Lymphedema: What You Need To Know

By: Pamela Paredes, PT, DPT, CLT-LANA, Barnabas Health Ambulatory Care Center

A woman in her late 50’s walks into the clinic on a late Thursday afternoon. She had just finished her 8-hour shift at her job in retail. The patient was scheduled for a Lymphedema evaluation as referred by her vascular doctor. During evaluation, patient complains of swelling in her feet, worse at the end of the day. She recalls that the swelling started many years ago on one foot, but did not seek medical attention at that time as the swelling was “on and off”. Only this year has she decided to seek medical treatment as the swelling progressed to both her feet and is unable to wear her favorite winter boots.

This a typical case of an uncomplicated lymphedema patient that we treat in our clinic every day. But what exactly is Lymphedema?

Lymphedema is an abnormal fluid accumulation in a body part, mostly the limbs, but can appear anywhere from face, neck, genitals, trunk and abdomen1. It is a dysfunction of the Lymphatic System, and is characterized by accumulation of protein-rich fluid in the tissues. The Lymph System has multiple functions. Among them are collecting and transporting fluid from the tissues back to the venous system; absorption of nutritional fatty acids in the intestines; immune response through lymph nodes and other lymph organs, acting as “filters” to remove foreign bodies, microbes and detect cancer cells2.

Lymphedema can be classified as Primary, affecting a person at birth or puberty or Secondary, which occurs as a result of another condition that causes damage to the system. The latter is more common in US, affecting 1 in 1000 Americans3. This often occurs from cancer and its treatments, trauma, infection and wounds. In the clinic, we often treat secondary lymphedema patients through cancer treatments and patients with multiple history of skin infections called cellulitis and leg blood clots. According to the Lymphatic Education and Research Network7, up to 10 million Americans are affected by Lymphedema and Lymphatic diseases--that is more than the combination of Multiple Sclerosis, Parkinson’s, ALS, Muscular Dystrophy and AIDS combined. This is the reason why we need to educate more and more people that there is a treatment for Lymphedema available right here at the Barnabas Health Ambulatory Care Center (ACC).

The typical signs and symptoms of lymphedema are: edema/swelling mostly in extremities, complaints of “heaviness” and tightness in the area and on later stages of the condition, patients may present with skin thickening also known as hyperkeratosis and blisters and bumps on skin. If left untreated, lymphedema can result in recurrent skin infections, wounds and difficulty with daily tasks and emotional distress according to a study in 20094.

The gold standard treatment for Lymphedema is called Complete Decongestive Therapy5. It is a combination of special type of massage called Manual Lymph Drainage, compression bandaging, skin care and exercises and compression garments for maintenance care once therapy has been completed. Only a Certified Lymphedema Therapist (CLT) that has undergone 180 hours of special training can work with Lymphedema patients. In our clinic at the ACC, there are 5 Physical Therapists that are CLT’s who are all dedicated in treating Lymphatic Diseases and Breast Cancer patients. The treatments typically lasts 4-6 weeks, depending on the severity of symptoms assessed during Therapy Evaluation. We are also one of the few clinics that offer compression garment fitting to our patients.

Early diagnosis is important in the treatment of this condition. A study in 2003 have mentioned that 60% of the patients are self-referred for treatments while having the condition for many years6. Therefore, one of our goals as Certified Lymphedema Therapists is to educate our patients about this condition. We are not diagnosing anybody but rather, helping our patients get the information they need from reliable resources and from us Physical Therapists, who have spent many hours becoming certified in this field. If you feel you have this condition, talk to your doctor to find the best treatment option for you.

Reliable patient resources:

www.Lymphaticnetwork.org

www.Lymphnet.org

www.breastcancer.org

Pamela Paredes, PT, DPT, CLT-LANA

Pam is a Physical Therapist working at the Barnabas Health Ambulatory Care Center. She is a specialist working with Lymphedema, Breast Cancer and Pelvic Floor patients. She graduated in the Philippines with a Bachelor’s degree in Physical Therapy in 2008. She then pursued higher education and graduated with a Doctorate degree in Physical Therapy in 2011 from Dominican College in Blauvelt, New York. She became a Certified Lymphedema Therapist in 2014 through Norton School of Lymphatics. This year, Pam successfully passed the LANA certification and is now a member of the prestigious Lymphedema Association of North America. When not in the clinic, Pam loves to go hiking with her dog and husband and loves traveling the world. She also runs leisurely and has finished 5 marathons in her lifetime. She is continually expanding her knowledge on Lymphedema and Pelvic Floor by taking 2-3 classes a year. Her career goal is to become a specialist in Women’s Health and Pelvic Health.

The Saint Barnabas Medical Center Rehabilitation centers are open and ready to help you achieve your goals. With four locations in West Orange, Millburn and Livingston, the experienced and compassionate staff at Saint Barnabas Rehabilitation offers adults and children the specialized care they need to resume an active life after surgery, injury or illness. They are committed to providing patients with the most advanced services in a safe, caring and soothing environment. For high-risk patients who are unable to visit in person, telehealth is an option. Patients do not need a prescription for physical therapy services.

References:

  1. Norton S, et al. Norton School of Lymphatic Therapy Manual
  1. Zuther, J. (2020). How Lymphatic Insufficiencies Result in Edema or Lymphedema

https://www.lymphedemablog.com/2014/12/05/the-science-behind-compression-therapy-in-lymphedema-management/lymphedema/?fbclid=IwAR0W-vujeSxpciWA48hs9qLbm9Du3MCLo_BtZwMqYxaxTPaPmtB8vQctOtk

  1. Lymphedema by Sleigh BC, Manna B. (2020).

https://www.ncbi.nlm.nih.gov/books/NBK537239/

  1. Ridner, S (2009). The Psycho-Social Impact of Lymphedema

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904185/

  1. Complete Decongestive Therapy

https://www.breastcancer.org/treatment/lymphedema/treatments/cdt

  1. Szuba A, et al. (2003). The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema

https://pubmed.ncbi.nlm.nih.gov/12515876/

  1. Lymphatic Education and Research Network

https://lymphaticnetwork.org/treating-lymphedema