Milford Vascular Institute will be opening a state-of-the-art lymphedema treatment center in early 2020. This center will focus on promoting total health improvement with on-site lymphedema therapists and nutritionists.
Lymphedema is edema, or swelling, that typically occurs in an extremity. The swelling is caused by an obstruction in the lymphatic system.
The lymphatic system is a system of tissues and organs that rid the body of toxins, germs, or other unwanted bodily waste. The primary function of the lymphatic system is promoting immunity in the body. The system does this by transporting lymph, a fluid containing infection-fighting white blood cells, throughout the body.
The system is primarily composed of lymph vessels and lymph nodes. Lymph vessels are very tiny. Most are smaller than capillaries in your circulatory system. These vessels are the conduits which move lymph to and from lymph nodes. Lymph nodes have two major functions: filtering the lymph of bacteria and viruses and producing lymphocytes. Lymphocytes are the white blood cells which act as defenders against invaders. There are also 4 primary organs in the lymphatic system: the spleen, thymus, tonsils, and adenoids.
Lymphedema develops from an obstruction in the lymphatic system. It is most common to develop lymphedema in one of your extremities. However, some patients do develop swelling in both arms, both legs, their head, chest, or genitals. This blockage is most commonly caused by the removal of or damage to your lymph nodes. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.
Lymphedema signs and symptoms include:
Swelling of part or all of the affected area
A feeling of heaviness or tightness
Restricted range of motion
Aching or discomfort
Hardening and thickening of the skin
Unfortunately, there is currently no cure for lymphedema.
To treat the disease, we have to manage the symptoms. There are 4 stages of lymphedema and treatment varies at each stage of the disease.
Stage 0: Subclinical Stage. During this stage, patients have not fully developed lymphedema. The transport capacity of the patient's lymphatic system is suboptimal, but remains sufficient to manage the lymph load. Patients at this stage should wear compression stockings and should follow up with their doctor at least 1-3 times over 4-6 weeks to ensure compliance of treatment and to prevent progression of symptoms.
Stage 1: Reversible Stage. During this stage, the affected area is pliable but there has not been any hardening or thickening of the skin. When pressure is applied to the area, pitting occurs easily. Pitting edema is present when a mark is left in the skin by applying pressure from a finger, hand, or object. Patients at this stage require manual lymph drainage daily for 2-3 weeks until the swelling is resolved. Afterwards, the patient must wear compression daily. With compliance, lymphedema at this stage is reversible.
Stage 2: Spontaneously Irreversible Lymphedema. During this stage, the tissue of the affected area is proliferated and hardening of the skin has begun. Pitting is difficult to induce and tissue becomes more firm. At this stage, if swelling is present in an extremity, patients would be unable to lift or have great difficulty or pain in lifting their fingers or toes. Infection develops easily. Patients at this stage require manual lymph drainage daily for a minimum of 3-4 weeks.
Stage 3: Lymphostatic Elephantiasis. During this stage, the volume of swelling increases and there is a further progression of tissue changes. Patients may develop papillomas, cysts, fistulas, hyperkeratosis, fungal infections, ulcerations, or frequent cellulitis. At this stage, patients are at risk of developing Stewart-Treves syndrome, a cancer of the inner lining of blood vessels which can occur in any area of the body. It is very aggressive and highly lethal. Patients at this stage require manual lymph drainage daily for a minimum of 4-6 weeks.