Lymphoedema Control  
This section deals with the diagnosis, tests for, and reduction/control of lymphoedema

Contents:
1.      Introduction
          (a) What is lymphoedema?
          (b) What causes lymphoedema? 
          (c) A cure for lymphoedema  

2.            Diagnosis & grades of lymphoedema
          (a) Diagnosis of lymphoedema
          (b) The grades of lymphoedema

3.            Diuretics; Antibiotics; Skin Care for lymphoedema
(a) Diuretics and lymphoedema
(b) Skin Care for lymphoedema
(c) antibiotics for lymphoedema infections

4.            Recording details for future reference

5.            Optimal Lymphoedema management
(a) Hospital and Clinic Lymphoedema reduction 
(b) Treating/Reducing Lymphoedema from Home
(c) Combination Treatment for Lymphoedema
(d) Cost and Benefits of treating lymphoedema

6.            How are lymphoedema reductions made?
(a) The mechanics of lymphoedema reduction
(b) Where does lymphoedema therapy start?
(c) Clinic or lymphoedema treatment at home
(d) Home treatment for lymphoedema

7.            Diet and vitamins for lymphoedema assistance

8.            New lymphoedema treatments 
(a) Laser and lymphoedema therapy
(b) other equipment for lymphoedema therapy

9.     Conclusion

1: Introduction
1 (a); What is lymphoedema; In medical terminology; Lymphoedema is an oedema or swelling of the tissues termed a ‘high protein oedema’. This condition is caused when normal lymphatic load into the tissues is greater than the available lymphatic transport out of the tissues, long term and over prolonged and indefinite periods of time.

What is lymphoedema; Lymphoedema explained everyday language;
Lymphoedema causes swelling when your lymphatic system is unable, for a long period of time, if ever, able to remove sufficient protein to maintain a level of 2% in the fluids contained between tissue spaces in the tissues of your body. This inability of the lymphatic system to remove enough protein causes you to retain other fluids in the tissues also. The consequence of too much protein retention in your tissues is you swell up and get "lymphoedema" wherever this problem occurs. 

Note; The proteins that are referred to in the above-mentioned paragraph, are plasma proteins leaked from the capillary ends of your blood vessels into your body tissues, this is a normal body function, and reducing the amount of protein you eat will not resolve the problem of excess protein in the tissues causing lymphoedema swelling.  

Lymphoedema is caused by a permanent insufficient function of the lymphatic system, which allows an accumulation of excess protein greater than 2% in fluids (interstitial fluid)  contained in the tissues of your body to cause the resultant swelling and discomfort.  Whereas, the oedema and swelling of an injury is caused by a temporary release of fluids into the tissues of your body from damaged blood vessels. As the damaged blood vessels repair, and, the action of a normally functioning lymphatic system removes the wastes and any excess protein deposited into the tissues from the injury, the swelling will subside.

1(b): What causes lymphoedema;
Lymphoedema is caused by compromised lymphatic function in an affected part of the body which allows excess protein to accumulate in the fluid bathing the cells of the body (interstitial fluid), and contained in the spaces between body tissues, at a level greater then 2%.

1 (c); A cure for lymphoedema;
Is there a cure for lymphoedema? Persistent well planned treatment can make a lymphoedema affected limb look smaller and more normal by gradually reducing the oedema and swelling. This can increase your mobility and generally make you feel better about how you look. Until a way to regenerate a dysfunctional lymphatic system is devised, then the cure for lymphoedema is yet to be found.  

·       What always needs to be remembered is; by re-routing excess protein from a lymphoedema affected area to other areas of the body where the lymphatic system is functional and protein can be naturally removed from the body tissues to be returned back to the blood circulatory system, then lymphoedema can be controlled, reduced and kept manageable, even if at this time there is no known permanent cure.  

·       If your lymphoedema is increasing in size, in most cases it will eventually have a period of stability or latency when it does not worsen and seems to settle down, these times may last for months or years. Many times after a period of stability (latency), lymphoedema affected limbs will commence activity again with resultant increased swelling and discomfort to grow larger. This is a normal progression of lymphoedema if left untreated.  

·       When lymphoedema is treated reductions can be best described as Lymphoedema in reverse. With treatment, lymphoedema swelling may be reduced quickly over a short period of time, then often, a time of waiting plus a little maintenance therapy must elapse before the next significant reduction can be obtained.  

·       In the cooler times of winter Lymphoedema is more easily managed than in the warmer weather of summer. Winter is a good time to have, or commence lymphoedema reduction therapy.

2 (a): Diagnosis of lymphoedema
Tests used to ascertain Lymphoedema (a simple explanation). Following are the main accepted safe medical tests for ascertaining lymphatic function/dysfunction which will ultimately cause lymphoedema and the tests for venous insufficiency which also impact on unwanted swelling.   

·       Lymphoscintigraphy; – a radio-nuclide with water is injected near finger or toe of affected limb and its progress is traced with a gamma camera up the arm or leg. From this information it can be ascertained how well the lymphatic system is working and to what degree of the normal expected lymphatic uptake is available.  

·       Computed tomography; - (CT Scan) shows cross section images of tissues or MRI Scan where malignancy may be suspected.  

·       Duplex imaging study; - Ultrasound to identify/rule out chronic venous insufficiency.  

·       Bioimpedence analysis (BIA) - an extremely small electrical current is passed through the body and depending on the electrical resistance encountered it is possible to presume/predict the probability of a lymphoedema condition becoming evident, prior to clinical signs becoming noticeable, and after taking into account the risk of a patients susceptibility.  

2 (b); The grades of lymphoedema are medically defined as;
Grade 1 Lymphoedema;  
·       When the skin is pressed hard with the end of a finger or blunt object the skin will remain indented (pitted) after the finger or object is removed. If the affected limb is elevated higher than the other parts of the body (normally overnight) the swelling is reduced  

Grade 2 Lymphoedema;  
·       Grade 2 lymphoedema has much more excess fibrous tissue contained within the affected limb, and if the skin is pressed hard with the end of a finger, it does not indent or 'pit'. There will be little or no reduction to the swelling or oedema by elevation of the limb, even if the limb is elevated and rested in bed overnight or for 2-3 days. The limb gradually 'hardens' because of the excess fibrous (scar) tissue due to chronic inflammation.

Often at this stage there will be evidence of lack of oxygenation in the tissues, this will be indicated by discoloured skin and elevated temperature of the whole limb, or sometimes only the lymphoedema affected part of the limb may have elevated temperature and discoloration..  

Grade 3 Lymphoedema, elephantiasis:  
·             With Grade 3 lymphoedema there appear gross changes to the skin with many protrusions and huge bulges in the tissues of the affected limb. It is often considered irreversible lymphoedema, however, this is not the case and much can be done to alleviate the condition with proper lymphatic therapy, care and attention  

·             It is to be noted Doctors and Lymphoedema therapists alike describe lymphoedema according to its grade.  

·             There is no substitute for a Doctors opinion, and your doctor can arrange tests to ascertain if a condition is really lymphoedema. However, these tests may be expensive and not always conclusive.  

·             Lymphoedema is not only the only cause of oedema, so possibilities need be explored obtain diagnosis, testing may take time so patience is beneficial for you. A tense body restricts muscular movement, which in turn will be to the detriment of lymphatic flow and cause further swelling. Patience will help you relax more and consequently help improve your condition by not having continual tense muscles.  

·             Symptoms that do not show conclusive evidence of lymphoedema from testing may be visually recognizable to many experienced lymphoedema practitioners, who can then in conjunction with your doctor ascertain a suitable treatment regimen.  

·             You, your doctor and lymphoedema practitioner working together is the most helpful way forward to control your condition. Your Doctor can often help locate a suitable Lymphoedema Practitioner for assistance/treatment when this is required.  

·             Venous insufficiency and/or capillary fragility should always be considered as a possible trigger for oedema and lymphoedema look-alike conditions. Even after testing not all conditions show positive to all investigative procedures and these conditions may be contributory towards causing a high protein oedema and the consequential overload of a lymphatic system causing swelling, pain and discomfort.  

·             For assistance with diagnosis look at family heredity; have there been other family or extended family with varicose veins, swollen legs, swollen ankles, knees or with not quite normal sizes to limbs or body? These can be good indicators for diagnosis.  

·             Circulatory problems normally respond well to dietary change and vitamin supplementation and can have a major beneficial effect in assisting lymphoedema reduction. See Diet and Lymphoedema for more information on this subject.  

3 (a): Diuretics and Lymphoedema;  
·             Diuretics to control lymphoedema are not helpful long term to treat lymphoedema conditions; they remove fluid but not excess protein from the spaces between the cells of the body which are the cause of a lymphoedema problem.  

·             If using diuretics for lymphoedema control, check with your doctor to see if they are required for other conditions and if not whether their use may be reduced over time, long term use of diuretics to treat lymphoedema will normally exacerbate the problem.  

3 (b); Skin Care & Lymphoedema  
·             Dry broken and cracked skin; tinea between toes or other fungal infection in skin folds can allow opportunistic invading micro-organisms entry to swollen tissues and cause infection. Prevention from infection is best policy; to assist prevention from infection, keep skin moist and supple using a cream (see creams for options) or just use plain sorboline cream daily.  

·             To prevent injury, it is well advised to wear protective coverings over a lymphoedema affected limb when performing manual task.  

·             Too much sun will exacerbate a lymphoedema affected area as the heat will reduce lymphatic function. Where possible wear a sun-block cream, keep out of direct sunlight and if impossible to do this, wear suitable clothing for protection.  

3 (c): Antibiotics for Lymphoedema; 
·             Lymphoedema affected limbs are prone to infection due to elevated protein levels and reduced levels of tissue oxygenation. Ask your doctor for antibiotics to have on hand ready for immediate use should infection become apparent. Always consult your doctor quickly if you suspect or see the signs of infection.  

4: Recording size details for future reference  
·             It is recommended to record measurements of lymphoedema affected limbs and also unaffected limbs for later comparisons prior to beginning treatment. You may not notice differences on a day to day basis; however, recorded measures will allow you to plot reductions over time.  

·             Measure sheets for arm or legs are available at www.poppylaneclinic.com.au Click on the Lymphoedema button and the measure sheets are located at bottom of page by clicking the appropriate link.  

5: Optimal Lymphoedema Management
There are a few ways to approach lymphoedema reduction;  
·             (a) Hospital & Clinic Lymphoedema Therapy. Hospital or clinic treatments will perform lymphatic draining massage, followed by bandaging of an affected limb which provides fast reductions and require compression garments to be worn at completion of treatment. Clinics and hospitals can also provide ongoing CPT Lymphatic Draining Massage to assist reduction of swollen lymphoedema affected limbs.  

·             (b) Treating Lymphoedema from Home; Gradual lymphoedema reduction using self help techniques from home, this treatment option is slower, however, it does allow skin and tissues to return back to normal without the imperative use of heavy compression garments. The website sponsor believes that Home Treatment for Lymphoedema offers the easiest long term and cost efficient option for treatment of lymphoedema. Contact julietgeorge@lymph.com.au for more information

·             (c) Combination lymphoedema treatment; Combination of clinic/hospital treatments and self help at home work well and can give you the additional support and confidence for continued reductions to your lymphoedema affected limb.  

·             (d) Cost v Benefit of treating lymphoedema; The cost of not treating your lymphoedema can result in a reduced capacity for paid work, or early retirement from paid work and subsequent loss of income. Insofar as enjoyment of social and family life is concerned, not treating lymphoedema often reduces your mobility and can reduce your opportunity to participate in many activities that you would like to do and enjoy. The cost of not treating you lymphoedema in fact can have large costs to your income and your daily enjoyment of life. 

·             The benefit of treating your lymphoedema can improve your lifestyle, make you feel less swollen, less conspicuous, let you be more mobile, plus, make your life easier and more enjoyable. There is of course a financial outlay for treatment,  however, proactive treatment of your own accord is much better than being forced into treatment due to immobility, infection or pain of a lymphoedema affected limb.    

·             Both clinic/ hospital treatment and optimal self help home treatment proposed by the website sponsor, Poppy Lane Skin Care & Lymphoedema Clinic, involve an initial monetary outlay, however, provided you are willing to take control of your own lymphoedema condition, with a little help as required, the self help treatment option is the most cost effective over time. To find out more contact Juliet, at Poppy Lane Skin Care & Lymphoedema Clinic (email julietgeorge@lymph.com.au for more information).  

6; How are lymphoedema reductions made?  
·             The mechanics of lymphoedema reduction; Optimal Lymphoedema treatment will reduce the size of a lymphoedema affected limb by the use of massage and laser therapy, plus bandaging (in some cases), compression garments, good skin care, diet supplementation and other equipment when available. 

The Physical massage therapy and laser therapy will sequentially open a pathway for lymphatic fluid to return to the blood circulatory system via fully operational lymphatic systems in other parts of the body, plus, by using a combination of all treatment types, you can stimulate other complimentary systems to assist reducing the cause of your lymphoedema. See diet & lymphoedema for more information.  

·             Where does lymphoedema therapy start; Lymphoedema reduction therapy should always commence near the neck and progress in a sequential manner towards the lymphoedema affected limb. First the front of the body (above collar bone, chest and abdomen) will be cleared using massage and or laser, then the rear of the body is cleared (shoulders and back), then only after the front and rear of the body is cleared will the affected limb be cleared or treated.

         A Lymphoedema draining massage should last approximately one hour or longer with the majority of massage stokes being slow in motion and light in touch. A small part of a lymphoedema clearance massage will be firm or hard, the majority of lymphoedema reducing massage movements will be slow and light in touch.  

·             Clinic, or Lymphoedema treatment at Home. The Choices; 
For people requiring large lymphoedema reductions quickly, CPT Lymphoedema Therapy performed in a clinic or hospital will normally provide a good result. Reduction of 40-60% of oedema can be expected from daily treatment taken over a 1-3 week period. The website sponsor provides full clinic lymphoedema therapy treatments and will also follow doctor prepared management plans when provided.  

·             Clinic or Hospital Lymphoedema Treatment should include CPT Lymphatic draining massage, Laser therapy and on immediately on completion of these therapies, bandaging to retain reductions from the massage. Bandaging also will further assist reduction of the lymphoedema affected limb overnight whilst the limb is bandaged. At final completion of treatment when no further reductions are possible at that stage, compression garments must be regularly worn to maintain the reduction.  

·             Home treatment for lymphoedema allows flexibly of treatment times and treatment at a frequency to suit you with the added benefit it is performed in the privacy of your own home. 

With the optimal home lymphoedema treatment proposed by the website sponsor Poppy Lane Skin Care & Lymphoedema Clinic, you are able to perform therapy whilst sitting in a lounge chair watching the TV. A component of self massage, skin care, light compression garments and exercises compliment the use of equipment supplied with this program.

·             The cost effectiveness of lymphoedema therapy at home is undeniable, and provided there are no additional complications and ongoing therapy is performed, reductions should be sustained and further reduced over time. 

For more information about how you can have optimal home lymphoedema reduction therapy, you may contact Juliet, from Poppy Lane Skin Care & Lymphoedema Clinic by email at julietgeorge@lymph.com.au for more information.  

7: Diet & Vitamins for lymphoedema assistance  
·             Diet can assist with lymphoedema control. Certain molecules in some foods stimulate the body's secondary responses which can have positive effect on lymphoedema reductions. More detailed information is available at the diet for lymphoedema page.  

·             The website sponsor promotes, recommends and makes available a registered dietary supplement ‘Lympaction’ a combination of rutin powder and vitamin C. It is endorsed by the Lymphoedema Association of Australia. See diet and lymphoedema pages for more information about this product.  

8: New Lymphoedema Treatments  
·             In late 2006 the FDA in the USA approved the use of a low level laser for the treatment of lymphoedema. Laser has proved an exceptional new tool for treating lymphoedema. More information is contained in the detailed laser therapy pages at this website. Laser & Lymphoedema

·             Other treatments with similar function to the laser are Bioptron/ Polarized light and Pulsed Magnetic Field Therapy, you will find links for detail of these products on the vertical page sidebar.  

·             All these new products are suitable for home use and are provided with personalized instruction for you when purchased from the website sponsor Poppy Lane Skin Care and Lymphoedema Clinic. For more information please contact Juliet the clinic Director by email at julietgeorge@lymph.com.au

8: Conclusion  
·             Lymphoedema occurs for a variety of reasons; it has the one common denominator of an insufficient lymphatic system which allows too much protein to accumulate in the interstitial fluids of an affected body part.  

·             Lymphoedema is controllable and the swelling of lymphoedema can be reduced in size. Lymphoedema treatments can be successfully performed in a hospital, a clinic or at home.  

·             If you want a personalised plan or equipment to help reduce your lymphoedema you should contact Juliet at julietgeorge@lymph.com.au Juliet is the Director at Poppy Lane Skin Care & Lymphoedema Clinic, this website sponsor. Juliet can supply home based plans to reduce your lymphedema swelling, and the equipment and personalized advice to help you reduce the swelling of lymphoedema at home. Plus, if you live close enough, clinic based care too. All of these actions can assist and help you reduce your lymphoedema swelling to lead a more active, mobile and happy life.  

I wish you well.

Feedback about this page would be appreciated.  

Email feedback to; julietgeorge@lymph.com.au

© Copyright, February 2007 Poppy Lane Skin Care & Lymphoedema Clinic,. N.S.W. 2166 Australia

References:
1. Casley - Smith JR Benzo pyrones in lymph.dema Int Angiol, 1997 in press
2. Casley-Smith JR & Judith R "High Protein Oedema and the Benzo Pyrones, Lippincott Sydney & Balt (1986)
3. Coumarin - Biology, Application and modes of action ,ed R, O'Kennedy, and R D Thorns, N.Y Wiley, 1997a: 143 - 184
4. Casley-Smith JR & Judith R 'Modern Treatment for Lymphoedema' Fifth Edition (Pg 233) Bowden Printing, Adelaide
5. Robert Twycross, Karen James & Jacquelyne Todd. 'Lymphoedema' Ausmed Publications P/L. ISBN 0 9579876 68.  
6. Arthur c. Guyton, M.D., John E. Hall, Ph.D. Textbook of Medical Physiology, Eleventh Edition. Reed Elsevier, New Delhi , India ISBN 10: 81-8147-920-3 .