Lymphedema treatment ranim.A. Elmasry.pptx

Presentation for lymphedema Treatment collected from different sources

1. Lymphedema treatment

2. Questions we will answer: What is lymphedema? Who is at risk? How do I reduce my risk? How is it treated? What are the exercise guidelines?

3. What is lymphedema? Lymphedema is an abnormal accumulation of protein-rich fluid in the tissue which can result in swelling of a body part and fibrosis.

4. Who is at risk? Removal of lymph nodes Damage to the lymph system Other factors Obesity Poor diet

5. types Primary lymphedema Mainly due to developmental defect of lymph vessels or nodes 1.15/100,000* individuals <20 years old secondary lymphedema Cancer-related lymphedema Trauma-related lymphedema Infection-related lymphedema

6. Breast Cancer-Related Lymphedema

7. Secondary Arm Lymphedema Incidence & Prevalence www.nci.nih.gov - lymphedema Among 1151 women followed for 15 years…

8. The at risk region is the area where lymph nodes were removed. This includes all tissues in the arm, chest and back that are draining lymph fluid toward those nodes. Skin Lymph Drainage Territories

9. Role of the Lymphatic System Transports proteins Removes excess water Absorbs fat molecules from the gut Removes cellular debris and foreign material (e.g. bacteria, viruses, cancer cells)

10. Illustrating the Concept of Lymph Formation

11. Arm Lymph Drainage

12. Lymph Node

13. Thoracic Duct

14. Breast Lymph Drainage

15. Stages of Lymphedema Stage 0 − Latent, sub-clinical Stage 1 − Spontaneously reversible At this stage, it is present during the day but goes away overnight Pitting starts between Stage 1 and 2 Stage 2 − Spontaneously irreversible By this stage, it is still present after a night’s rest, even if improved Stage 3 − Lymphostatic Elephantiasis Rare occurrence in breast cancer

16. What changes occur with an altered lymph system? Excess protein in the tissues Accumulation of excess fluid in the limb Decreased oxygenation Slow tissue-healing time Formation of fibrosis

17. What does lymphedema feel like? Tightness or heaviness in the limb Achy Pins and needles Tenderness in the elbow ‘Odd’ sensations ‟Pain of congestion” Discomfort NOT ‟unbearable pain,” which might be malignant lymphedema radiogenic plexopathy NOT muscle soreness Let’s discuss the difference…

18. Lymphedema risk-reduction practices include: Skin care Activity and lifestyle Avoiding limb constriction Compression garments (If appropriate) Avoid Limb Constriction If you have lymphedema, wear a well- fitting compression garment for air travel Avoiding extremes of temperature

19. Treatment Often Offered Lymphedema treatment Compression Pump Surgery Complete Decongestion therapy Elastic Support Garment Medication

20. Pneumatic Compression Pump Advantages: Fast home application. Disadvantages: Can cause genital lymphedema Has to be applied many hours per day. Traumatize residual lymph vessels.

21. Surgery Reduction (Debulking) Microsurgical Technique(lymph collector/node Transplantation & Lymph-venous anastomosis) Liposuction

22. medication Diuretics Usually prescribed but make the case worse. Increase protein concentration in the tissue.

23. How is lymphedema treated? Complete Decongestive Therapy is an effective therapy for lymphedema and other swelling disorders.

24. Volume of Extremity CDT phase 1 CDT phase 2 Plateau of Decongestion Weeks Complete Decongestive Therapy

25. Complete Decongestive Therapy PHASE 1: Decongestion Acute PHASE 2: Maintenance chronic 1-Meticulous skincare 2-Manual Lymph Drainage 3-Gradient compression bandaging 4-Remedial exercises Compression garment Meticulous skin care Day: Compression garment Night: Gradient compression bandaging Self-Manual Lymph Drainage Remedial exercises Follow-up assessment

26. Meticulous Skin & Nail Care Low-pH, gentle soaps Moisturizer (Low pH also recommended) Do not cut cuticles Prevent infection Keep skin working optimally

27. Skin Care Avoid trauma/injury and reduce infection risk Keep arm clean and dry Apply moisturizer daily to prevent chapping and chafing of skin Give attention to nail care; do NOT cut cuticles Protect exposed skin with sunscreen and insect repellent Use care with razors to avoid nicks and skin irritation (shave arm pit/axilla with electric razor) Wear gloves while doing activities that may cause skin injury If scratches/punctures to skin occur, wash with soap and water, apply antibiotics, and observe for signs of infection If a rash, itching, redness, pain, increased skin temperature and swelling, fever, or flu-like symptoms occur, contact your physician immediately

28. Manual Lymph Drainage Expert Stretching of the Skin

29. Manual Lymph Drainage Drains the congested areas Reduces the risk of infection Normalizes the size and pressure in the limb Reduces pain/discomfort

30. Compression Therapy Gradient, short-stretch bandaging Medical compression garment

31. Short-stretch bandages are proven to be the most effective. Objective: To avoid the further development of the Edema and support the physiological muscle pump function short-stretch bandages are applied according to a special bandaging regime. Benefit supporting high working pressure exerts no dynamic resting pressure(save during sleeping The short-stretch bandaging regime develops its best efficacy during exercise. Objective: To activate the muscle pump to its best remedial exercise is highly recommended. Benefit : The muscle pump works against the high resistance force of a multiple-layered short-stretch bandage.

32. Gradient Compression Bandaging Decreases the filtration rate Prevents re-accumulation of fluid Softens fibrosis Provides external counter-pressure during exercise

33. Indication of the complex decongestive therapy (CDT) Phlebo-Lipo-lymphoedema Lipolymphoedema Primary and secondary lymphoedema Phlebolymphoedema Musculoskeletal disorders in the context of rheumatic diseases (Recovery after any surgery

34. General (absolute) contraindications Cardiac edema Renal Failure Acute dVT Acute infections caused by pathogenic germs Malignant active cancer with metastases and not treated

35. General contraindication for Compression therapy Absolute general contraindications Serious arterial circulatory disorder Chronic regional pain syndropm / Sudeck syndrom (CRPS) Acute bacterial inflammation Relative (just under medical care) Arterial high pressure Angina pectoris Cardiac arrhythmia Age 70+ Serious allergic Spastic paresis

36. Erysipelas and Lymphoedema FREQUENCY 26,3 % STAGEI: 1% STAGEII: 27% STAGEIII: 72% ERYSIPELAS–FREQUENT COMPLICATION OF LYMPHOEDEMA AND OFTEN CONTRIBUTES TO A RAPID WORSENING OF LYMPHOEDEMA

37. Diagnosis erysipelas CLINICALDIAGNOSIS Swelling and redness of the leg Sharply restricted Unilateral Flame-shaped Plump accompanying edema Chills, fever up to 40°

38. General contraindication for Manual lymph drainage RELATIVE: Malignant lymphedema Active cancer is causing the lymphedema (treatment with MLD requires physician's approval) ABSOLUTE LOCAL CONTRAINDICATIONS Neck: hyperthyroidism, heart rhythm disorder, carotid sinus hypersensitivity( vagus nerve Relatively: Age Abdominal: pregnancy, inflammatory bowel disease, Relatively: Age Arm, Leg: acute, venous disease (Phlebitis, thrombosis)

39. Garment Measurement Jobst

40. Treatment with CDT Before CDT After CDT

41. Custom Compression Garment

42. Remedial Lymphedema Exercises Improves range of motion, endurance, coordination, and strength, where possible. Will provide optimal results with decongestive therapy. Non-aerobic, gentle stretching Swimming, scuba diving, singing, yoga, Tai Chi, Chi Kung

43. Diaphragmatic Breathing Abdominal breathing stimulates the transport of lymph back to the heart through the thoracic duct.

44. NLN Exercise Guidelines (cont.) Flexibility/Stretching May improve lymph flow by decreasing scarring and tightness Avoid over-stretching Strength Training Modifications are needed Adequate rest between sessions is crucial Modify your program according to your symptom response

45. For more information… National Lymphedema Network www.lymphnet.org BreastCancer.org www.breastcancer.org Living Beyond Breast Cancer www.lbbc.org American Cancer Society www.cancer.org