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MANUAL LYMPHATIC DRAINAGE

& EDEMA MANAGEMENT

What is lymphedema?

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Lymphedema is a pathological condition in which the lymphatic system (the lymph vessels or lymph nodes) does not work effectively. This fact makes the transport capacity of the system insufficient to remove the normal lymphatic load (mechanical failure). This usually drives the fluid and protein load into the intercellular space resulting in the appearance of the clinical signs of lymphedema, ie swelling of the area and accumulation of lymph. If lymphedema occurs in the intestinal wall, the removal of long-chain fats in the area of the intestinal lymphatics is disturbed. Practical edema, due to some insufficiency of the lymphatic system, we have all experienced at some point in our lives, and it is nothing more than the "swelling" after an injury or other pathological condition. However, a healthy lymphatic system succeeds and in a few days reverses the situation, restoring the normal image again, as it manages the lymphatic load successfully. When this return to normality is not possible, we have pathological and chronic lymphedema.

When can I get lymphedema and what types are there?

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Lymphedema as mentioned above is due to some abnormality in the normal form, quantity and function of the lymph vessels or lymph nodes. Such an abnormality occurs in 2 cases, which are also the categories of lymphedema. A) Primary lymphedema: In this case, the lymphatic network presents congenital anatomical peculiarities or malformations. For genetic reasons, a person may have fewer or dysplastic lymph vessels/nodes in one or more areas. The result is that at some stage of the person's life, the lymphatic network is deemed insufficient to manage the lymphatic load, resulting in the appearance of persistent swelling, which becomes chronic and is now characterized as lymphedema. If primary lymphedema occurs in children or adolescents and manifests itself at ages up to 35 years, it is called early, while if it appears in people older than 35 years, it is called late primary. It is characteristic that most of the time the onset of lymphedema occurs after an insignificant injury or even from simple mosquito bites. B) Secondary lymphedema: Secondary lymphedema occurs in adults after a serious injury to some part of the lymphatic system. The concept of injury also includes the most common cause, which is none other than a surgical removal of neoplastic lymph nodes (lymph node cleansing) or their irradiation as part of a treatment plan for cancer patients. Of course, the above does not exclude the appearance of lymphedema after a serious accident, where a large part of the lymphatic network may have been extensively or irreparably injured. In any case, we must mention that lymphedema can make its appearance from 2-3 to 20 or 30 years after a process of injury to part of the lymphatic vascular system.

Where can I develop lymphedema and what are the most common symptoms?

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Lymphedema can occur anywhere there are lymph vessels. In other words, it can appear literally anywhere on the body. Of course, the highest frequency is in the lower extremities, followed by the upper ones, while there are not a few times when we may have swelling in the trunk and genitals. The symptoms of lymphedema depend on the stage at which the swelling is. At first it can be generalized (eg the whole lower limb) or local (eg only the foot). The early stages of lymphedema are characterized by a soft, easy-to-move indurated swelling. However, the presence of swelling alone is not enough to make the diagnosis. There are various diagnostic tests, such as Stemmer's point, palpation and observation, which will give us the safe characterization of lymphedema. Other symptoms in lymphedemas that exist for a longer period of time are the proliferation of connective tissue resulting in the gradual hardening of the edema, hyperkeratosis and epitheliomas. We may also have thickening of the skin, an excessive increase in the volume of the affected member (elephantiasis), lymphorrhoea, melanocytosis, lipid deposition, etc.

What if I don't deal with it?

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Lymphedema, as long as it is not treated effectively or even worse if it is neglected, goes through all the stages, sometimes ending up in the 3rd stage of elephantiasis. So a stage 1 lymphedema with a soft and easily treatable swelling, can easily become a hard, fibrous, oversized brownish and difficult to manage swelling. The problems of the development of a lymphedema are many. To begin with, we mention the most dangerous ones, which are summarized in the fact that the area with the swelling shows a significantly reduced immune defense against possible infections. Thus, a simple hack on the already sensitive skin can very quickly end up in an erysipelas-type infection or an inflammatory cellulitis, situations that are painful and dangerous for the general health of the person. But a neglected lymphedema also affects the appearance, something that has physical and psychological ramifications. A severely swollen leg or arm may  be a reason for a person to start avoiding social exposure. Even worse, a lymphedematous condition in the genitals, an area sensitive in all respects, can become the cause of serious problems in the patient's sexual confidence and psyche.   Finally, we should not forget that as lymphedema goes through its stages of development, it also causes various problems in the person's daily life. In the 2nd and 3rd stage it becomes increasingly difficult for the person to choose clothing and footwear, as the problem of unevenness of the 2 sides of the body should be addressed, especially in local lymphedema.

Lymphedema and the healing process

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Lymphedema is a completely manageable condition. Even neglected lymphedema can, with appropriate treatment, return to a relatively normal state, restoring normality to the person's daily life. Obviously, the earlier the treatment plan begins, the better the prognosis for the development of the edema. ​ The treatment process includes the following steps: Update process At this first meeting with the lymphedema specialist, you will be given a detailed presentation and explanation of your condition. Through taking a history, detailed evaluation and physical examination, the picture of your lymphedema becomes clear to you. At the same time, in this first appointment, the treatment plan will be drawn up, its costing will be done and all your possible questions will be answered. This way you will know from the beginning what will be done, how much it will cost, how long it will take and what you should expect from this process. What does a typical session include? Lymphedema management sessions initially include assessment and reassessment. In short, the therapist evaluates the initial situation and systematically checks the course of treatment with various measurements and clinical tests. Then follows the purely therapeutic part. With specialized techniques and in a special way, the excess lymphatic load is removed from the area, enabling the lymphatic system to function and create collateral lymph management circulation.   The lymphatic drainage process is (and should be) gentle and painless, so as not to cause spasm of the lymph vessels. Also, the therapist must know the lymphatic network very well in order to drain the lymph in the right direction. Finally, in each session, a compression bandage is applied to maintain the result until the next session. With special materials and a specialized way, the therapist creates a graduated compression to drain the lymph, combined with muscle activation. How long does a treatment plan last? The duration depends on the clinical picture presented by the lymphedema. While a stage 1 lymphedema can come to normal levels in just 3-4 sessions, an advanced lymphedema will need 10-12 treatments before it is ready to accept the compression garment. Possible complications, such as an infection or inflammation, may lengthen the overall duration of treatment. Compression garment After the end of the therapeutic process, the measurement and manufacture of a specialized garment of graduated compression should be done, which the patient should place according to the therapist's instructions. Placing the compression garment and annual therapeutic maintenance of the area with the lymphatic deficiency will maintain the results of the initial treatment, facilitate the lymphatic system to return to a proper function and allow the person to return to the normal everyday life and functionality they had before lymphedema occurs. ​ source: https://bioanadrasis.com/department/lemfoidima/

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