphedema in the context of cancer. It can result from surgery and/or radiation therapy during treatment for cancers of the breast, abdomen, melanoma, connective tissues (sarcomas) and the pelvic area, as well as lymphomas, in both men and women. Lymphedema may also be the result of infection, such as dermatophytosis in the foot.

Cancer tumors also can block the lymph vessels, especially in people with prostate cancer or lymphoma.

IF I HAVE CANCER WILL I DEVELOP LYMPHEDEMA?

Not necessarily. The most frequent cases occur in women with breast cancer; 10% to 25% of breast cancer patients will develop lymphedema. While most cases are mild, approximately 400,000 women cope daily with some degree of disfigurement, discomfort, and sometimes disability because of arm and hand swelling.

Because of improvements in radiation and surgical techniques (such as removing smaller samples of lymph nodes), lymphedema is less common today than it use to be. Lymphedema develops in about one in four breast cancer patients who have a mastectomy with lymph-node dissection. The risk doubles for those who also receive radiation treatments to the underarm area.

Radical prostatectomy, a procedure that removes the prostate gland, seminal vesicles and sometimes the nearby pelvic lymph nodes, can lead to lymphedema .One type of Kaposi’s sarcoma is called the lymphadenopathic form that can spread throughout the body and may aggressively involve lymph nodes, viscera, and occasionally the GI tract –resulting in a kind of lymphedema.

SENTINEL LYMPH NODE BIOPSY

If breast cancer spreads, it first goes to the lymph nodes under the arm. That's why women with breast cancer have these nodes examined. Until recently, surgeons would remove as many lymph nodes as possible, but this greatly increased the risk of lymphedema. More recently, a growing number of physicians have begun focusing on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to show evidence of cancer’s spread. Experts believe that if a sentinel node is removed and found to be healthy, then the chance of finding cancer in any of the remaining nodes is very small and no other nodes need to be removed. This spares as many as 75% of women who have no evidence of tumor spread to the axillary nodes the risk of complications, especially lymphedema.

WHEN DOES IT DEVELOP?

Lymphedema can appear any time after surgery or radiation treatment including many years later.

When the condition develops very soon after surgery, it is usually mild, and goes away within one to two weeks. It can also develop six to eight weeks after surgery or radiation. Again, this type of lymphedema usually goes away in a few weeks.

Unfortunately, the more common form of lymphedema in cancer survivors develops slowly over time. It may show up many months or even years after treatment ends and swelling can range from mild to severe. In most cases however, lymphedema appears between six and 12 months after treatment. While people who have many lymph nodes removed and radiation therapy have the highest risk of developing lymphedema, some high-risk patients won’t develop the condition.

WHEN TO CALL A PROFESSIONAL

Patients should contact a physician if they had a mastectomy, lower abdominal surgery or radiation treatments in the past, and the affected limb becomes red, painful or hot, or if it develops open sores or areas of broken skin. Doctors should be consulted especially if there is a fever in addition to swelling.

Diagnostic Tests

Usually, no specific testing is necessary to diagnose lymphedema, but tests may be done such as a blood count that can identify signs of infection. Ultrasound may be ordered to look for blood clots, which can cause swelling. Computed tomography (CT) may be used to find a tumor that could be blocking lymph vessels. In addition, there are more specialized tests that can identify lymph flow and lymph vessel abnormalities.

Symptoms

The first signs of lymphedema can be a change in a patient’s arms or legs or other affected area such as the groin. Initially, skin will remain soft, but if the problem continues, the limb may become hot and red and the skin hard and stiff. The lymph fluid that collects in the tissues can be very uncomfortable, but pain is not always present. Early symptoms of lymphedema may include:

A feeling of tightness around the arm on the area that was treated for cancer,

Decreased flexibility in a hand, elbow, wrist, fingers, or leg,

Difficulty fitting into clothing,

Tight fit of a ring, wristwatch, bracelet, or shoe,

Weakness, pain, aching or heaviness in the arm, legs, or feet,

Skin that looks shiny, has fewer folds, and feels stiff or taut,
A dull ache in the affected limb,

A feeling of tightness in the skin of the affected limb,

Difficulty moving a limb or bending at a joint because of swelling and skin tightness,

Pitting (small indentations left on the skin after pressing on the swollen area)

In most cases, only one arm or leg is affected. If the leg is involved, swelling usually begins at the foot, then progresses upward toward the ankle, calf and knee.

Severity

The severity is directly related to the extent of surgery and radiation treatment to the lymph nodes. Severity and general risk of developing lymphedema seems to increase with obesity, weight gain and infection in the affected area.

TREATMENTS

Lymphedema has no cure so treatment focuses on reducing the symptoms. Treatment has varied from virtually no treatment to surgery, but there are various practical methods to deal with the condition, including elevation of the limb (in the first year only), compression garments (no greater than 20-30 mm Hg), certain types of massage and exercises, pneumatic compression devices (controversial), and other types of physical therapy. Experts also recommend keeping the affected limb clean, dry and lubricated.

The National Lymphedema Network (www. Lymphnet.org) encourages massage by an specially certified expert in lymphedema massage.. In many cases, patients can also be trained to massage themselves to improve the flow of lymph fluids.

Medications

There are no medications to treat lymphedema. Diuretics have been found to be ineffective and may actually exacerbate the condition. Other medicines have been tried, but there is no clear evidence of significant effectiveness with any particular drug.

MILD LYMPHEDEMA:

Elevating the arm or leg above the level of the heart(during the first year) and flexing it frequently are basic methods to manage the condition. Since elevation is impractical except for short periods, patients should be fitted with an elastic sleeve, covering the arm or leg.

A significant reduction in edema (swelling) has been reported after wearing elastic sleeves for 6 consecutive hours per day. Using these garments during exercise, physical activity, and especially air travel is recommended, since air travel seems to exacerbate the condition.

If the legs are affected, avoid periods of prolonged standing. If working or standing a lot, a doctor may prescribe special graduated compression stockings to wear throughout the day. A doctor may also suggest a protein-rich, low-salt diet for those who are over-weight or obese.

MODERATE TO SEVERE:

For people with moderate to severe lymphedema in the legs, doctors prescribe pneumatic compression devices to be used at home to help reduce limb swelling. The “pneumatic stockings” are worn every day for an hour or two to reduce the swelling. Once the swelling has been reduced, a person may still need to wear elastic stockings up to the knee every day from the moment of rising until bedtime.

For lymphedema in the arm, pneumatic sleeves--like pneumatic stockings--can be used every day to reduce the swelling; elastic sleeves may also be needed.

Others recommend a special type of massage therapy called manual lymph drainage. Antibiotics also may be prescribed to prevent or treat infection in the affected limb. Since skin infections can be more serious in people with lymphedema, a person may need to have antibiotics administered intravenously in the hospital during an infection.

Complex Decongestive Therapy

More serious cases of lymphedema can be treated with Complex Decongestive Therapy by a physical therapist or other health care professional, who has special training. Complex Decongestive Therapy consists of skin care, massage, special bandaging, exercise, and fitting for a compression sleeve. Seeking and getting treatment early should lead to a shorter course of treatment to get the lymphedema under control. While most insurance companies will pay for this treatment, some do not.

Someone certified in the procedure should perform Manual Lymph Drainage (MLD).

In the case of lymphedema of the arm, the procedure involves a type of massage that moves built up fluid around the blocked vessels and across the chest to the other side of the body where the lymphatic system is still in tact. Usually the healthy area will be “worked” first. After each treatment, the effected area is carefully bandaged with a special layered wrap that looks like an ace bandage but is made of a different fabric. The wrap is important for keeping the effected limb de-congested. An average course is 15 daily treatments of 60 to 90 minutes each. After a MLD course of treatments, the patients will wear a compression garment every day. The patient should be measured for a new compression sleeve every six months or so. Sometimes a yearly MLD treatment course is recommended as a kind of “tune up.”

PREVENTING COMPLICATIONS

Because lymphedema development may occur even after several decades, patients should monitor themselves for signs of lymphedema and report any changes to their physicians.

Prevention is important and can require daily attention to manage the symptoms of swelling in particular. Arm and hand precautions are based on two key ideas: (1) Do not increase lymph production, which is directly proportional to blood flow, and (2) do not increase blockage to lymph system. Therefore, patients should avoid excessive heat, infections, and overly-strenuous arm exercises which would increase blood flow in the arm and thereby increase lymph production.

MANAGING LYMPHEDEMA

Patients should follow these suggestions to manage their lymphedema:

Avoid puncturing or injuring the skin in any way. Use first aid care if there is a break in the skin.

Avoid vaccinations, injections, blood pressure monitoring, blood drawing, and intravenous administration in the arm affected.

Avoid tight-fitting clothing or jewelry.

Avoid heat, such as with sunburns or tanning, baths, and saunas.

Avoid strenuous exertion, but do exercise while wearing compression garments.

Exercise, But Avoid Muscle Strain

It is important to use your affected limb for normal everyday activities, yet overuse can cause lymphedema to occur in some people. Follow these suggestions whenever possible:

Use affected arm or leg as normally as possible until fully healed, about 4 to 6 weeks after surgery or radiation treatment.

Exercise regularly but do not strain the arm or leg. Before any strenuous exercise, such as weightlifting or tennis, talk with a doctor, nurse, or physical therapist about specific goals and limitations to decide what level of activity is right. Ask if a fitted sleeve or stocking should be worn during strenuous activities or while flying.

If an arm or leg starts to ache, lie down and elevate it.

Avoid vigorous, repeated activities, heavy lifting, or pulling.

Watch for early signs of infection: rash, red blotches, swelling, increased heat, tenderness, or fever. Call a doctor right away if there are signs of infection.

Experts also recommend that those with lymphedema avoid any trauma to the area affected.

Trauma includes extreme temperature changes, repetitive movements against resistance (pushing or pulling), heavy lifting, and excessive exercise.

For More Information

American Cancer Society

The American Cancer Society held an international conference on lymphedema in 1998 in New York City. It involved 60 of the world’s leading experts and included a forum of more than 250 breast cancer survivors, leaders of breast cancer advocacy groups, and others. The conference report plus a lymphedema resource guide are available as a book from the ACS at cancer.org. (See below for title.)

National Lymphedema Network

The National Lymphedema Network is a charitable organization with an international scope. Founded in 1988, the Network’s mission is to provide education and guidance to patients and health care professionals. The Network promotes standardizing quality treatment for lymphedema patients. In addition, the organization supports research into the causes and possible alternative treatments for this “often incapacitating, often-neglected condition.”

Sources:

Current Trends in Lymphedema Management, Esther Muscari Lin, RN, MSN, CS, ACNP, AOCN, November 7, 2002.

American Cancer Society, Cancer (Vol. 92, No. 4: 748-752). http://www.cancer.org/

Cancer Principles and Practices of Oncology, Lippincott Williams & Wilkins, 6th Edition, 2001.
http://www.lww.com/productdetailresults ... 60,00.html

Harvard Medical School, Intelihealth.com,
http://www.intelihealth.com/IH/ihtIH?t= ... W000|~b,*|

Lymphatic Research Foundation, http://www.lymphaticresearch.org/

Lymphedema Online Support Group, http://www.acor.org/.

Lymphology Association of North America, offers professional certification. http://www.clt-lana.org/main.html

Merck Manual, 17th Edition, 1999. http://www.merck.com/pubs/mmanual_home/contents.htm

National Lymphedema Network, http://www.lymphnet.org
https://www.cancerpage.com/centers/Side ... hedema.asp
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