Central Baptist’s Lymphedema Program is staffed by highly trained Physical Therapists.  Each member of the Lymphedema Program has completed over 100 hours of specialized training in Complete Decongestive Therapy – Manual Lymph Drainage (Vodder Technique).   

Understanding Lymphedema

Lymphedema is a type of swelling caused by an abnormal accumulation of protein-rich fluid due to an insufficiency of the lymph system.  The heart pumps the blood, the arterial blood vessels transport the blood to the tissues, the venous system transports 80-90% of the fluid, and cells, back to the heart.  The lymph system transports the remaining 10-20% of fluid, plus larger molecules like proteins, and long chain fatty acids back to the central circulation.  When the lymph system cannot keep up with the fluid load or proteins become trapped in the tissues, swelling or lymphedema develops. 

Lymphedema may develop due to trauma, surgery, radiation treatments, etc. (secondary lymphedema) or due to an abnormal lymph system (primary lymphedema).  Lymphedema typically occurs in the arm(s) or leg(s), but can also occur in the head or face, the body and the genitals.  Generally, lymphedema develops slowly over time; it may go down overnight, but eventually the swelling does not go down on its own.  The limb or tissues may be come hard (fibrosis) and the skin may become very dry or red.  Lymphedema may also be aggravated by tissue infection or cellulitis. True lymphedema, even chronic, can be reduced and managed using a comprehensive approach.

Treating Lymphedema

Lymphedema treatment involves a reduction phase and a maintenance phase.  The reduction phase has several steps: Complete Decongestive Therapy –Manual Lymph Drainage (massage), skin care, bandaging and exercise.  Prior to beginning treatment the involved limb or body area needs to be free from infection; the skin is inspected, a complete medical history is obtained (screening for contraindications), the limb is measured and / or photographed to establish the current size. 

The lymph massage is sequenced to provide a siphoning effect rather than trying to push the fluid out of the area.  The body is prepared first (emptying the deep lymphatic system and massaging over groups of lymph nodes).  Groups of lymph nodes in adjacent areas of the body are used to help the damaged or removed lymph nodes (i.e. right underarm lymph nodes have been irradiated, so the left underarm lymph nodes are recruited).  The fluid is moved across the body to the functioning lymph nodes.  The area affected by the edema is massaged next.  Specialized techniques may be needed to soften and loosen scar tissue. 

After the massage is complete, a skin moisturizer is applied to help keep the skin healthy.  Clean, healthy skin is very important to preventing skin infections and cellulitis.  The limb is then wrapped with low-stretch bandages.  Layers provide the needed pressure to continue to move fluid out of the affected area.  The compression bandages may feel like a soft cast.  Special foam pads or silicone inserts may be used to help further soften and break up scar tissue.  Loose clothing and large shoes are needed depending on the edema location.  Specialized compression systems are created for lymphedema affecting the head /face and neck. 

Specialized exercises are recommended to assist with fluid movement.  Exercises are designed to be completed while the compression wraps are in place; this uses the pumping action of the muscles to move more fluid out of the involved area(s).  Exercises can also be prescribed to assist with regaining lost movement and gently regaining lost strength.

The reduction phase consists of these steps repeated daily until the limb is near baseline or the volume has reached a plateau.  The patient and caregivers are instructed in basic lymph massage and compression wrapping to be performed on the days that therapy is not scheduled.  When the reduction has reached a plateau, the limb is measured for and fit with a compression garment.  There are many options with ready-made and custom compression garments available.

The maintenance phase consists of continued skin care / good hygiene, compression garment use during the daytime, compression wrapping (or other compression system) for night time, home lymph massage, and exercise.  The maintenance phase is designed to allow people with lymphedema to be able to keep the edema under control and still lead an active lifestyle. 

Avoiding Lymphedema or Keeping It in Check

For the person with lymphedema, skin care is very important. All skin abrasions need to be cleaned and covered immediately to help prevent infection. We recommend keeping alcohol swabs, antibiotic ointment and bandages available at all times. Avoid any trauma to the involved limb, including needle sticks or burns. Other recommendations include:

• Avoid temperature extremes such as hot baths, hot tubs and hot showers; Turkish baths or saunas; burns from cooking, smoking or the sun; and travel in hot or cold climates.
• Avoid infections from insect bites; manicures or pedicures; vaccinations, venipunctures or acupunctures in the affected limb; pet scratches; skin punctures and cuts; venography; and lymphography.
• Avoid blunt trauma such as lifting heavy objects; playing golf or tennis; applying a blood pressure cuff to the affected limb; wearing tight clothing, especially breast straps; wearing a heavy breast prosthesis; or wearing rings, watches or bracelets on the affected limb.

General precautions for people with lymphedema include:

• Practice good nutrition. Limit salt and fried foods.
• Avoid alcohol and nicotine as much as possible.
• Maintain a normal weight.
• Keep the affected limb meticulously clean. Be very careful with skin and nail care.
• Sleep with the affected limb elevated.
• Exercise. Try walking, swimming or specially-prescribed exercises.
• Use hypoallergenic soaps and fragrances.
• Seek treatment for even the slightest sign of lymphedema.
• Treat infections vigorously.

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