Regional One Health’s East Campus Center for Rehabilitative Medicine is now offering Complete Decongestive Therapy for patients with lymphedema, a swelling of the limbs that can occur when the lymphatic system is disrupted.
Patients who have breast cancer surgery, radiation near their lymph nodes, and other conditions that impact the lymph nodes can be at risk of lymphedema.
However, with early, consistent care including Complete Decongestive Therapy, they can typically lead a normal, healthy life.
If your lymphatic system is disrupted due to illness, surgery or trauma, fluid can build up in the tissue under your skin and cause swelling of the arms or legs known as lymphedema.
Lymphedema is associated with conditions where the lymph nodes are removed or damaged, such as breast cancer and other cancers, plastic surgery, and traumatic injuries.
Regional One Health’s Center for Rehabilitative Medicine at the East Campus is now offering Complete Decongestive Therapy, which treats lymphedema using manual drainage techniques, compression and exercise. Dardhielle Jean, OTR/L, CHT encourages patients who are at risk for lymphedema to educate themselves about the condition so they can access care early on.
“Even though lymphedema is a chronic condition, it can be managed so patients aren’t suffering from the swelling and aching,” she said. “With consistent therapy and proper management, a patient’s life doesn’t need to be significantly altered.”
What is lymphedema?
Occupational Therapist Dardhielle Jean noted, “Even though lymphedema is a chronic condition, with consistent therapy and proper management, a patient’s life doesn’t need to be significantly altered.”
The lymphatic system helps regulate body fluids, so when it is disrupted, there is a risk of fluid retention and swelling.
“In stage 1 lymphedema, fluid accumulates superficially, causing swelling in the limbs that can lead to decreased range of motion, hardening of the skin, and a feeling of fullness,” Jean said. “Depending on how long the fluid has been sitting, there can also be aching and pain.”
If lymphedema progresses to stage 2, patients can suffer wounds, fungal infections, and a loss of sensation. Stage 3, which is rare, is known as elephantiasis and can cause severe disfiguration.
Lymph nodes do not regenerate, so lymphedema is considered a chronic condition. It is different from edema, which is a temporary accumulation of fluid after surgery or injury.
Who is at risk?
In rare cases, patients have primary lymphedema, where they are born without lymph nodes, or their lymph nodes don’t function properly.
More common is secondary lymphedema, which occurs when the lymph nodes are damaged by illness or injury. Common causes include cancer, surgery, accidents, infections, obesity, cardiac or vascular impairments, and kidney disease.
“Breast cancer is one of the conditions most often associated with lymphedema,” Jean said. “If a patient has surgery to remove the lymph nodes around the breast, it disrupts their lymphatic system, and they can have accumulation of fluid on the side where the surgery was performed.”
Complete Decongestive Therapy for lymphedema includes manual lymphatic drainage, wrapping the limbs to create compression, and exercises.
Radiation for cancer near the lymph nodes can also cause damage. Along with the armpit, lymph nodes are located in the neck, chest, abdomen, and groin.
Why is early intervention so important?
Jean said early intervention can reverse lymphedema to stage 0, or latency, in which swelling is not evident and the limb returns to its previous size.
“Ideally, patients who are at risk for lymphedema should begin therapy before significant swelling occurs,” Jean said. “We don’t want it to get to a point where swelling keeps them from moving, which can make the symptoms and condition worse.”
How does Complete Decongestive Therapy help?
Complete Decongestive Therapy includes several components.
Each session starts with manual lymphatic drainage (MLD), where the patient lies on a treatment table as the therapist manually guides lymphatic fluid away from the affected limbs. This reduces swelling and allows fluid to go back to the heart so it can be redistributed.
MLD is a gentle technique best described as “brushing,” rather than massaging, the skin. “Most patients find it very relaxing and relieving, and not painful,” Jean said.
Next, therapists use bandages to wrap the limbs to create compression. This helps the lymphatic system bring fluid back to the heart and away from the swollen limbs.
Lymphedema occurs when a patient’s lymphatic system is disrupted by illness or injury. It is commonly associated with breast cancer surgery and radiation treatment near the lymph nodes.
Therapists also teach patients therapeutic exercises including gentle stretching and range-of-motion moves that help keep the muscles and joints healthy. “We encourage patients to walk, use their arms, and do specific exercises to maintain the size of the limb,” Jean said.
Compression garments and an anti-inflammatory diet rich in fruits and vegetables can also help.
Patients are advised to keep their skin clean and free of water, check their skin for wounds, and use sunscreen, bug spray and low-PH moisturizer to protect the integrity of the skin.
How can I access therapy?
Ask your health care provider for a referral for Complete Decongestive Therapy.
Jean starts with three to five sessions each week and transitions patients to two to three days a week when they have significant reduction in swelling and limb size.
“Starting therapy early and being consistent are important to successfully treating lymphedema,” she said. “When lymphedema is well managed, patients can lead a very normal, fulfilling life.”