Lymphoedema Treatment and Support for Patients

When

Prevent Lymphoedema from Worsening

• We have no control over these factors such as age, radiotherapy, the number of lymph vessels and nodes removed.
• We can:

1. Control our weight (means there may be a greater load of fluid waiting to be removed). Being overweight can be related to poor diet and activity levels. However, there is also lipoedema, a condition where fatty deposits in the surface tissues can reduce the ability of the lymphatic system to work properly. It has a genetic component. In other instances, sometimes the body’s fluid load can be so great that even a normal lymphatic system fails. So if the lymphatic system has been damaged or destroyed because the fluid load is too heavy for your body frame, it can lead to a worsening of any swelling.
2. Good quality skin care is important as it is the ultimate barrier to bacteria/fungus.
3. Wear a medic alert bracelet “caution lymphoedema leg/arm” to alert heath care workers to not needle that arm or use BP arm sleeve etc.
4. Wear loose fitting clothes that do not constrict your limb.
5. All these little things can make a difference either through reducing the lymph load (the amount of fluid waiting to be removed) or through increasing the lymphatic transport capacity (fluid load carrying capacity).

Why skin care is so important

• The skin is a very important barrier. It separates your internal body contents from the outside environment. If you have had any operation or any situation which has damaged or interfered with your lymphatic system, then for the rest of your life you must take greater care to maintain the quality and the integrity of your skin. The main reason is to prevent bacteria from entering your body. Take particular care of your feet and toes. Moisturise and keep your skin and tissue soft constantly.
• Take care especially if shaving your legs. It is best not to use a blade type razor since these may damage the skin. An electric one is preferred.
• The whole system is in a rather delicate balance, ideally you do not disturb it since then you might get a swollen limb, or the swelling can get worse.
• When you get a cut or scratch or when you develop a dermatitis rash, the area becomes redden and sometimes warmer. This means that more fluid and proteins than normal will be leaking out of the blood capillaries into the tissue spaces, this will increase lymph load and if bacteria gets through a break in the skin will result in an infection and further inflammation.

Ways to Manage Lymphoedema

• Mild Exercise – is good for the circulation and the variation in pressure that the muscles surrounding the deeper lymph vessels create helps move the lymph out of the limb. For example, swimming which is good for external compression and cooling effect or hydrotherapy are very beneficial
• Walking, gentle bike riding, practising Yoga, Tai Chi and Qi Gong
• Deep breathing is important to get the lymph vessels pumping
• Being overweight will aggravate the lymphoedema. Take care to monitor your diet and weight.
• Manage your stress! Stress has been found to make lymphoedema worse due to its effect on the blood pressure
• Wear a light compression garment and perform mild exercises with deep breathing when flying. Often in large planes, the cabin pressure is reduced below that of the atmosphere at sea level. This combined with immobility of the limb can often lead to swelling when flying. The steps taken will encourage the lymph to leave the tissue spaces and get into the larger remaining lymph vessels to be transported away. However, in using any support garment, ensure that it is not exerting a tourniquet effect on the ankle, knee or in the groin since it may exacerbate your condition.
• Avoid strenuous exercise unless you are fit. Warm up and down carefully. This increase your heart rate and blood pressure, causing more fluid to leak from your blood vessels into tissue spaces. Means that there is more fluid awaiting removal and thus the lymphatic system must work harder. A good gentle exericse program helps to pump out some of the excess fluid from the limbs.
• Do not get sunburnt. Wear sun-screen or protective clothing
• Avoid hot spas or sauna or steam rooms due to increase of blood flow to superficial tissue and put an unnecessary load on the lymphatic system.
• Avoid sleeping on the affected side – over compression.
• Avoid any event which could disrupt the skin, cuts, scratches, bruises etc, always wear gloves when doing house hold chores
• Avoid injections on the affected limb or Acupuncture treatments
• Elevate your limb when and where possible
• Avoid long periods of total inactivity (it is really important to help the pumping of lymph by variation in pressure that the muscles exert on the tissues and the fluid within them.
• Wear an insect repellent when outdoors if mosquitoes are common
• Tell us about your problem, if you notice any change at all e.g. darkening of colour of skin, change in texture, hardening of skin, pitting of tissue, whether a change in how it feels or looks, contact your doctor or your lymphoedema therapist as soon as possible.

Cellulitis  Management

• When you noticed tingles and prickling sensation, manage it from flaring up with cold compresses as often as possible and rest and elevate your leg.  Best if possible is to elevate and have complete rest in bed for 24 hours.  Keep the cold compress on the area with whatever creams or lotions you use to help to keep the pain down to a minimum until your affected area improves or heals.
• Do not compress your legs with stockings or tight bandaging at this time.
• Meanwhile stand by some anti-inflammation creams or simply use essential oils that are anti-inflammatory in nature.
• I used Blue Chamomile, Niaouli, Tea Tree, Everlasting, Palmarosa mixed in a carrier base and my patients have applied this to their affected area, it effectively calms down the problem.  This method works because it is directly addressing the infection through skin absorption and it has yet to be proven that anti-biotics is the only thing that works, because anti-inflammatives also works for this condition. (Ekataksin et al 2009 ISL Conference)
• If condition keeps getting worse and fever develops, call your doctor.
• When condition improves, that is it is no longer red and hot, you should start your bandaging, self massage or see your lymphoedema therapist as soon as possible because cellulitis can be re-occur. You need to improve the fluid flow of the affected limb.