Lymphedema

Complete Decongestive Therapy for cancer patients suffering from Lymphoedema
 
Lymphedema is a swelling of a body part usually occurring in the arms or legs. It can also occur in the face, neck, abdomen, or genitals. Lymphedema is the result of the abnormal accumulation of protein-rich fluid in the affected area. Remarkably, even though it afflicts approximately 1% of the population, there is a shortage of lymphedema information, and the problems it creates are poorly understood in the medical community.

 
Lymphedema is classified as either primary or secondary. Primary lymphedema is the result of malformation of the lymphatic system. It may be present at birth but more often develops later in life without obvious cause.
 
Secondary lymphedema is much more common and is the result of surgery or is a side effect of radiation therapy for cancer. Secondary forms may also occur after injury, scarring, trauma, or infection of the lymphatic system.
 
Lymphedema has important pathological and clinical consequences. In stage I lymphedema, the swelling consists of protein-rich fluid and may be temporarily reduced by simple elevation of the limb. If it remains untreated, however, the lymphedema causes a progressive hardening of the affected tissues which is the result of a formation of connective tissue, adipose tissue, and scarring (stage II lymphedema).
 
Stage III lymphedema is characterized by a tremendous increase in volume, hardening of the skin, hyperkeratosis, and papillomas of the skin. Infections such a cellulitis, erysipelas, and lymphangitis frequently develop in individuals suffering from lymphedema. Infections are most common in stage II and III lymphedema with each infection contributing to a worsening of the condition making frequent hospitalizations necessary. Lymphedema treatment options offered in Mauritius include compression garments,  Manual Lymph Drainage (MLD), and Complete Decongestive Therapy (CDT).
 
Manual Lymph Drainage (MLD)
 
MLD, a gentle manual lymphatic therapy technique, is a potent way to activate the lymphatic system, especially when the transport capacity of the lymph vessel is reduced because of prior surgery and/or radiation therapy. However, if carried out as an isolated treatment for lymphedema, the results are very temporary and lasting relief of lymph fluid from a congested limb is not possible. Many MLD practitioners have been trained only in basic MLD and are not qualified to treat lymphedema at all. However, MLD alone may be used with much success in many conditions unrelated to lymphedema.
 
Complete Decongestive Therapy (CDT)
 
CDT is a combination of MLD, bandaging of the affected areas, remedial exercises, and skin and nail care. CDT is divided into a two-phase program that initially involves an intensive treatment phase and is then followed by a maintenance program continued by the patient at home. Carried out with great care and consistency by a certified lymphedema therapist, CDT is the treatment of choice for chronic extremity lymphedema. Even in advanced lymphedema, CDT achieves excellent results with no side effects. Because CDT is labor intensive, time-consuming, and requires patient compliance, many patients have difficulty committing to the program at first. However, because the results of CDT are always superior to those achieved with all other treatments, increasing numbers of patients are undergoing CDT treatment and are consequently able to maintain the reduction of their limbs through diligent participation in a home maintenance program. 
 
CDT is very new in Mauritius, and is currently only available to patients through Restorative Therapies in Tamarin.  Patients from vulnerable group can receive the first consultation free of charge by contacting Link to Life and requesting an appointment in either Vacoas or Pamplemousse.
 
For a lymphedema therapist to be fully competent in treating lymphedema using CDT, it is vital that the CDT training consist of the four components of CDT:
(1) basic and advanced MLD, (2) lymphedema bandaging, (3) remedial exercises, (4) skin and nail care. The therapist must also have a complete understanding of the anatomy, physiology, and pathophysiology of the lymphatic system, the treatment of primary and secondary lymphedema, the indications and contraindications of CDT, and the proper measuring techniques for lymphedema support garments. Furthermore, lymphedema therapy should not begin unless the patient has been examined and diagnosed by a board-certified physician who understands lymphedema and its complications. Once the diagnosis of lymphedema has been confirmed and treatment has begun, the progress must be monitored by the physician.
 
Whereas the clinical diagnosis of lymphedema can most often be established without invasive testing, and electrocardiogram before the treatment begins and during the course of treatment is sometimes necessary to ensure safe treatment for each patient. Because of the complications associated with lymphedema, the involvement and supervision of a qualified physician is essential for safe and effective lymphedema therapy.
 
Medications
Diuretics, while often prescribed, usually make the lymphedema worse. Diuretics are able to draw off the water content of the edema while the protein molecules remain in the tissue spaces. These proteins continue to draw water to the swollen areas as soon as the diuretic loses its effectiveness. These accumulated proteins also lead to a higher concentration of proteins in the edema fluid and cause the tissues to become even more fibrotic and indurated.
 
Although there is a lot or research being done into surgical cures and medications for the treatment of lymohoedema, CDT remains the most effective treatment for the management of Lymphedema.