Whidbey General Hospital

Rehabilitation Services Lymphedema Program

Lymphedema Program - Lymphedema is a medical condition where an abnormal amount of lymph fluid collects in the arms or legs. This usually occurs as a result of lymph nodes or vessels being damaged or removed due to surgery, radiation, or injury. Although Lymphedema is a chronic condition it can usually be controlled by carefully following an individualized treatment program.

The Lymphedema program is offered at both the hospital and north clinics and is provided by physical therapists trained specifically in this approach. Treatment may include:

  • Manual lymphatic drainage to soften the edema and move the fluid along lymphatic passageways.
  • Bandages and compression garments to maintain the reduction of limb size and promote lymphatic drainage.
  • Exercise to help the muscles pump the lymphatic fluid out of the affected limb.
  • Patient and family education on how to manage long term.

Lymphedema is a little known condition that is becoming better understood in the United States. To comprehend it we must grasp the role of the lymphatic system. The lymphatic system is a component of the circulatory and immune systems consisting of lymph vessels, nodes and lymphoid tissues.

The normal lymphatic system returns excess fluid and blood protein from the tissues to the blood circulation. It also plays an important role in protecting the body against illness. Lymph is a clear, colorless protein-rich fluid originating in tissue spaces throughout the body. It is cleared from tissue spaces through a network of thin-walled vessels (lymphatics), which ultimately empty into the venous system.

As it circulates through these narrow vessels, the lymph is filtered through lymph nodes removing bacteria, toxins and dead cells.

What is Lymphedema?
Lymphedema is a chronic inflammatory disorder in which lymph fails to circulate properly and, as a result, accumulates in the tissues of a limb or other part of the body. Left untreated, the condition can lead to increased swelling and a hardening of the tissue. This can result in decreased function of affected limbs. Because of the lymphatic system’s role in immune function, it can also lead to chronic infections and other illnesses.

Swelling occurs when the lymphatic system—the lymphatic vessels and/or lymph nodes—is damaged and cannot transport lymph back to the blood circulation.

When this happens, large protein and fat molecules collect in the tissue spaces and chronic inflammation and scar tissue develop. With normal flow impeded, lymphatic fluid backs up causing the swelling known as lymphedema. The condition causes a feeling of heaviness, slight discomfort, cosmetic deformity, and repeated bouts of infection.

Lymphedema should not be confused with normal post-operative swelling or edema resulting from venous insufficiency. However, untreated venous insufficiency can progress into a combined venous/lymphatic disorder that is treated in the same way as lymphedema.

Types of Lymphedema
There are two general categories of lymphedema: primary (congenital or hereditary) and secondary (acquired).

    • Primary Lymphedema
      A malformation of the lymphatic system where lymph vessels are missing or impaired. Primary lymphedema is rare and may be present at birth or develop later in life.
    • Secondary Lymphedema
      Occurs when some kind of damage happens to the lymph system. According to the National Institute of Health, approximately 3–5 million people in the U.S. have this more common form. This type of lymphedema happens as a result of surgery, radiation, infection or trauma. Surgeries requiring removal of, or radiation to, lymph nodes can put patients at risk of developing lymphedema. Secondary lymphedema can develop post-operatively, sometimes not displaying until years later.

A damaged lymphatic system, whatever the cause, is unable to tolerate the demand for the drainage of lymph fluid. The risk of developing lymphedema depends on how many lymphatics the individual had originally and what percentage of the lymphatics is not working. There is no easy way to test this so it is a good idea to be aware of the tips for prevention.

If you are scheduled for surgery that will include lymph node removal and/or radiation you should discuss the risk of lymphedema with your doctor. If you have undergone lymph node removal, with or without radiation, be aware of the following:

  • In the hospital
    Have your blood drawn and IVs/injections given in your unaffected arm or somewhere else such as the hip. Have your blood pressure taken on an unaffected arm or leg.
  • At doctor’s visits
    Be sure to make all staff aware of the above guidelines including no chemotherapy in the affected arm.
  • Laboratory tests
    Avoid blood draws in affected arm.
  • Patients with post-surgical drains
    Good skin care around the drain site is important. Empty the drain regularly and be sure to watch for signs of infection in the incision and drain areas.

(You may request to have the above information placed in your medical record.)

Avoid vigorous, repetitive movements against resistance and heavy lifting with the at-risk or affected extremity. Also avoid any type of trauma (bruising, cuts, sunburn or other burns, sports injuries, insect bites or scratches) to the limb. Consult your doctor if you notice any of the following signs and symptoms:

  • A "full" sensation in the limb(s), chest wall, neck, abdominal or genital area

  • Skin feeling tight

  • Decreased flexibility in the hand, wrist, or ankle

  • Difficulty fitting into clothing in one specific area

  • Ring/wrist watch/bracelet tightness

It is normal to have some swelling for the first few days following surgery. Having one limb slightly larger than the other does NOT necessarily mean that there is anything wrong. If you notice persistent swelling it is important that you seek immediate medical advice (and get at least one second opinion) as early diagnosis and treatment improves both the prognosis and the condition.

Information about your medical history, any surgeries, and past or present illnesses is important for your doctor to make a diagnosis of lymphedema. Sometimes tests are done to rule out problems that may look similar to lymphedema. You should only follow treatment designed for lymphedema if your doctor has diagnosed it.

Treatment of Lymphedema
There is a special type of treatment for the management of lymphedema that originated in Europe. It is slowly becoming available in the U.S. and involves:

  • Management of any infections that may exist

  • Manual lymph drainage (MLD) — a specific form of massage, performed by a specially trained therapist. It is designed to mobilize lymph fluid

  • Bandaging of the limb(s) to promote lymph drainage out of the limb (if needed)

  • Instruction in self-MLD and self-bandaging

  • Proper skin care and diet

  • Specific exercises to encourage movement of fluid

  • Compression garments (sleeves, stockings)

  • Following prophylactic methods at all times to prevent a worsening of the condition

Unfortunately, there is neither a cure for lymphedema nor any way to absolutely prevent it from occurring. Lymphedema therapy is designed to help in understanding the condition, decrease swelling, restore normal function of the involved limb(s) and provide ways to manage the condition.

Whidbey General Hospital Rehabilitation Services Department now offers a lymphedema management program. If you have lymphedema, a specially trained therapist can work with you to develop a program that allows you the best control of your lymphedema within the limits and lifestyle you prefer.