LYMPHOEDEMA@Trayah

Lymphoedema @ Trayah

MLD

What is the Lymphatic System?

To understand what Lymphoedema is, we must first understand what the Lymphatic System is.

The lymphatic system forms part of our immune system and helps us to deal with infection and disease. However, it is also responsible for cleansing our tissues, transporting helpful vitamins and hormones and maintaining a balance of fluids in our body. It can be likened to a waste disposal system, taking tissue fluid, bacteria, proteins and waste products away from the tissues around skin, fat, muscle and bone.

Once inside the lymphatic vessels (just under the surface of the skin) the tissue fluid becomes known as ‘lymph’ and it is then transported in one direction, by increasingly larger and deeper lymphatic vessels. Movement of lymph depends on muscle movement (exercise) and the contraction of the deeper vessels themselves. Gentle massage known as Manual Lymphatic Drainage (MLD) and deep breathing can also help to move the lymph more effectively.

At some point in its journey, lymph will pass through a lymph node, or gland. Clusters of these nodes are found in the neck, armpits and groins. It is here that the lymph is filtered and cleansed, so that the waste matter, bacteria and harmful cells can be identified and removed by the body’s defence system.

Having passed through these nodes, lymph finally drains back into the large veins of the body at a point just behind the collarbone, on each side of the neck. From here it travels back into the circulatory system and is returned to the heart. Waste/toxins are removed from the body as urine through the kidneys.

What is Lymphoedema?

Lymphoedema (pronounced Lim-fo-dee-ma) is a chronic inflammatory condition in which a part of the lymphatic drainage system fails to work effectively causing a build up of fluid and thus swelling.

In addition to swelling, there may be changes in the skin and the tissue under the skin. The skin may become very dry, cracked and less stretchy. The skin may feel thickened as the tissues under the skin become firmer and fibrotic.

Early symptoms of lymphoedema include:

Feelings of tightness, tension or discomfort, possibly tingling
Feeling clothes, shoes or jewellery tight or seeing marks or indentations on the skin where clothing digs in.
A cellulitis attack (a bacterial infection of the skin) may be the first indication that there is a problem with the lymphatic system

It can affect any part of the body, including the torso and head/neck, but is most commonly seen in an arm or a leg.

There are different stages of lymphoedema and each may have a different treatment plan. It is really important to catch it early and start treatment as soon as possible.

What causes Lymphoedema?

Lymphoedema may be Primary. This means there is an abnormality of the lymphatic system that has been present from birth. In some people, it will be evident at birth but in others, it may be identified later in life, possibly triggered by an event that has caused further damage to the system.

Secondary lymphoedema arises as a result of damage to a normally functioning lymphatic system. There are many causes of secondary lymphoedema including:

Cellulitis

Lifestyle factors including obesity and inactivity
Inflammatory conditions that may impair the small lymphatic vessels, such as chronic skin conditions, wounds, particularly if healing is prolonged, untreated fungal infections, inflammation following insect bites or stings.
Conditions that cause more fluid to leak into the tissues of the body, such as varicose veins, deep venous thrombosis, heart failure.
Surgery or treatment that removes or damages areas where there are a lot of lymph nodes, such as cancer of the breast, pelvic area (gynaecological or genito-urinary cancers in men), melanoma, head and neck cancer. Orthopaedic surgery also carries risks.
Conditions that inhibit mobility and activity, such as stroke, multiple sclerosis and frailty.
Some medications, such as calcium channel blockers used to treat hypertension, especially amlodipine. Others include corticosteroids, non-steroidal anti-inflammatory drugs and sex hormones

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How can Lymphoedema be managed?

Lymphoedema is a lifelong condition but there are many ways to minimise its disruption to daily functioning and impact on psychological and emotional well-being. The outcome is dependent on the daily management by you, however. This is definitely a case of the more effort you put in, usually the greater the rewards.

There are four main pillars of lymphoedema treatment, some of which can be self-managed by you.

Movement – Remaining active in a safe way will assist the lymphatic system in collecting, transporting and safely removing lymph (fluid and cells). Movement does not need to mean exercise; simple activities like walking, stretching to hang out the washing on the line and heel-raises will aid the lymphatic system.

Skin care – keeping the skin moisturised and clean to prevent Cellulitis. Avoiding sunburn and insect stings and injury, e.g. wearing protective clothing when doing activities like gardening.

Compression – is a key part of treatment to reduce swelling and keep it under control. Its effect is enhanced by movement and activity as together they encourage movement of lymph through the vessels. Treatment may involve the use of compression garments (socks/stockings/tights or sleeves and gloves), bandages or Velcro wraps to compress the affected areas. This helps drain fluid and reduce swelling. There are many options and it is important to determine what will work best for the individual.

Self Lymphatic Drainage – the use of massage techniques to move fluid through the lymphatic system. This is taught to you by me in a separate appointment to ensure you feel confident in giving yourself a treatment daily to stay on top of the swelling as much as possible. It is a simplified version of Manual Lymphatic Drainage. and can also be performed by a family member or carer.

For people with a more severe swelling, additional treatments may be recommended within a more intensive treatment programme called Decongestive Lymphatic Therapy (DLT) or Combined Decongestive Therapy (CDT). This intensive treatment may last for a period of 2 – 4 weeks and combines a package of treatments on a daily basis. This can include multi-layer lymphoedema bandaging and MLD.

I also use kinesiology tape and a LLLT (Low Level Laser Therapy) machine to soften tissue and help move the fluid.

The Trayah Way.......

There's no other way to say this but, "It's all about YOU!" No one person is the same and Lymphoedema affects everyone differently. At Trayah I listen. I listen to how the condition affects you on a daily basis, what you feel you need from treatment and your treatment goals. Together we create a care plan personalised just for you. This care plan gets reviewed and adjusted as often as is required to try and ensure progress.

I can offer advice and management around the 4 Corner Stones of Lymphatic Care:

Skin care
Activity/exercise
Self Lymphatic Drainage
Compression (including measuring and organising a prescription where appropriate)

I also provide more intensive therapies including Manual Lymphatic Drainage and multi layer lymphoedema bandaging (MLLB) - where appropriate.

Your first appointment with me will be a more assessment-based - dependant upon your situation and whether you're under the care of the Lymphoedema Service. Trained by the NHS Lymphoedema Wales, I will be asking lots of questions about how Lymphoedema affects you physically, mentally, emotionally and socially. I may take base limb measurements, and calculate limb volume as a baseline for assessing progress and also for compression garments (if appropriate).

This first appointment will always include advice around skin care as this is the foundation of Lymphoedema management. I also have samples of skin creams for you to take away that can also be prescribed by your GP and I'm happy to provide a letter in support requesting this. I will also teach you many other ways to self-manage the condition to hopefully reduce the number of appointments required! Normally 2-3 appointments are needed initially close together to fill you full of knowledge and skills and then we take it from there as you need.

I always work within my scope of practice. I cannot prescribe medications but can liaise with your GP. Should we need to enlist the support of specialists such as dieticians, podiatrists, counsellors etc., I can refer as needed. It is normal to have more frequent appointments in the beginning (situation dependant) to ensure you've got all the tools for self-management you need but the aim is to reduce these as much as possible. I am ALWAYS at the end of a telephone however!

So much about Lymphoedema management and success in treatment depends on you and your motivation. This really is a time when the more effort you put in, the more rewards are usually reaped. I will always encourage and motivate and am at the end of a telephone/email if you have any questions along the way!

So, as part of your journey - I look forward to welcoming you to Trayah.

Working partnership with Footnotes UK (Worcester), Back to Life Cancer Support & Worcestershire Breast Unit Haven

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