Lymphedema

What is lymphedema?

In order to understand what lymphedema is, we will first have to understand what the lymphatis system is.

Lymphatic system

When you see your arms, you see the bulging vessels that collapse under pressure. These are veins that take majority of the blood from the body back to the heart. There is however, some fluid inbetween the tissues and under the skin that needs draining. This is drained by a group of specialised vessels called lymphatics that finally join the big veins in the body. The fluid that they drain is called lymph. These vessels go through groups of nodes that are situated at various levels in the body. These nodes are called lymph nodes

Lymphedema:

After surgery or radiation therapy for malignant lumps, these nodes are also taken out and some of the lymph vessels are also taken out. This essentially means that the draining of the fluids in the midst of tissues is decreased, causing the part of the body it drains to swell up. This is called lymphedema.

What are the features to watch for?

  • Gradual feeling of heaviness in the limb on the side of procedure
  • Clothes feeling a bit tighter
  • Skin may feel tight/ stretched/ itchy
  • This progresses to swelling that is seen through the day but decreases on resting
  • Swelling will Increase gradually if not attended to, skin will become firm and rough, swelling will not decrease.
  • Neck pain due to the heaviness in the limb/ after surgery

How to care for the limb that has lymphedema?

There are 4 cornerstones of managing the limb

  • Skin Care

    • Clothing should be loose and made of pure cotton.
    • Ensure skin is kept moisturised – coconut oil is excellent. If using other creams – use non-fragranced ones as they will not cause skin irritation.
    • Do not scratch the skin. The fluid is food for bacteria and will get infected.
    • Do not allow BP monitoring/ blood collection/ IV cannulation in that arm
    • Ensure that every few hours you rest for 45minutes and keep the arm elevated.
  • Exercise:

    It is important to do the exercises taught by the lymphedema Nurse Specialist. The lymph vessels run through muscles, that act as a pump to help improve the return of collected fluid.

  • Massaging:

    The flow of collected fluid can be directed through these massages, that are done in a particular way, towards the functioning lymphatic vessels. This is called Manual Lymphatic Drainage Therapy.

  • Compression bandaging:

    • Compression garments. It is better to use ones that are tailor made for you specifically. This will prevent pain and trauma of the skin. These garments can be used in the initial stages of lymphedema, but as the lymphedema worsens, these will not be sufficient
    • Lymphopress – Pneumatic compression technology – improves lymphatic flow
    • Multi-layered compression dressing which will be taught to you by your lymphedema Nurse Specialist. To have optimal effect, they have to be worn for about 10-12 hours continuously and simultaneous exercises to be done.

Important facts:

Having lymphedema is not easy. There are challenges faced, that affect you emotionally, psychologically and financially. It is important to:

  • Voice your concerns to your doctor/ Lymphedema specialist Nurse
  • Have open communication with your family
  • Family support is essential
  • It is equally important for the family to express their concerns as they care for you
  • Empowering the family to help you is most important part of care

Team there to help you:

  • Primary physician – actively manages your care
  • Pain Specialist – helps with pain of any cause
  • Lymphedema Specialist Nurse – who will guide management
  • Rehabilitation Specialist – helps you get back maximum function
  • Physiotherapist – ensures the exercises maximise effect of treatment
  • Psychologist – who will empower family and you in ways to cope
  • Occupational therapist – Who will help you cope with your daily activities
  • Mind and Body Medicine – will help you find ways to relax mind and body.

What are the situations to seek help:

  • When there is sudden increase in the limb
  • If there is increased redness in the limb
  • If there is fluid leaking from the limb
  • Fever and rashes on the limb
  • Increased pain from any cause
  • If there is increased distress of any cause – physical, emotional, psychological
  • Sleep disturbance

If there are any concerns please contact Multispecialty Clinic - Pain, Palliative and Rehabilitation Department. Aster CMI Hospital, Bengaluru

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