Managing Swelling in Your Arms and Legs
What is Lymphedema?
Lymphedema is a condition that afflicts an estimated two million people in the United States. It is a chronic, persistent condition characterized by an accumulation of protein-enriched fluid found in the tissue spaces of the body. It is caused by a disruption in the lymphatic system that results in obstructed lymphatic flow. This leads to swelling--most often in the arms and legs, but it can occur in other areas of the body as well. Left untreated, the condition usually deteriorates over time, resulting in reduced skin integrity, fibrosis (hardening and loss of elasticity of the skin) impeded wound healing, and increased potential for infection.
The lymphatic system is a part of our circulatory system, which also includes veins and arteries. The purpose of the lymphatic system is to:
- Produce disease-fighting cells (lymphocytes) for the immune system which help fight bacteria and viruses
Collect fluids from our tissue and return those fluids to our bloodstream
Remove excess protein and bacteria from the body
Unfortunately, there is no cure or effective surgical option for lymphedema. Early intervention, proper treatment and vigilant self-management are essential for the control of lymphedema. Lymphedema is a life-long condition, requiring continued and diligent management. If ignored, the condition almost always increases in severity, becomes more difficult to manage and is less likely to return to its normal size. Although managing lymphedema may involve some lifestyle changes and a few restrictions, living a normal, active life is still possible.
Lymphedema Treatment and Management
Determining the appropriate therapeutic program depends greatly on the nature and severity of the lymphedema, as well as patient tolerance and compliance. A combination of treatment modalities, based on the individual, often proves to be the most effective way to manage lymphedema. The recommended treatment plan is normally based on an approach called Complete or Complex Decongestive Therapy (CDT) or Complete Decongestive Physiotherapy (CDP), both essentially sharing the same meaning. This approach combines manual lymph treatment (a treatment method using a series of light, rhythmic, strokes to reduce swelling and improve the return of lymph to the circulatory system) with compression techniques, and self-care, education and training.
Successful management of lymphedema depends on patient compliance. Patients may find one method easier to apply or more effective over another. The treatment modality that works best, alone or in conjunction with another, may differ depending on the individual. Sometimes, only trial and error will determine what is most effective. Results are achieved slowly and are painstaking to maintain. Because lymphedema can be disfiguring and is sometimes painful and disabling, there are often psychosocial considerations and lifestyle adjustment issues that patients must deal with on a continual basis. Lymphedema can affect self-image, interfere with routine activities, limit what clothes can be worn, and remind cancer survivors of the disease they thought they had overcome, leading to understandable frustration.
Graduated compression hosiery and arm sleeves offer a cost-effective method of treatment both for preventative and post operative venous and lymphatic disorders. Graduated compression stockings are a safe, non-invasive medical product offering proven therapeutic benefits.
Graduated compression stockings are scientifically designed to regulate blood flow velocity through the feet and legs. Blood flows faster in compressed vessels than in dilated ones. Medical compression hosiery effectively helps promote the venous and lymphatic return by gently compressing the limb with graduated pressure—pressure which is greater distally (direction farthest from the heart) than proximally (direction closer to the heart). This is important in counter-acting the forces of gravity.
Elastic stockings and arm sleeves are primarily designed to maintain and support the limb, not to reduce its size. Garments should be applied in the morning to prevent gravity from pulling fluid down into the limb. They should be worn daily while active, and removed for sleeping when the body is recumbent and the stronger external pressure of elastic garments is not necessary.
Only stockings with graduated compression will be effective in preventing the development of and controlling the extent of the edema, as well as for restoring the blood flow velocity to normal.
Short stretch compression bandages are minimally elastic. They compensate for the diminished skin pressure associated with lymphedema, and prevent the reaccumulation of evacuated, stagnating lymph fluid. The more inelastic the bandage is, the greater the potential working pressure (pressure produced when the muscle pump works against the resistance of the bandage, as when exercising). Inelastic and short stretch bandages have advantages over elastic garments because they force a higher working pressure and greater muscle pump efficiency. Conversely, because of the low resting pressure (pressure exerted when the muscle is inactive and relaxed), compression bandages may be worn day and night with good patient compliance.
Compression bandaging is applied in layers. The digits (fingers and toes) are individually wrapped with gauze bandages. A tubular bandage, primarily made of cotton, is worn underneath the compression padding and bandages to protect the skin and absorb excess perspiration. Padding bandages are applied just prior to the actual compression bandages to cushion the limb (especially over skin creases or bony prominences) and to prevent sharp indentations and irritations to the skin. In addition, they serve to distribute the pressure evenly over the limb. The last stage is the actual short stretch compression bandages used to apply the final compression. They are wrapped with mild to moderate tension in an overlapping pattern in a distal to proximal direction.
Compression pumps are designed to promote venous and lymphatic circulation, and remove edema from the extremity by progressively moving fluid in a distal to proximal direction. Pumps are dynamic compression therapy systems that pump air into garments worn over the affected areas of the body. The air cells within the garments inflate in a special sequence with alternating waves of compression and brief periods of pause and refill. This action massages the affected area with a "milking" motion that stimulates lymphatic uptake and venous return, thereby reducing edema and swelling.
Lymphedema compression systems differ from elastic compression garments because they are non-elastic, applying a high working pressure and low resting pressure. They are also a good alternative to compression bandages which can be difficult to self-apply or are applied with uneven pressure. When external pressure is applied, these devices not only cushion the area, they increase venous return and lymphatic flow, and help prevent fibrosis. These systems can be used independently to prevent nighttime swelling, under pneumatic appliances used with a compression pump, or under short-stretch bandages and compression binders.