Ellen G. Poage, MSN, ARNP, CLT-LANA has been treating lymphedema in Lee County since 1995. She is certified by the Lymphedema Association of North American (CLT-LANA).
Our goal is to manage the disease process of lymphedema: diagnose early, treat quickly and reduce risk of exacerbating events and cellulitis. We treat all forms of swelling and lymphedema.
Facts About Lymphedema
The American Cancer Society has acknowledged that all cancer survivors whose treatment includes the removal of (or radiation to) the lymph nodes or damage to the lymphatic system are at lifetime risk of developing lymphedema. The number of individuals in the U.S. affected by lymphedema is conservatively estimated to exceed one million.1 Lymphedema is a disease process that initially causes abnormal swelling of a body part, most often an extremity, but it can also occur in the face, neck, breast or genitalia. It can occur immediately after surgery or up to 30 years later. Most commonly symptoms begin within two years. Venous insufficiency, primary lymphedema (a genetic process of underdeveloped lymphatics) and high protein edemas, which result from soft tissue traumas such as accidents, surgeries, sports injuries, sprains, also affect thousands of people every year.Lymphedema produces progressive physical changes in the tissues resulting in fibrosis and increased risk for life-threatening infections. Lymphedema is both cosmetically displeasing and uncomfortable and can be so severe it reduces normal limb function. Patients need information from their providers to alert them of their risks for developing lymphedema and ways to prevent its development and complications. Of particular importance is early referral for therapy.
Lymphedema Management Therapy
We provide a unique state of the science program for lymphedema that dramatically improves the healing process for cancer patients post-treatment, venous insufficiency swelling, as well as for surgery related swelling as in joint replacement and cosmetic surgeries. If you are experiencing swelling of any form, please call our office. Our quiet, comfortable therapy room is a tranquil sanctuary specially designed for your comfort.
The treatment of lymphedema is known as Complete Decongestive Therapy and involves two phases. Phase I of treatment involves intensive and frequent Manual Lymph Drainage (MLD). During MLD, a certified lymphedema therapist will gently manipulate the area to encourage the natural drainage of the lymph. Limbs are usually wrapped at the end of the session to reduce refilling of tissues. Depending on the extent of lymphedema, this phase may last for up to 10 visits. Patient education is a significant part of therapy. Once the limb returns to normal or near normal size, Phase II begins. This includes the use of a compression garment and the continuation of self care and all therapy components at home. When treated at the onset of symptoms, the response is better as there is less fibrosis. Often, fibrosis has already set in resulting in joint tightness and pain. This requires various other manual therapy techniques.
Skin care, compression and exercise
Therapy also involves meticulous skin care to prevent drying and reduce the risk for infection. Since exercise stimulates lymph drainage, patients learn a series of simple exercises for decongestion and stretches to improve tightness and relieve pain.
Risk Reduction Strategies Expert Opinion
Patients and caregivers should be advised to:
Take good care of skin and nails
Consider infection precautions when having dental work
- Maintain optimal body weight
Eat a balanced diet
- Avoid binding clothing, shoes, jewelry and watches
- Wear non-restrictive bras, avoiding underwire
- Avoid extremes in temperature
- Use sunscreen and insect repellant
- Wear compression garment as prescribed
- Gradually return to your usual activity and full movement after surgery and radiation
- Undertake 30 minutes of moderate to vigorous exercise at least 5 days a week. Advance gradually
- Practice diaphragmatic breathing exercises & practice laughter exercises daily
- Avoid using an automated BP device on the affected limb
- Consider a correctly fitted compression garment for air travel if you are at risk to developing lymphedema. Discuss with your provider
- Watch for signs of infection (heat, pain, redness, increased swelling and fever)
- Report all extremity sensations: tightness, heaviness, fullness, soreness, burning
Source: 1 American Cancer Society, Lymphedema: understanding and managing lymphedema after cancer treatment. 2006, Atlanta: American Cancer Society.