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Lymphedema

Lymphedema generally occurs in one of your arms or legs. Although lymphedema tends to affect just one arm or leg, sometimes both arms or legs may become swollen.

The condition is characterised by swelling and a blockage in your lymphatic system, an important part of your immune and circulatory systems. The blockage prevents lymph fluid from draining well, and as the fluid builds up, the swelling continues.

Causes

Your lymphatic system is crucial to keeping your body healthy. It circulates protein-rich lymph fluid throughout your body, collecting bacteria, viruses and waste products. Your lymphatic system carries this fluid and harmful substances through your lymph vessels, which lead to lymph nodes. The wastes are then filtered out by lymphocytes, infection-fighting cells that live in your lymph nodes and are ultimately flushed from your body.

Lymphedema occurs when your lymph vessels are unable to adequately drain lymph fluid, usually from a leg. Lymphedema can be either primary or secondary. This means it can occur on its own (primary lymphedema), or it can be caused by another disease or condition (secondary lymphedema).

Causes of primary lymphedema

Primary lymphedema is a rare, inherited condition caused by problems with the development of lymph vessels in your body. Primary lymphedema occurs most frequently in women. Specific causes of primary lymphedema include:

• Milroy’s disease (congenital lymphedema) – This is an inherited disorder that begins in infancy and causes a malformation of your lymph nodes, leading to lymphedema.

• Meige’s disease (lymphedema praecox) – This hereditary disorder often causes lymphedema in childhood or around puberty, though it can occur in your 20s or early 30s. It causes your lymph vessels to form without the valves that keep lymph fluid from flowing backward, making it difficult for your body to properly drain the fluid from your limbs.

• Late-onset lymphedema (lymphedema tarda) – This occurs rarely and usually begins after age 35.

Causes of secondary lymphedema

Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphedema. Causes include:

• Surgery, if your lymph nodes and lymph vessels are removed or cut. For instance, surgery for breast cancer may include the removal of one or more lymph nodes in your armpit, to look for evidence that cancer has spread. If your remaining lymph nodes and lymph vessels can’t compensate for those that have been removed, lymphedema may result in your arm.

• Radiation treatment for cancer may result in scarring and inflammation of your lymph nodes or lymph vessels, restricting flow of lymph fluid.

• Cancer cells, if they block lymphatic vessels. For instance, a tumor growing near a lymph node or lymph vessel could become large enough to obstruct the flow of the lymph fluid.

• Infection can invade your lymph vessels and lymph nodes, restricting the flow of lymph fluid leading to the condition. Parasites also can block lymph vessels. Infection-related lymphedema is most common in tropical and subtropical regions of the globe and is more likely to occur in developing countries.

Complications

Lymphedema in your leg can lead to serious complications, such as:

• Infections – Making the affected leg particularly vulnerable to conditions such as cellulitis, a serious bacterial infection of the skin and lymphangitis, an infection of the lymph vessels. Any injury to your leg can be an entry point for an infection.

• Lymphangiosarcoma – This rare form of soft tissue cancer can result from the most severe cases of untreated lymphedema. Possible signs of lymphangiosarcoma include blue-red or purple marks on the skin.

Tests and Diagnosis

Your healthcare provider may try to rule out other causes of swelling when diagnosing lymphedema. Swelling can have many causes, including a blood clot or an infection that doesn’t involve your lymph nodes.

If you’re at risk for lymphedema for instance, and if you’ve recently had cancer surgery involving your lymph nodes, your healthcare provider may diagnose lymphedema based on your signs and symptoms.

If the cause of your lymphedema isn’t as obvious, your doctor may order imaging tests to determine what’s causing your signs and symptoms. To get a look at your lymphatic system, your doctor may use an imaging technique, such as:

• Magnetic resonance imaging (MRI) – Gives your healthcare provider a better look at the tissues in your leg.

• Computerized tomography (CT) – This is an X-ray technique that produces detailed, cross-sectional images of your body’s structures and can reveal areas of the lymphatic system that may be blocked.

• A Doppler ultrasound – A variation of the conventional ultrasound, it looks at blood flow and pressure by bouncing high-frequency sound waves (ultrasound) off red blood cells. It is helpful in finding obstructions.

• Radionuclide imaging of your lymphatic system – For this test you’re injected with a radioactive dye and then scanned by a machine. The resulting images show the dye moving through your lymph vessels, highlighting areas where the lymph fluid is blocked.

Treatment

There’s no cure for lymphedema. Treatment focuses on reducing the swelling and controlling the pain. Lymphedema treatments include:

• Exercises -Light exercises that require you to move your affected leg may encourage movement of the lymph fluid out of your limb. These exercises shouldn’t be strenuous. Instead, they should focus on gentle contraction of the muscles in your leg. Your healthcare provider or therapist can guide you with the exercises that may help.

• Wrapping your leg – Bandages wrapped around your entire limb encourage lymph fluid to flow back out of your affected limb and toward the trunk of your body. When bandaging your leg, start by making the bandage tightest around your toes. Wrap the bandage more loosely as you move up your leg. A lymphedema therapist can show you how to wrap your limb.

• Massage Therapy – A special massage technique called lymphatic drainage may encourage the flow of lymph fluid out of your leg. Lymph drainage involves special hand strokes on your affected limb to gently move lymph fluid to healthy lymph nodes, where it can drain. These massages aren’t for everyone, it is on a case by case basis.

• Compression Garments – These stockings are made to compress your leg to encourage the flow of the lymph fluid out of your affected limb. Once you’ve reduced swelling in your leg through other measures, your healthcare provider may suggest you wear compression garments to prevent your limb from swelling in the future. Obtain a correct fit for your compression garment by getting professional help.

In cases of severe lymphedema, your healthcare provider may consider surgery to remove excess tissue in your leg. While this reduces severe swelling, surgery can’t cure lymphedema.

Prevention

To reduce your risk of lymphedema, try to:

• Protect your leg – Avoid any injury to your affected limb. Cuts, scrapes and burns can all invite infection, which can result in lymphedema. Protect yourself from sharp objects. For example, shave with an electric razor, wear gloves when you garden or cook. If possible, avoid medical procedures, such as blood draws and vaccinations, in your affected limb.

• Rest your leg while recovering – Avoid heavy activity with that limb. Early exercise and stretching are encouraged, but avoid strenuous activity until you’ve recovered.

• Avoid heat on your leg – Don’t apply heat, such as with a heating pad, to your affected limb.

• Elevate your leg – When you get a chance, elevate your affected limb.

• Avoid tight clothing – Avoid anything that could constrict your leg, such as tight fitting clothing.

• Keep your leg clean – Make skin care and nail care high priorities. Inspect the skin on your leg every day, keeping watch for changes or breaks in your skin that could lead to infection. Don’t go barefoot outdoors.

Your feet mirror your general health . . . cherish them!

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