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Lymphoedema or Lymphedema

Lymphoedema is the swelling of an arm (or leg) caused by an accumulation of protein- rich fluid that cannot be properly transported through the lymph vessels and nodes once they have been damaged or removed.  It can occur immediately after surgery with lymph node removal, after radiotherapy or at any time after an injury to the arm (or leg), even many years later.

Although some people may be unlucky and develop Lymphodema immediately after surgery most will not.  However anyone who has had lymph nodes removed from the axilla or armpit and/or radiotherapy in that area is ‘at risk’ of developing swelling and should learn to take extra care.

It is very important to learn how to care for your affected or ‘at risk’ arm.  Here is a list of the most important things to remember:

AVOID insect bites, cuts, burns (wear gloves for gardening, washing up, D.I.Y etc.)

AVOID any blood tests, injections, vein punctures or blood pressure testing on that arm.  Many people, even medical practitioners and nurses are unaware of the dangers of performing certain procedures on your ‘at risk’ arm.  It is up to you to remember to warn and inform them every time! 

AVOID vigorous exercise especially involving the arms.  Cross country skiing, front crawl or butterfly stroke when swimming, weight lifting or punching a punch bag are a few examples.

AVOID very hot weather and sun burn

AVOID taking very hot showers or baths

AVOID letting anyone perform massage, acupressure or acupuncture on that arm.

AVOID wearing tight jewellery make sure bra straps are wide and do not cause marks or dents in the skin.

What to do in the case of injury.

If you do suffer any injury to your arm, even a minor scratch or a torn cuticle, you should immediately clean the wound and apply an antiseptic cream and sterile dressing.  If you notice any redness or swelling around the wound or injury, immediately see your doctor, reminding him if necessary of the risk of Lymphoedema. Your doctor may prescribe antibiotics or a topical antibiotic cream.

If you do notice swelling of the ‘at risk’ arm, immediately remove any rings, bracelets or watch.  Rest in a chair or on a bed and support your arm with cushions so that your hand is higher than your shoulder.   Perform slow gentle squeezes with your hand (as if squeezing a small ball).   

Examine the skin of your arm for any injury or redness.  Try to think back to what might have provoked the swelling.  Perhaps the shopping was rather heavy, perhaps the weather is very warm (have your ankles swollen too?), or have you started a new exercise class or sport recently?
If your arm remains swollen the next day arrange to see your doctor straight away.  Your doctor may decide to send you for tests or recommend that you undergo treatment for Lymphoedema straight away.

Treatment of Lymphoedema

Lymphoedema treatment is often called Complex Decongestive Therapy.  CDT should only be carried out by Physiotherapists with appropriate training in the treatment of Secondary Lymphoedema.   Many therapists advertise that they do Manual Lymphatic Drainage, even beauticians and hairdressers offer this, but be warned that they are not qualified to treat the special case of Lymphoedema, and can worsen an already critical situation.

Complex Decongestive Therapy consists of three kinds of treatment.

1/ Specialised Manual Lymphatic Drainage.

This is a very light and gentle form of massage that encourages the drainage of lymphatic fluid through alternative channels and may stimulate the formation of new lymphatic vessels.

2/ Compression Bandaging

Compression Bandaging or the wearing of a compression sleeve to prevent the swelling getting worse and to maintain the effect of the MLD.

3/  Exercises

Exercises that are carried out whilst wearing the bandaging or compression sleeve.

Your First Appointment

Your Physiotherapist will examine you and take your case history.   She/he will then recommend a treatment plan.  This will depend on the severity of the swelling and any other symptoms or complications you may have.

Initially the treatment is very intensive.  During the first few weeks the sessions should be held daily. Once the swelling has been controlled you may continue to have treatment once or twice a week.   


LYMPHOEDEMA IS NOT CURABLE but its symptoms are controllable.   Getting the correct treatment as soon as possible will help to prevent some of the unpleasant skin changes that may occur as a result of Lymphoedema.  If you have not had treatment and have long standing Lymphoedema, treatment may take longer but it can still be very effective.  Over time the condition of the skin and the shape of your arm (or leg) will improve greatly.

 
........Sarah Wheatly + 34 679 410 843 | sarah@physio-onthemove.com