Therapy Necessary For Fluid Build-Up
People who develop lymphedema can find relief through special therapy

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EDITOR’S NOTE: The name of the patient has been changed to protect her privacy.

BY ANNA WILSON
BLUE RIDGE HEALTHCARE

MORGANTON - Over a seven-year period, 87-year-old Mary Scott has been treated for lymphedema three times. This latest episode flared up after she fell and fractured bones in her wrists.

“After I fell, I wasn’t walking,” she said. “I was sitting on the couch most of the time, and that’s when this swelling started. This is the worst it’s been and I blame that on not moving or exercising.”

As soon as her wrists healed and one cast was replaced with a removable one, she was up walking around in her kitchen. “I’m not one that’s used to sitting,” she said. “I’m doing better now that I can move around.”

But the damage was done and Mary had swelling in both legs. She began her daily treatment at Blue Ridge HealthCare’s Rehabilitative Services at Grace Hospital with certified lymphedema therapist Gloria Chester, PTA, CLT.

“Lymphedema patients have to come in for treatment five days a week,” said Chester, one of two certified specialists at Blue Ridge. The other is Keisha Paige, PT, CLT, who works in rehab services at Valdese Hospital. “The daily treatments last until the swelling is under control or the limb is down to the size we want. Then treatment drops to three times a week.”

Follow up treatment calls for compression garments fitted especially for the patient and another visit with the therapist in four to six months.

What is lymphedema?

The lymphatic system is often referred to as the body’s “second circulatory system,” and when it’s working correctly, the lymph nodes filter fluid, trapping bacteria, viruses and other foreign substances.

Special white blood cells call lymphocytes then destroy these harmful elements.

But if the system is damaged or lymph nodes have been removed, protein-rich fluid builds up most often in the legs or arms causing swelling, medically termed edema. Once present, lymphedema is not curable. “It’s maintainable and manageable, but not curable,” Chester said.

What are the causes?

Many of Chester’s patients are cancer survivors who have had their lymph nodes removed or have undergone radiation therapy.

“As soon as you have cancer surgery, we think of you as being a lymphedema patient,” she said. “Even though the swelling may not show up until months after the surgery.”

The cancer itself doesn’t cause lymphedema, but the trauma of the surgery can damage the lymphatic system.

Ideally, surgical cancer patients would come see a lymphedema specialist right after surgery, but most are not concerned until the actual swelling starts.

“More than likely, they will develop it,” Chester said. “I’d like to see them right away to teach them a little bit about controlling it. Unfortunately, we sometimes won’t see a patient until the swelling is beyond self-management.”

Other causes include tamoxifen, trauma or infection of the lymphatic system. These are all known as secondary lymphedema. In rare instances, primary lymphedema is caused by a birth defect of the lymphatic system and can be present at birth or develop later in life.

Symptoms of lymphedema include feeling as though your clothes, rings, wristwatches, or bracelets are too tight; a feeling of fullness in your arms or legs; and less flexibility in your wrists, hands, and ankles. Patients may feel very tired and have discolored skin overlying the swelling.

If left untreated, the swelling causes tissues to harden from lack of oxygen and increased presence of proteins, which interferes with wound healing. The swollen limb or limbs make movement difficult and can lead a decrease in the patient’s quality of life.

“It can be life-threatening,” Chester said. “Especially if the person gives up and stops taking care of themselves. Their sores or ulcers aren’t taken care of and they get infected leading to many complications.”

What is the treatment?

Chester and Paige use the Complete Decongestive Therapy (CDT), which uses compression therapy, manual lymph drainage, skin care and range of motion exercises.

For Mary, the compression bandages start at her toes and end at her groin. The location of the swelling determines how far up the bandages will go. Chester uses cotton netting as the first layer to protect the skin and also to protect bandages from the body’s sweat and oils.

Her feet and toes get wrapped with gauze individually so the fluid will flow up and not settle any lower. The next layer is thin foam followed by elastic bandages wrapped tightly - but not too tightly.

“She said she was going to fix me like a mummy,” Mary said. “I didn’t believe her, but she did.”

The wrapping shouldn’t hurt and it shouldn’t cut off circulation to her feet. That’s why Chester and Paige attended intensive training classes in order to get certified. The training consisted of 135 hours - two weeks of eight-hour a day classes followed by a practical and certification exam. Both had to demonstrate extensive knowledge of the anatomy, especially the lymphatic system, and understanding of the Complete Decongestive Therapy.

The two also learned how to perform manual lymph drainage, a gentle manipulation of certain lymphatic areas including around the neck, under the arms and near the groin.

Treatment can last an hour to 90 minutes.

Both the bandages and draining hopefully will cause the fluid to return to the blood circulation system where it will be filtered through the kidneys. Patients can expect an increased need to urinate soon after treatment and for several hours afterward. It’s important for the patient to drink plenty of water after a session.

Lymphedema patients learn to be careful with razors, gardening tools, pet claws and nail clippers. Even small injuries or an insect bite may cause an infection.

And finally, treatment consists of exercise. “We have a list of exercises for our patients and we develop a customized program,” Chester said. “Most are range of motion exercises.”

These slow exercises aid in getting rid of fluid and also because some patients with chronic lymphedema will have poor strength or range of movement. However, vigorous movements or exercises should be avoided.

Skin care also is an important aspect of treatment since lymphedema causes a patient to be more susceptible to infections. The disease also leaves the skin very dry.

“They have to put on their lotion every day,” Chester said. “And the lotion shouldn’t contain alcohol.”

If you’re not sure about a lotion’s alcohol content, Chester suggests reading the first seven ingredients. “If alcohol is listed in that first seven, then don’t use it,” she said.

For more information on how a certified lymphedema therapist or other therapy professional can help you, please call Blue Ridge HealthCare’s Rehabilitation Services at 580-6816 or 879-7592.

Anna Wilson is a writer and graphic artist in Blue Ridge HealthCare’s Marketing and Public Relations Department.

The second largest employer in Burke County, Blue Ridge HealthCare serves a four-county area and includes Grace and Valdese hospitals, Blue Ridge Home HealthCare, Grace Heights and College Pines Health & Rehabilitation Centers, Grace Ridge Retirement Community, Phifer Wellness Center and a number of physician practices.