: Karen Cay

By Saskatchewan Lymphedema Association

Understanding Lyphedema

Lymphedema Awareness Day – March 6

Mar 5, 2019 | 9:34 AM

Lymphedema is a chronic swelling of tissue unrelieved by limb elevation or medications, if present more than 3 months. Most often it is present due to inadequate drainage from tissue by veins and lymphatics.

Primary lymphedema is swelling resulting from too few lymphatic structures to effectively drain tissue. The swelling may be present in infancy or show up decades later.

Regardless of whether primary or secondary, inflammation is a result of chronic fluid collection ( lymphedema) in tissues . Recently the anti -inflammatory drug ketoprofen has been found to help in lymphedema related inflammation.

Some people recognize vein disease by varicosities, spider veins and increased ankle /foot pigmentation. Most people have limited knowledge of lymphatics except that nodes swell at the neck when they get a sore throat. The lymph nodes connect to a network of drainage vessels comparable to veins.

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Both systems must work effectively to drain a limb or tissue.

Following a mastectomy surgery or radiation therapy, lymph nodes and segments of the collection system can be absent or damaged. Often lymph node biopsy is needed in the management of cancer. A swelling of the arm or chest wall following radiation or lymph node biopsy is easily recognized as Lymphedema.
Recognition of leg swelling following lower body cancer treatment seems to be easier too.

In North America, the challenge of recognition of lymphedema relates to vein failure.

Apart from the visible signs of spider or varicose veins and skin hemosiderin stain, the presence of chronic swelling has damaging effects. Not only is there fluid in the tissues of feet and calves ( or beyond) , protein molecules start to accumulate.

Over time, more and more fluid and protein build up. The contours of youth become hidden. Soft tissue changes, to become firm with a dry irregular surface. These changes over time interfere with the ability of immune cells in performance of their job. Tissue infections can have devastating effects.

The good news is, with early intervention damage effects can be stopped.

Many people have learned that compression garments improve their quality of life. By controlling the fluid and preventing its daily accumulation in legs, there are fewer night awakenings for elimination of fluid (urination) at night.

Achy heaviness is also improved or gone.

It is easy to wear compression stockings in fall, winter, and spring. *Summer compression is the most important of all, since legs swell more in the heat.* Swimming is great for legs, as water pressure pushes fluid back into veins and lymphatics.

Compression garments are essential for people who stand or sit for long hours. Walking is far healthier for legs that being stationary.

Weight control is important.

Following the 2019 Canada Food Guide and increasing activity should be a goal for all. Obesity makes limb swelling worse.

If wondering how to get started with compression garments, it depends on limb contours. If there is minimal swelling, there are light garments which may be adequate. Often light circular knit stockings can be purchased over the counter, even from a grocery store.

If the effect is not satisfying, swelling problems may be more advanced or limb contours, challenging. Circular knit garments may migrate into narrow aspects of the ankle. Stiffer flat knit garments may be needed.

When fitting is a challenge, it is preferable to see a either a trained lymphedema therapist who can assist with eliminating fluid through massage or clinicians who will start with a comparison of blood pressure in arms to legs- depending if non-diabetic or diabetic (either the ankle brachial index or the toe brachial index ). The BP comparison tells nurses and garment fitters how much compression can be applied in each instance. The BP comparison also guides nurses if limb wrapping is used to reduce limb volume and restore limb contours. Winter is a great time to access this service.

**If volumes and contour can be improved , it is best to do so BEFORE a garment fitting ** Often individuals have much smaller limbs following compression wrapping. Garments are fitted to the individual and used to maintain the volume reduction/ contour. Fitting at the wrong time will increase expense through ineffective garment purchases.

An additional benefit to control of chronic edema / lymphedema is a limiting effect in cell growth. Lymphedema encourages growth of fat cells. While there is a chicken and egg effect here, the extra protein in the tissue nourishes fat cells. Without intervention ( compression) , swelling gets worse over time.

There is nothing healthy about swollen tissue and many BENEFITS to control of lymphedema. It may be an effort to gain control, but it is worth it.

For more information check sasklymph.ca