What is Lymphedema?
Lymphedema is an incurable disease of swelling due to removal of, or damage to, or insufficiency of, the lymphatic system. Many people don’t know how important the lymphatic system is – but it helps keep your body from swelling in addition to being part of your immune system (to fight off germs and cancers and help keep you from getting sick) and helping your body absorb fat (in a good way). This article explains how to recognize and treat lymphedema.
Circulation 101
Arteries bring fluid from the heart to the body, and veins bring fluid back from the heart. What most people don’t know is that the lymphatics bring 10% of the fluid back to the heart that the veins don’t, along with large proteins that don’t fit in the veins.
People with CVI, or Chronic Venous Insufficiency, understand that they can have swelling in their legs because the veins aren’t bringing fluid back from the heart. What is not commonly understood is that when the lymphatics are not working right, they cannot help drain fluid from their assigned body part or parts.
A Few Examples
For example, after left breast cancer surgery, lymph nodes may be removed from the left armpit area. These nodes drain the left arm as well as the left ‘trunk’ or chest wall, front and back, from below the collarbone to the breastbone, to the belly button. Therefore not just the arm, but also the breast (if lumpectomy) or chest wall (if mastectomy) is at risk for swelling in this case.
As another example, lymph nodes may be removed or damaged during surgery or radiation for skin cancer of the face. These nodes drain the following areas of the face:
- Cheeks
- Eyes
- Chin
- Forehead
If these nodes are affected, the face can swell. It is common medical practice to remove lymph nodes during surgery to help doctors learn if the cancer has spread from its origin. In the past, many lymph nodes were removed, with the thought of ‘the more the better.’ However, research has shown that in many cases, removing fewer lymph nodes will cause less damage to the area, including less lymphedema risk.
Catching and Treating Lymphedema
We are at an exciting time in lymphedema treatment. We now know that in some cases, if we catch the swelling early and are proactive about treatment, some cases of lymphedema can be avoided (in one study, 25% of women who had axillary lymph node dissections were diagnosed with lymphedema but only 7% of women referred to a PT for lymphedema education and other care were diagnosed with lymphedema).
There is a lot to say about this subject, and more will be covered in future blogs. Cutting right to the point: lymphedema is a risk for anyone that has had lymph nodes removed or damaged for any reason, most commonly surgery but also trauma to the lymph nodes or if you were born with a lymph system that doesn’t work correctly.
PT of Costa Rican National Soccer Team for 2007 World Cup in Victoria, CAN. Clinical Instructor for University of Minnesota Doctor of Physical Therapy Affiliations
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