Lymphedema Prevention and Treatment

treatment

General: Lymphedema cannot be cured, as damage to the lymphatic system cannot be repaired. Treatment focuses on minimizing the swelling, controlling pain, and preventing complications. Treatment includes physical methods, such as compression stockings, and medicines. In cases of severe lymphedema, surgery may be performed to remove excess tissue from the affected area. Medications are generally not used. However, antibiotics may be used to treat and prevent infections. Diuretics or anticoagulants (blood thinners) should be avoided.
Complete decongestant therapy (CDT): Complete decongestant therapy (also called combined physical therapy) occurs when several treatments for lymphedema are combined, such as massage, bandaging, exercises, and skin care. This combination therapy should be managed by a specialist and should be avoided in patients that have high blood pressure, diabetes, paralysis, heart failure, blood clots, or serious infections.
Compression devices: Compression devices, also called pneumatic compressions, are sleeves that are worn over the affected arm or leg. The sleeve is connected to a pump that occasionally inflates the sleeve, putting pressure on the affected arm or leg, gently moving lymph fluid away from the fingers or toes. This prevents swelling by preventing fluid from building up in the arm or leg.
Compression garments: Compression garments (also called pressure garments, compression sleeves, and lymphedema sleeves or stockings) are long sleeves or stockings that are made to compress the arm or leg, encouraging the flow of lymph fluid out of the affected arm or leg and preventing it from building up in the future. A patient may wrap the arm or leg with bandages or have custom-made compression garments. Wearing a pressure garment during exercise may help prevent further swelling in an affected limb. It is important to use pressure garments during air travel, because lymphedema can become worse at high altitudes.
Exercise: Studies have shown that slow, carefully controlled exercise may prevent the development of lymphedema by encouraging the movement of the lymph fluid out of the affected arm or leg. In breast cancer survivors, upper-body exercise does not increase the risk that lymphedema will develop. Exercise should be designed and monitored by a physical therapist. Patients who have lymphedema should wear a well-fitting pressure garment. Avoid strenuous activity until complete recovery from radiation or surgery. Exercise should be stopped if swelling worsens. If exercise is stopped for a week or longer, it should be started again at a low level and increased slowly.
Laser therapy: Laser therapy may help decrease lymphedema swelling and skin hardness after a mastectomy (breast removal).
Massage: A special massage technique called manual lymph drainage (MLD) helps to drain excess lymph fluid out of the affected arm or leg. MLD involves special gentle hand strokes on the affected limb to move the lymph fluid to healthy lymph nodes, where it can drain. It should be performed by a professional with experience with lymphedema. Patients can be taught to do this type of massage therapy themselves. Massage should be avoided in patients that are undergoing radiation therapy, or have a skin infection, fever, active cancer, blood clots, or congestive heart failure, or where the skin is cut or wounded.
Skin care: A cream or lotion should be used to keep the skin moist. Small cuts or breaks in the skin should be cleaned promptly and treated with an antibacterial ointment. Sunscreen and shoes should be used when outdoors. Sharp objects should be avoided. An electric razor should be used when shaving, gloves should be worn during gardening or cooking, and a thimble should be used when sewing.
Surgery: In cases of severe lymphedema, surgery may be performed to remove excess tissue from the affected area. Surgery reduces severe swelling but does not cure lymphedema. Types of surgery include liposuction, removal of abnormal lymphatic tissue, and a transplant of normal lymphatic tissues to areas with abnormal lymphatic drainage. On rare occasions, a surgeon may bypass abnormal lymph tissue using vein grafts.
Weight loss: In patients who are overweight, lymphedema related to breast cancer may improve with weight loss.

integrative therapies

Unclear or conflicting scientific evidence :
Aromatherapy: Aromatherapy refers to different therapies that use essential oils. These oils are either sprayed in the air, inhaled, or applied to the skin in managing lymphedema and lymphedema-related conditions. Clinical aromatherapy is used in conjunction with complete decongestive therapy (CDT), which is a physically complete approach of managing lymphedema. A blend of frankincense, grapefruit, hyssop, and lavender can be used to soften and release scars and improve circulation. Clinical research has evaluated the effects of self-massage and skin care using massage cream with aromatherapy oils in lymphedema patients. Although self-massage and skin care significantly improved symptom relief and well-being, it only slightly and nonsignificantly reduced limb volume. The aromatherapy oils did not seem to affect these measurements. Additional research is needed in this area.
Carrier oils often used for lymphedema conditions contain proteins and can increase lymphatic load. These carriers should be avoided; examples are grape seed oil and safflower oil.
Hesperidin: Hesperidin is a flavonoid found in citrus fruits such as lemons, oranges, and grapefruits before they ripen. Most studies of the effects of hesperidin have used combination products that contain other ingredients in addition to hesperidin. Hesperidin-containing products may have beneficial effects on blood vessels. A combination product (Cyclo 3 FortĀ®) containing Ruscus aculeatus root extract, hesperidin methyl chalcone (HMC), and ascorbic acid may help reduce swelling of the arm in women who have been treated for breast cancer. Additional research on the effect of hesperidin alone is needed.
Use cautiously in patients with diabetes or hypoglycemia and those taking drugs, herbs, or supplements that affect blood sugar. Use cautiously in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Use cautiously in patients with musculoskeletal disorders or those taking muscle relaxants. Use cautiously in patients prone to headaches. Use cautiously in patients with gastrointestinal disorders or those taking antacids or agents to treat nausea and vomiting. Use cautiously in patients taking agents processed by the liver's cytochrome P450 enzyme system, sedatives, CNS depressants, antiseizure agents, or cardiovascular agents, such as beta-blockers, calcium channel blockers, or agents that lower blood pressure. Avoid in patients with a known allergy or hypersensitivity to hesperidin, and hesperidin-containing foods and supplements, such as citrus. Avoid in pregnant or breastfeeding women.
Iodine: Iodine is an element that is needed by the human body to make thyroid hormones. Footcare with BetadineĀ®, a tincture of iodine, may help in the management of filarial lymphedema.
Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin, because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
Moxibustion: Moxibustion is a therapeutic method in traditional Chinese medicine, classical (five-element) acupuncture, and Japanese acupuncture, in which an herb, usually mugwort (Artemisia vulgaris), is burned above the skin or on the acupuncture points for the purpose of introducing heat into an acupuncture point to alleviate symptoms. It may be applied in the form of a cone, stick, or loose herb, or it may be placed on the head of an acupuncture needle, to manipulate the temperature gradient of the needle. Heat is believed to be a potent force for influencing the flow or qualities of qi through the body. Preliminary evidence from one small study suggests that moxibustion and acupuncture may reduce symptoms of lymphedema caused by intrapelvic lymph node dissection in gynecological cancer. However, the evidence is insufficient to make concrete recommendations at this time.
Use cautiously over large blood vessels and thin or weak skin. Avoid with aneurysms, any kind of "heat syndrome," cardiac disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, inflammatory conditions, or allergic skin conditions. Avoid over ulcerated sores or skin adhesions. Avoid areas with an inflamed organ and inflamed areas in general; contraindicated acupuncture points; and the face, genitals, head, and nipples. Avoid in patients who have just finished exercising or taking a hot bath or shower. It is not advisable to bathe or shower for up to 24 hours after a moxibustion treatment. Use caution with elderly people with large vessels. Avoid if pregnant or breastfeeding.
Physical therapy: Various types of physical therapy have been employed in the treatment of lymphedema, such as complex physical therapy (CPT), self home maintenance therapy (wearing a bandage or elastic garment and exercise), and pneumatic compression. No high-quality trials have shown the benefit of these therapies over other therapies or controls. Physical therapy has also been used in combination with sodium selenite application. Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate preexisting conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy, and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.

prevention

General: Primary lymphedema is inherited and cannot be prevented. Patients at risk of developing secondary lymphedema can take measures to help prevent it. Patients having tumors removed and/or radiation therapy should find out if the procedure will involve the lymph nodes or lymph vessels. The chance of improving the condition is better if treatment begins early. Untreated lymphedema can lead to problems that cannot be reversed.
Avoid heating the affected arm or leg: Do not apply a heating pad to the swollen arm or leg.
Cleanliness: Keep the skin on the affected arm or leg clean and check daily for any changes or breaks in the skin, which could lead to an infection. Fingernails should be kept trimmed and clean.
Do not restrict blood flow: Body fluids should be able to move freely, especially through an affected limb or in areas where lymphedema may develop. For this reason, the following should be avoided: crossed legs, tight jewelry or clothing, carrying purses or bags over the affected arm, elastic bandages or blood pressure cuffs on the affected arm or leg, or swinging the affected arm or leg in rapid circles. The sitting position should be adjusted every 30 minutes.
Elevation of the affected arm or leg: The affected arm or leg should be raised higher than the heart when possible.
Exercise: Studies have shown that slow, carefully controlled exercise may prevent the development of lymphedema. In breast cancer survivors, upper-body exercise does not increase the risk that lymphedema will develop. Avoid strenuous activity until complete recovery from radiation or surgery.
Foot care: Toenails should be cut straight across to prevent the risk of infection caused by ingrown toenails. A podiatrist (foot doctor) may be seen for foot infections. Feet should be kept clean and dry. Socks should be made of cotton.
Prevent infection: Bacteria can enter the body through broken skin, such as a cut, scratch, burn, or insect bite. Avoid blood draws and vaccinations in the affected limb. Scratching the affected skin should be avoided. Fluid that is built up in arms or legs affected by lymphedema provides an environment where bacteria are able to grow. Contact a healthcare provider if signs of infection are found, such as redness, pain, swelling, heat, fever, or red streaks below the surface of the skin.
Sentinel lymph node dissection: Sentinel lymph node dissection is a surgical procedure where the very first lymph node that filters fluid draining away from the area of the breast that contained the breast cancer is removed. In some women, this procedure may prevent lymphedema from developing after surgery for breast cancer.