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Lymphoedema @ Eden Valley Health
What is Lymphoedema?
Lymphoedema is a chronic inflammatory condition in which either a part of the lymphatic drainage system fails to work effectively or the walls of the blood capillaries are too permeable and leak out an excess of water, salts and small molecules into the tissue causing the lymphatic system to struggle maintaining fluid balance. The end result, either way is fluid build up and 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. This can lead to wounds and ulcers which can take many months to heal. It can also cause cellulitis which is something that all Lymphoedema care is trying to reduce the risk of. All of these further damage the lymphatic system and increase oedema.
Early symptoms of lymphoedema include:
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Feelings of tightness, tension or discomfort, possibly tingling
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Clothes, shoes or jewellery feeling tighter or seeing marks or indentations on the skin where clothing or jewellery digs in
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Swelling that increases during the day but goes down overnight
It can affect any part of the body, including the torso, genitals 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:
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Cellulitis
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Lifestyle factors including obesity and inactivity
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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.
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Conditions that cause more fluid to leak into the tissues of the body, such as varicose veins, deep venous thrombosis, heart failure.
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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.
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Conditions that inhibit mobility and activity, such as stroke, multiple sclerosis and frailty.
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Some medications, such as calcium channel blockers used to treat hypertension, especially amlodipine. Others include corticosteroids, non-steroidal anti-inflammatory drugs and sex hormones
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 with my support. This is definitely a case of the more effort you put in, usually the greater the rewards.
There are historically four main pillars of lymphoedema treatment although, in reality, there are now many more! Many of these can be self-managed by you with my support and teaching. However, during the initial assessment I go through all the recognised ways to help you support yourself. The traditional four pillars are:
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Skincare - arguably one of the most important aspects of self care. The aim of all treatment is to not only reduce the fluid but improve or maintain skin integrity. This is to reduce the risk of developing cellulitis. Those with Lymphoedema are more prone to cellulitis due to the increase in protein rich fluid.
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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.
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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 decongest 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. I am qualified to assess for, measure compression garments and am able to order it on the NHS via your GP.
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Self Lymphatic Drainage – the use of massage techniques to move fluid through the lymphatic system. This is taught to you in a separate appointment to ensure you feel confident in giving yourself a treatment 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.
Additional management and treatment principles also include:
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6D Taping
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Photobiomodulation Therapy
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Weight management
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Nutrition
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Decongestive Lymphatic Therapy
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SIPC (compression pump therapy)
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MLD
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Scar rehabilitation
For people with a more severe swelling, additional treatments may be recommended within a more intensive treatment programme. This is called Decongestive Lymphatic Therapy (DLT) or Combined Decongestive Therapy (CDT). This intensive treatment may last for a period of approximately 10 days and combines a package of treatments on an almost daily basis. This can include combining multicomponent bandaging or compression wraps and MLD, Photobiomodulation Therapy, pneumatic pumps etc. This treatment reshapes limbs that have become misshapen due to oedema/swelling and will then enable you to wear daily compression garments comfortably and improve your quality of life enjoying activities and hobbies possibly long-forgotten.
The Eden Valley Health 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. I listen. I listen to how the condition affects you on a daily basis, your concerns and fears, what you feel you need from treatment and your treatment goals. Together we create a treatment plan personalised just for you incorporating as many of the mentioned treatments as needed. This plan gets reviewed and adjusted as often as is required to try and ensure progress against your initial, or new goals.
The initial appointment involves me carrying out a full Lymphoedema assessment and listening to what you hope to achieve from coming to see me. I will be asking lots of questions about how the condition affects you - physically, mentally, emotionally and socially and together we will put together a treatment plan of needs. If you require compression, I will also assess for, measure and order the compression to be delivered to Clinic via Patient Choice. I will then, following your appointment, write to your GP/Health Team and share my assessment and our plan. Our plan of ongoing care will involve a couple of shorter appointments to follow up to go through:
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Assessing your compression garments once they've arrived and to check fitting and that you're able to pop them on and take them off successfully
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Teaching you all the ways you can manage the condition at home including self lymphatic drainage, skin care, movement (specific to your capability) plus many more
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Hands on therapies which can include manual lymphatic drainage, pump therapy, photobiomodulation therapy, negative pressure therapy, intensive therapy (if required) amongst others
If you already have a diagnosis and compression garments and are purely seeking treatment, please book the New Client MLD appointment. I will still take a full health history and check your knowledge to see if there's anything I can teach you, but it will be mostly hands on treatment.
I place a huge emphasis on education and teaching including those who are at higher risk of developing Lymphoedema - usually having gone through cancer treatment. All this education and empowerment is exceptionally important to me.
I can support complex Lymphoedema including head and neck, genital and mid-line Lymphoedema.
In Clinic, I use MLD, 6-D tape, K-tape, a therapeutic ultrasound machine, multicomponent bandaging, sequential intermittent pneumatic compression (compression pump therapy), negative pressure therapy and photobiomodulation to support those, where appropriate, with Lymphoedema. These techniques can also improve scar healing and improving scars can increase range of motion and improve posture and breathing which also improves lymphatic flow!
Should you have restricted movement due to surgery or treatment, I can also support you with remedial massage tailored specifically to you as part of a treatment plan. I also provide more intensive treatment including Clinical Manual Lymphatic Drainage and multicomponent bandaging or velcro wraps - where appropriate and where the tissue needs decongesting first.
I always work within my scope of practice. I cannot prescribe medications but can liaise with your GP. Should I 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 I am at the end of a telephone/email if you have any questions along the way!
I have been a proud referral partner for Worcestershire Breast Unit Haven supporting many ladies following their cancer treatment. I have also received referrals from Spire Southbank and the local Lymphoedema Services. I look forward to building a supportive network across Cumbria and North Yorkshire.
So, as part of your journey - we look forward to welcoming you to Eden Valley Health.