The OSUCCC – James certified physical therapists and lymphedema experts work with patients on many posttreatment challenges, including swelling, impaired mobility, muscle and joint strength, range of motion in joints and tissues, endurance, fatigue and energy, and overall well-being before, during and after cancer treatment.
How long rehabilitation therapy treatment lasts depends on each patient’s individual needs and specific goals. Some patients may need only a single visit to learn about their condition and develop a home exercise program, and others may need treatment for several weeks or months.
Physical therapy is helpful in any phase of treatment and the OSUCCC – James experts carefully tailor physical therapy to each patient’s needs.
What is the Lymphatic System?
The lymphatic system represents the link between the circulatory system (the heart and its network of blood vessels) and the immune system (the complex system that defends our body against disease). It is made up of lymphatic vessels or channels, lymph nodes and other organs. It maintains the balance between the production of interstitial fluid (fluid that naturally accumulates between the cells that make up our bodies) and its clearance. It clears several liters of interstitial fluid daily.
The lymphatic system accomplishes three things:
- Removes extra fluid from body tissues
- Absorbs fat and recycles it into the bloodstream
- Defends the body against disease
What is Lymphedema?
Lymphedema simplified is swelling.
This can occur in any part of the body but is most common in the arms and legs. This occurs when there is more fluid generated than can be cleared by the lymphatic system, resulting in a relative backup of fluid. Lymphedema may affect just one arm or leg, or it may occur in both extremities.
The lymph fluid is full of protein. This protein-rich fluid accumulation may cause symptoms that include swelling, heaviness, decreased range of motion (ability to move or bend the limb), tightness, discomfort in the affected joints, and other symptoms.
On a molecular level (at a scale best seen with a microscope or smaller), lymphedema also results in thickening of the skin and progressive scarring of the affected limb. All of this may result in the affected extremity being more prone to infection, which in turn may worsen the lymphedema and its harmful effects, creating a dangerous cycle.
What Causes Lymphedema?
There are two types of lymphedema: primary and secondary.
People are born with primary lymphedema. It may be seen at birth or during puberty or adulthood and represents an inherent insufficiency of the lymphatic system.
Secondary lymphedema is more common in the developed world and is most commonly caused by an injury or disruption of the lymphatic system. For example, surgery, chemotherapy and/or radiation therapy may injure the lymphatic system. Lymphedema often happens following surgery with removal of lymph nodes or after radiation therapy. It can appear weeks, months or even years after the surgery. It is not always clear why some people develop swelling while others do not.
Does Lymphedema Go Away?
Although there are rare cases when lymphedema has improved and not come back, in most patients it remains and requires long-term treatment.
How is Lymphedema Treated?
The mainstay of treatment is called complex decongestive therapy (CDT). A certified lymphedema therapist will evaluate you and create a treatment plan that may include one or more of the following:
Avoid injury and infection. Practice good hygiene, and put on moisturizing lotion. We will teach you how to care for your skin.
Two basic types of massage are used to treat lymphedema:
Manual lymph draining is a precise and gentle form of massage that helps move the fluid to other parts of the body for clearance.
Soft tissue mobilization (or myofascial release) is a type of massage used to loosen scar tissue and other tightness that might contribute to the swelling. Sometimes massage is taught to patients or family members to do at home.
Sometimes doctors prescribe antibiotics, diuretics or other medicines as part of the treatment plan.
Stretching to loosen the tissues, strengthening and range-of-motion exercises can help restore to a more normal functional level and improve the movement of fluid.
Exercise may also be helpful with weight control, which is an integral part of lymphedema therapy. Exercises should be performed under the guidance of a lymphedema certified therapist.
Cotton, low-stretch bandages apply constant pressure on the limb. Bandaging is usually combined with other methods of treatment.
Elastic fabric garments, similar to a girdle or support stocking, put pressure on the arm or leg to help move fluid and keep new fluid from collecting.
For many patients, surgery may help treat lymphedema.
How are OSUCCC – James Doctors Treating Lymphedema With Surgery?
Doctors at the OSUCCC – James do the following procedures to treat lymphedema:
- Lymphaticovenous bypass, which redirects the lymph fluid to small veins
- Vascularized lymph node transfers, which connect with the affected lymph channels and assist with lymph fluid clearance
Lymphaticovenous bypass and vascularized lymph node transfers allow for improved drainage of lymphatic fluid, which can lessen lymphedema.
In select cases, liposuction procedures or other debulking procedures may be used.
Your doctor can talk with you about which procedure he or she would recommend specifically for you.
Who May Have This Procedure?
Any patient with lymphedema may be a candidate. Please ask your doctor about the surgery. Patients who have had lymphedema for a shorter time and with less severity tend to have better results with the Lymphaticovenous bypass procedure.
Frequently Asked Questions
What Should I Expect From this Procedure?
Many patients improve; however, every patient is different. The surgery does not help every patient. Do not expect a complete cure. You will be evaluated and very precisely measured prior to and following the surgical procedure by one of the OSUCCC – James certified lymphedema therapists. These assessments will assist in documenting your improvement and providing follow-up care if needed.
What Does This Procedure Involve?
The procedure involves general anesthesia and takes about four to six hours.
The doctor makes multiple small cuts (incisions) about one inch long in the affected arm or leg. The hospital stay is less than 24 hours.
Lymph Node Transfers
Using microsurgery, the doctor removes lymph nodes from one part of your body and transplants them, reattaching their blood supply to the affected arm or leg. The hospital stay is usually about four to seven days.
What Care Would I Need After Surgery?
There is usually limited pain, and you may have to limit some of your activities or movement after surgery. After four to six weeks, compression stockings can be worn and lymphedema therapy can resume.
What Are the Risks?
As with any surgery, there are risks such as infection. Your surgeon will talk with you about all of the risks.
What Are the Disadvantages of This Procedure?
The procedure may not help the lymphedema, and you will have small, permanent scars.
What Are the Advantages of This Procedure?
The procedure may help reduce the severity and progression of the lymphedema, reverse some of the changes seen within the affected limb, and diminish pain, heaviness and infection.
Would I Still Need Lymphedema Treatment After Surgery?
Although you may improve after surgery, we recommend you continue treatment to get the best result. For example, continue wearing the compression garment, having massages, caring for your skin and exercising.
Will My Health Insurance Pay for This Procedure?
This depends on the health insurance company. To learn more, please contact your insurance company or your physician.
Has Anyone Researched This Procedure?
Yes, there are many published articles about this procedure. You may ask your OSUCCC – James certified lymphedema therapist or plastic surgeon for copies of these articles.
To make an appointment or refer a patient to the OSUCCC – James lymphedema treatment team, call 614-293-0043.