- by Danuta Valleau, PT/CDT (Physiotherapist and Complex Decongestive Therapist)

Lymphedema is the swelling of a body part, an abnormal accumulation of protein-rich fluid that results from impairment or overloading of the lymphatic vessels. It is a chronic condition. Untreated it leads to disfigurement, discomfort, restricted mobility, repeated infections, and impacts on quality of life for both the individual and their family. There are psychosocial and financial impacts.

The lymphatic vessels serve as our body's drainage system. They are an intricate network that transports excess fluid, long-chain proteins and fats to the lymph nodes where cell wastes and toxins are filtered out. From the lymph nodes, larger vessels carry the lymph to the large veins that enter the heart. It is an important part of our immune system. It is of crucial importance to recognize and immediately treat incidences of cellulitis.

Lymphedema can result from any event that damages the vessels. Cancer treatments that include surgical removal of lymph nodes and/or radiation are the most common causes. Trauma and infections damage vessels. When venous impairment causes congestion in the legs, it increases demand on the lymphatic system and ultimately overloads it.

Primary lymphedema is less common. It results from insufficient development of the lymphatic vessel system. There is unexplained swelling, often in the legs, one side more than the other that starts in a young person and does not resolve.

Diagnosis is based on the history of the swelling, of medical or surgical events that may have contributed to it and a physical examination of the affected area, skin condition, the size and type of swelling that presents. Sometimes additional tests need to be done to eliminate other possible causes.

Goals of treatment are twofold: 1) reduction of swelling and 2) empowerment of the individual and/or family to self manage the condition long term.

Combined Decongestive Therapy (CDT) remains the best practice treatment of choice for lymphedema. It begins with an intensive phase of several weeks aimed at reducing swelling to a stable and manageable level. Following that is the management phase to maintain life-long control of the condition. There are several established training courses in Canada for health professionals interested in learning these skills.

There are five components to this treatment: 1) manual lymphatic drainage – a specialized soft tissue massage technique; 2) compression with multilayer bandaging and eventually, fitted garments; 3) education in skin care and prevention of infection; 4) regular exercise; 5) education to tailor management to fit the individuals' lifestyle and personal goals.

Why is awareness of lymphedema important?

· There are an increasing number of cases of lymphedema and/or chronic edema resulting in lymphedema.

· There is a growing at-risk population: the elderly, treatment of cancer, less mobile, overweight.

· Early identification and timely treatment can improve outcomes and prevent irreversible impairment.

· Often it is undiagnosed. The role of the lymphatic system and the treatment for lymphedema has been poorly addressed in professional health education. There is limited expertise or knowledge of how to treat it.

· There is no comprehensive public funding in Ontario that covers patients for the treatment of lymphedema by a qualified practitioner.

· There is no standard listing or formal certification system in Canada for trained Lymphedema Therapists.

Lymphedema is a treatable condition. The best outcomes result from catching it in its' early stages. Improved widespread knowledge about lymphedema and its treatment among health professionals and the public would help make this possible. That and improved access to Certified Lymphedema Therapists.

Recommended websites:

Canadian Lymphedema Framework: www.canadalymph.ca

International Lymphedema Framework: www.lympho.org

Lymphedema Association of Ontario (LAO): www.lymphontario.ca