April 26, 2006



LYMPHEDEMA TREATMENT

WHAT PATIENTS CAN EXPECT

By Mary Rosenberg, PT, CLT-LANA

Lymphedema is a swelling of a body part that is caused by an insufficiency in lymph vessels that transport lymph, a protein rich fluid that is responsible for removing waste and unwanted substances from the body or an insufficiency of lymph nodes, the filtering stations responsible for processing and destroying those unwanted substances.

The causes of lymphedema are:

1. Either from removal of or radiation therapy to lymph nodes as is the case in treatment for many different types of cancer.

2. Hereditary causes; some individuals are born with too few or mis-shapened lymph vessels or lymph nodes.

3. Vascular conditions such as venous insufficiency, diabetes, obesity; when venous valves do not function well eventually the lymph system becomes challenged also

4. Certain kidney, liver and thyroid conditions (myxedema)

5. Mixed Edemas; vascular combined with other causes

6. Trauma or multiple surgeries in the same location

The treatment for lymphedema is called complete decongestive therapy. It includes the following:

1. Skin care – patients who have lymphedema are vulnerable to getting skin infections called cellulitis. Venous insufficiency patients are vulnerable to getting venous stasis ulcers (wounds). These kinds of wounds are usually easily treatable with lymphedema treatment.

2. Multilayered short stretch bandaging – a special type of bandages that are changed daily or every 2 days by our trained staff to help compress, re-shape and reduce the size of the arm or leg.

3. Manual lymph drainage – a type of gentle soft tissue technique that is used primarily for patients whose lymphedema is caused by destruction of lymph nodes (not usually needed for vascular patients).

4. Fitting with gradient compression stockings or sleeves - (depending on the location of the lymphedema) to be worn during the daytime and sometimes nighttime bulkier compression garments that are safe to wear when sleeping. Patients are measured for these garments following intensive treatment with the bandages after their size has been reduced. The time taken to achieve a good reduction depends on the cause of lymphedema, patient compliance to the program and how long the patient has suffered from the condition. Vascular patients usually reduce rapidly within one to two weeks. Lymphedema caused by cancer if the onset of the condition is recent usually reduce within 2 weeks. Morbidly obese patients may take 3 to 4 months to achieve a

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reasonable reduction of size. Custom made garments generally take up to 2 weeks to manufacture and deliver. Off the shelf garments usually take about 3 to 5 working days to deliver. Because

most cases of lymphedema become chronic, patients will have to wear their garments for the remainder of their lives to prevent their size from increasing once again.

5. Exercises – are performed in garments or bandages and walking is encouraged. Strengthening exercises are proven to be useful in further reducing and maintaining decreased lymphedema volume. Patients are discharged with home exercise programs.

How you can prepare for your visits to us:

1. What to wear – please wear very loose and comfortable clothing to your appointments. If your lymphedema is in your arm, you will need to wear a shirt with oversized sleeves and if it is in your legs you will need to wear stretchy oversized pants or warm up pants that zip or snap on the sides. During bandaging, you will need extra large shoes. We have post operative Velcro fastening shoes that fit well over most lower extremity bandages. Lower extremity patients, if your walking is even only slightly unsteady, please bring a walker. Walking in the bulky bandages can at first be a challenge to your balance. Many patients complain of the heaviness of the layered bandages. Most patients accommodate after a day or two wearing them. Bandages are worn around the clock until garments are measured for and delivered.

2. Number and length of visits – visits are usually one hour long however, patients with multiple draining wounds and obese patients often require 1 ½ or 2 hour sessions. Sessions are scheduled 3 to 5 times per week for 2 to 4 weeks.

3. Costs – Most insurances cover the treatment for lymphedema however; Medicare, while they pay for some wound care supplies, does not pay for any supplies related to lymphedema. Medicare patients can expect to pay approximately $150 for bandage supplies (these are reusable) for each leg. Daytime stockings, sleeves and gloves can cost from $100 to $900 depending on the type of garment needed and whether it is an off the shelf size or a custom garment. Nighttime garments can cost anywhere from $185 to $1,800 also depending on the type of garment needed and if it is custom or not. An average bilateral (both) lower extremity lymphedema patient who has lymphedema from the knees down will pay approximately $500.00 for all supplies. Daytime hose and sleeves when well cared for can last from 6 to 9 months before they need to be replaced.

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THE GOOD NEWS: LYMPHEDEMA IS AN EASILY TREATABLE AND MANAGABLE CONDITION. RESULTS OF TREATMENT ARE USUALLY QUITE SATISFACTORY.

Resources: Most research articles and further resources are available through the National Lymphedema Network →

Photos

Before Treatment

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During Treatment

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After treatment

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Multilayered bandaging with foam padding

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