Lymphedema: What It Is And How To Address It.

Lymphedema 101
By Ilyse Streim, LMT, CMLD, Certified in Oncology Massage

The lymphatic system is a wondrous part of our anatomy with multiple functions
that include the removal of extracellular fluid that bathes most tissue and helping rid the body of toxins, waste, and pathogens.  The following is a primer in understanding the effects of cancer treatment on the lymph system, how to minimize the risk of lymphedema, and how to work with existing lymphedema.

What is the lymphatic system?
Our lymphatic system consists of lymph vessels, lymph nodes, lymphocytes (white blood cells), and lymphoid tissue (including the tonsils, thymus, and spleen). Lymph fluid (which consists of water, proteins, fats, cellular debris, and foreign substances such as bacteria and viruses) is normally transported out of a region of the body by an extensive network of lymph vessels.  This lymph fluid is then transported to lymph nodes that act as “filtering stations” in the body. In the lymph nodes, cells from the body’s natural defense system, called lymphocytes, help fight bacteria and viruses. The filtered fluid is eventually transported back to the venous system.

What is lymphedema?
Lymphedema is the swelling of a body part caused by an abnormal accumulation of the protein-rich lymph fluid.  This swelling usually occurs in the arm or leg, but may also occur in the trunk of the body, the head, neck, or genitals.  In ‘primary lymphedema’ swelling can result when lymphatic vessels are impaired due to a hereditary condition.  ‘Secondary lymphedema’ occurs when lymph pathways are damaged (e.g. due to trauma, surgery, etc.).

The effects of cancer and its treatment can result in lymphatic impairment and may lead to the onset of secondary lymphedema. In cancer treatment, the removal of lymph nodes can disrupt lymphatic drainage. Radiation therapy can damage lymph nodes and cause scarring of the lymphatic vessels with subsequent diminished lymphatic flow. Tumor growth may also impede the flow of lymph.

When the collection of protein-rich fluid remains in a specific area, an inflammatory reaction may result which generates fibrosis (a thickening or scarring of connective tissue). The presence of fibrosis makes it even more difficult for the excess fluid to be removed from the area. As a result, the increased fluid and fibrosis prevent the delivery of oxygen and essential nutrients to the area, which can delay wound healing, and provide a culture medium for bacteria to grow increasing the risk of infections in or below the skin (called cellulitis).

Unfortunately, once a person has had lymph nodes radiated or removed from the neck, armpit, or groin or has had lymph collectors damaged through surgery or radiation, he/she is always at risk for developing lymphedema. The onset of lymphedema can occur at any time following treatment for cancer: days, months, or years later.  The National Lymphedema Network is an excellent resource regarding practices that can reduce the risk of lymphedema.

http://www.lymphnet.org/resources/position-paper-summary-of-lymphedema-risk-reduction-practices-summary
Lymphedema should not be confused with other types of edema resulting from venous insufficiency, cardiac conditions, kidney failure, or other inflammatory processes. These conditions are not lymphedema and are generally treated differently.

What is Manual Lymph Drainage?
Manual Lymph Drainage (also referred to simply as MLD) is a slow, gentle, and rhythmic massage technique that is applied gently in the direction of lymph flow, and can facilitate the movement of excess lymph fluid from the body’s tissues into functioning lymphatic vessels.
Dr. Emil Vodder and his wife, Estrid Vodder, developed MLD in Europe during the 1930s. It was first used on patients as an effective way to detoxify the body. A certified MLD massage therapist applies a light form of circular massage to the client’s bare skin.  No massage oils or lotions are used in order for the treatment to be effective. This technique, also known as the Vodder Method, will lightly stretch the walls of the lymph vessels and encourage lymph drainage.
MLD may also help to:
~soften areas of hardness (fibrosis) in the tissue
~reduce swelling and speed healing post-injury/-surgery
~detoxify the body
~reduce many types of edema
~promote relaxation
~reduce fatigue
~provide an analgesic effect for symptoms of fibromyalgia

Complete treatment for lymphedema:
Although lymphedema is a chronic condition, it can be managed with proper care.  The most effective treatment is COMPLETE DECONGESTIVE THERAPY which consists of:
•Manual lymph drainage (MLD)
•Compression bandaging and garments
•Exercise
•Skin/nail care
•Education in self-care

At Good Samaritan’s Center for Integrative Medicine, Ilyse Streim, LMT, CMLD provides MLD and Oncology Massage (in which the massage session is adapted for those who have or are at risk for developing lymphedema).

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