Lymphedema – Control and Management Intro

What is Lymphedema?

Lymphedema is a swelling of a part of the body, generally in the arm and leg appendages. The swelling is caused by an accumulation of lymph fluid in the swollen area. Lymphedema is a chronic and progressive condition but it can be controlled by proper care and attention to basic rules that can lead to a normal and active lifestyle.
Surprisingly, lymphedema affects about 1% of the population. Lymphedema generally results in a feeling of heaviness or cosmetic enlarging of the affected arm or leg, and a slight to severe discomfort. Repeated episodes of infection (erysipelas – an acute streptococcus bacterial infection of the dermis resulting in inflammation and characteristically extending into underlying fat tissue and lymphangitis – is an inflammation of the lymphatic channels that occurs as a result of infection (most common is Streptococcus Pyrogenes) at a site distal to the channel. Severe cases are associated with thickening of the skin, hardening of the limb, leakage of lymph and massive swelling.

Lymphedema is either primary or secondary lymphedema.

primary-lymphedemaPrimary lymphedema are those cases that occur without any obvious cause. Primary lymphedema may be present at birth or may develop after age 35. Primary lymphedema is generally more present in females and generally occurs more frequently in the legs. Secondary lymphedema is generally caused by an injury, scaring secondaryLymphedemaand radiation or surgery in the area of the lymph nodes. It is estimated that there is approximately two million cases of secondary lymphedema with most caused by breast cancer therapy.

So, what is the lymphatic system?

lymph-systemThe body has two circulatory systems which move liquid through the body; one is the blood system that circulates the blood in the veins and arteries and the other is the lymphatic system that which carries lymph thru the body and back to the large veins in the neck. Lymph is a colorless transparent fluid that originates in the tissue space throughout the body. It differs from blood in that it contains less protein and no red blood cells. The lymphatic systems responsibilities are to remove excess body fluids, bacteria, viruses, proteins, and waste products from the body tissues. As the lymph is passing from one part of the body it passes thru the regional lymph nodes where it is filtered. The lymph nodes, thymus gland, tonsils and spleen are all a part of the immune system. They produce lymphocytes which are important in fighting infection and enhance the body’s immune capabilities. When the lymphatic system is disrupted, the lymph pools in the interstitial spaces and swelling occurs.

The lymph is assisted in passing thru the body by muscular action, by contractions of the vessels, by movement of the diaphragm and by changes in pressure of the diaphragm (breathing). From here the lymph is propelled toward the veins in the neck where it joins with the blood on the way to the heart.

Factors that contribute to lymphedema are:

  • Surgery and/or radiation therapy
  • Post operative infections
  • Obesity
  • Infections (insect bites, athlete’s foot, paronychia – bacterial or fungal infection where the nail and skin meet at the side or the base of a finger or toe)
  • Sedentary lifestyles
  • Dependent limb position
  • Recurrent tumor
  • An inappropriately heavy breast prosthesis
  • Trauma to remaining lymphatics

There are many medications that have been tried to control lymphedema with little success. Surgery has never solved the problem. What is necessary is for you to educate yourself on lymphedema by talking to your physician or therapist. What has proven to be effective is Manual Lymph Drainage/Complete Decongestive Therapy (MLD/CDT), coupled with compression bandaging the affected limb and then followed by the application of compression sleeves or compression stockings.

Lymphedema should not be confused with edema. Edema is caused by an accident, surgery or injury resulting in the building up of excessive fluids in the tissue and can be treated by the application of a compression garment such as an arm sleeve or stockings. Untreated edema can progress to venous/lymphatic disorder which is treated as lymphedema.

Come back for the more information on lymphedema next month.

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Data and Graphics courtesy Lohmann & Rauscher.

Differences Between Edema And Lymphedema

In this day and age, everyone is more concerned with their health. They want to understand what their doctor is telling them and want to be informed enough to make good decisions concerning their health care.

When we have swelling in an extremity, it is important to understand the difference in edema and lymphedema. They have very different causes and the treatments; while similar in some circumstances they are entirely different.
What is Lymphedema?Lymphedema Stage II
The lymphatic system is often called our body’s second circulatory system. It collects and filters the interstitial fluid of the body and dumps it into the lymph nodes. Lymphedema occurs when the lymphatic vessels, which collect the lymph (proteins, wastes, water and fats) from cells in your body and carries this to the lymph nodes, are interrupted. The lymph nodes filter out the waste materials and then return the lymph to your blood stream. The system does not work properly when the lymph nodes become damaged or are removed by surgeries. The fluids cannot be drained and build up in the body resulting in swelling in the arms, legs, or the involved body part. Chronic swelling can affect anyone – of any age – and at any point in that individual’s lifetime. This kind of swelling lasts over a period of time and is marked by frequent recurrences. Generally if you have lymphedema you can benefit by seeking the advice of a physical therapist and undergo manual lymphatic drainage (MLD). Your therapist may wrap you in special bandaging, fit you in compression stockings or arm sleeves and teach you special exercises. It is always best to first seek the advice of you physician.

  • Lymphedema is a response which happens when the lymphatic system is impaired (in an area) to the extent that it cannot handle the amount of fluid present.
  • Lymphedema is caused by excess protein-rich lymph which cannot be moved to a lymph node to dump in the circulatory system.
  • Lymphedema is a compromised tissue response to injury with slow healing and /or a infection.
  • Lymphedema is caused by damage to lymphatic system (accident or surgical intervention) or may be congenital. Swelling manifests itself near the damaged area.
  • In early stages a finger pressed into the affected area leaves a temporary indentation. This is pitting edema. In later stages the tissue bounces back with out any indentation.
  • Lymphedema is harmed, not helped by diuretics. Diuretics stimulate the kidneys to remove fluid from the body. In areas affected by lymphedema, tissue fluid is reduced which produces higher levels of protein. This can lead to swelling and hardening of the tissues.

What is edema?Inflammation of the veins with striped reddening and chronic venous insufficiency with swelling and skin discoloration
Edema is the swelling of arms and or legs resulting from the building up of excessive fluids in the tissue. The skin in the affected leg or arm will become stretched and appear shiny. Edema can be caused by prolonged sitting or standing without muscle movements; pregnancy which puts pressure on the vena cava (a major blood vessel that returns blood from the lower extremities back to the heart); an injury or sprain to the arms or legs. To test for edema you press your thumb over the swelled area with a slow pressure. If you see an indentation when you release pressure you should see a doctor to determine why the swelling is occurring. Edema is generally not a permanent issue and can be treated. If you have venous insufficiency resulting in mild edema you should keep your legs elevated and wear compression stockings. Exercise your legs even while sitting or traveling will generally keep your legs from swelling.

  • Edema is a response to an injury such as a sprain as the injury heals, the swelling subsides.
  • Edema is caused by excess tissue fluid which cannot be transported to the circulatory system.
  • Edema can be due to an injury, this will cause excess tissue fluid in an area to aid with the healing process.
  • Edema can be caused by circulatory problems, such as chronic venous insufficiency. This usually occurs in the lower extremities.
  • Both pitting and non-pitting edemas (when a finger pressed into the edema leaves no mark or indentation) can be found.
  • Diuretics can relieve some edemas by stimulating the kidneys to increase the urine output.

Edema resulting from venous insufficiency and lymphedema should not be confused. Untreated venous insufficiency can progress to venous/lymphatic disorder which is treated as lymphedema. If you suffer from either of these diseases and are experiencing swelling in the arms or legs, please contact your Physician. They are always the best source for diagnosis and treatment. Hopefully, by taking care of yourself, the swelling can be controlled, the pain can be treated, and you can get back to your normal life style. If you wear support stockings or compression garments of any type, always remember they are not a quick fix and must be routinely worn to maintain control of the swelling. We have many styles that offer the compression you need and look good at the same time.

Compression Stockings 101

Gradient Compression Support Hose — What are they?
This month we are answering one of our customers most frequently asked questions. If you have questions or comments, please go to our blog Each and every question or comment will be addressed.

To begin, we will discuss diseases, which started your leg or arm problems. Venous diseases start by a feeling of heaviness, a tired feeling in your legs or a discoloration or swelling. Minor pain may be felt. This may be the result of insufficient blood flow back to the heart as blood pools or congests in the legs. When you see warning signs of venous diseases the first step is to see your doctor. But, before you do you may want to become an informed patient. We are supplying you with information and resource links on venous diseases and compression therapy. This newsletter and information provided in the links are not intended to be a substitute for your physician’s medical advice and treatment. Your Doctor is the best source of information on venous diseases. Here is a special list on symptoms you may want to take with you when you see your Doctor:
 Tired legs at night
 Heavy legs at night
 Shoe feels tight at night
 Swollen legs in the morning
 Swollen legs in the afternoon
 Swollen legs at night
 Swelling is gone in the morning
 Leg pain from prolonged sitting
 Dull, aching pain in leg
 Tingling, numbness burning
or cramping in the legs and feet
 Legs “fall asleep” often
 Spider veins
 Varicose veins
 More than one pregnancy (even though
varicose veins, swelling and pain may
disappear after giving birth, problems
may occur later in life)
 Pregnant
 Discoloration of the skin
 Hardened skin on the lower leg
 Patches of dry skin on the lower leg
 Open sores on the lower leg
 Ulcers on the lower leg
 Family history of venous disease
 Diabetes

Varicose Veins: Varicose veins are veins that become visible, primarily in your legs, as enlarged or twisted superficial veins. As your legs move the leg muscles push on the veins which activate tiny valves in your legs to pump the blood back to the heart. The veins become enlarged when the valves fail to work and allow the blood to pool in the legs. Varicose veins are frequently painful, itchy and look unsightly. If left untreated they can lead to much more serious problems. Compression therapy assists in the management of varicose veins by applying a gradient compression to the leg and assisting the muscles in moving blood back to the heart.

Lymphedema: A swelling primarily in the legs and arms resulting from the lymphatic vessels being unable to transport the protein rich lymph fluid back into your circulatory system. You can be born with this problem or it can be the result of injury or surgery. When the lymphatic system is not functional, fluid can build up which results in swelling or thickening of the skin. There is no cure for lymphedema, but it can be managed. The lymphatic drainage system must be opened through MLD (Manual Lymphatic Drainage) therapy. The compression stockings/arm sleeves/gloves can then be used to exert a constant pressure on the affected area to maintain the reduction achieved through MLD therapy. This in turn assists in the drainage of the lymphatic system to minimize the swelling.

Gradient compression: There are several levels of gradient compression support stockings. Gradient compression is measured in millimeters compression mercury. Please note that not all hose are a gradient compression. Gradient compression reduces swelling and helps prevent pooling of blood in the legs, by delivering the highest level of compression at the ankle and gently decreasing up the leg. Improving blood flow helps the wearer experience immediate relief from tired, aching legs. Generally support stockings come in 8-15mmHg, 16-20mmHg, 20-30mmHg, 30-40mmHg and 40-50mmHg.

The symptoms determine the amount of compression, as follows:

  • 8-15 mmHg Compression:
    • Feel good therapy for tired, achy legs
    • Minor ankle, leg and foot swelling
  • 16-20 mmHg Compression:
    • Minor varicosities
    • Minor varicosities during pregnancy
    • Tired, aching legs
    • Minor ankle, leg and foot swelling
    • Post Sclerotherapy
  • 20-30 mmHg Compression:
    • Moderate edema
    • Post Sclerotherapy
    • Help prevent recurrence of ulcerations
    • Post surgical
    • Moderate to severe varicosities
    • Moderate to severe varicosities during pregnancy
  • 30-40 mmHg Compression:
    • Severe varicosities
    • Severe edema
    • Lymphatic edema
    • Post surgical
    • Orthostatic Hypotension
    • Post Sclerotherapy
    • Management of active venous ulcerations
    • Helps to prevent recurrence of venous ulcerations
    • Helps to prevent post-thrombotic syndrome
    • Manage manifestations of PTS (post-thrombotic syndrome)
    • CVD/CVI (Cardio-vascular disease/insufficiency)

At Support Hose Plus we carry the four leading manufacturers of gradient compression stockings, Jobst, Medi, Juzo and Sigvaris. All four of these manufacturers have true gradient compression in the stockings.

Compression hose are available in three basis styles, knee-high, thigh-high and waist-high (pantyhose). Your physician will generally advise you which style to purchase. Depending upon where the problem is occurring in your legs will determine which style is best for you. Your comfort and life style will also determine which hose to consider. The support stockings are available in many styles and thickness ranging from sheer to very heavy. Some of the socks are available especially for diabetic foot-wear (well padded, thick stocking). There are socks available as a dress socks, athletic socks, silver socks (anti-odor, antibacterial and anti-fungal to help heal wounds)and even garments with 100% cotton skin contact. Whether you are looking for knee-high, thigh-high or waist-high (pantyhose) we have the hose that is right for you.

When you are experiencing venous insufficiency, edema, or lymphedema it is always best to first consult with your Health Care Provider. If they recommend support stockings please consult with as we are compression garment specialists. We carry all four major manufacturers, Jobst, Mediven, Sigvaris and Juzo, so we know we can fit you in the most appropriate stockings for your medical needs. Our customer service representatives are Certified Fitters and are available to assist you on our toll-free number 1-844-472-8807 . They will attempt to answer any questions you may have.

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