What is causing the swelling?
You’re visiting your grandfather after not seeing him for a while and notice that his left leg is swollen, and the skin looks different from his right leg. You ask him what’s going on, and he brushes you off. You insist on taking him to the doctor, who tells you that he has lymphedema. What is that? How can it be fixed? Is there any way to prevent it?
The lymphatic system is part of your immune system and is a network of vessels designed to carry protein-rich fluid throughout the body. Lymph nodes are filters that have cells that fight infection and cancer. Typically, the fluid is pushed through the vessels by the muscle contractions as you move and from small pumps in the wall of the lymph vessels. Lymphedema occurs when the lymph fluid isn’t able to drain, resulting in it leaking into the surrounding tissue. It’s important to note that anything that can block the drainage of lymph fluid can lead to lymphedema. However, the most common cause is cancer. In some cases, cancer cells block lymph vessels. Other times, radiation treatment for cancer can cause scarring and inflammation of lymph nodes or vessels. Often, lymphedema doesn’t occur until months or years after treatment. In developing countries in the tropics, lymphedema is usually caused by an infection with threadlike worms that clog the lymph nodes. A less common reason for lymphedema is inherited conditions where the lymphatic system doesn’t develop properly.
Lymphedema symptoms can range from mild to severe. They include swelling to part or all of an arm or leg (including fingers or toes), a feeling of heaviness or tightness in the affected limb, restricted range of motion, recurring infections, and hardening and thickening of the skin (fibrosis). If you notice any of these symptoms, you should see your doctor as soon as possible. If you already have lymphedema and notice a sudden increase in the size of the swelling, you should see your doctor.
Certain things can increase your chances of developing lymphedema, such as older age, excess weight or obesity, and rheumatoid or psoriatic arthritis. A common complication is skin infections (cellulitis) because the trapped fluid provides a breeding ground for germs so that the slightest injury can be an entry point for infection. If this happens, the area will appear swollen and red. Also, it’s typically painful and warm to the touch. If cellulitis isn’t treated, it can spread into the bloodstream and trigger sepsis, which is a life-threatening condition that occurs when the body’s response to an infection damages its own tissues. Another issue with lymphedema is leakage through the skin. When the swelling is severe, the lymph fluid will drain through tiny breaks in the skin or cause blistering. For some people with very severe lymphedema, the affected area’s skin becomes thickened and hardened, resembling an elephant’s skin. A rare form of soft tissue cancer can result from the most severe cases of untreated lymphedema.
Unfortunately, there’s no cure for lymphedema. So, the treatment focuses on reducing the swelling and preventing complications. Since the main concern is the development of cellulitis, your doctor may prescribe antibiotics for you to have on hand so that you can start taking them immediately if symptoms appear. When it comes to reducing swelling, specialized lymphedema therapists can teach you about techniques and equipment that can help. Certain exercises that allow for gentle contraction of the muscles in the affected limb can help move the excess fluid out. Another option is manual lymph drainage, which is when a therapist trained in this massage-like technique uses very light pressure to move the trapped fluid toward an area with working lymph vessels. If you have a skin infection, blood clots, or active cancer in the affected limb, you should avoid having manual drainage. Your doctor might also recommend compression bandages, which are low-stretch wraps covering the entire limb to encourage lymph fluid to flow back toward the body. A similar option is compression garments, which are close-fitting elastic sleeves or stockings designed to encourage lymph fluid drainage. These often require a prescription to ensure that the proper amount of compression is used, and you’ll need to be measured by a professional to ensure an appropriate fit. Another possibility is sequential pneumatic compression devices. These involve wearing a sleeve over the affected arm or leg and connecting to a pump that intermittently inflates the sleeve, putting pressure on the limb, and moving lymph fluid back toward the body.
There are surgical options available to treat lymphedema. One option is a lymph node transplant. This involves taking lymph nodes from a different area of the body and then attaching them to the network of lymph vessels in the affected limb. This is used for individuals with early-stage lymphedema. Another possible procedure is the creation of new drainage paths, which is where new connections between the lymph network and blood vessels are made, allowing the excess lymph fluid to be removed from the limb via blood vessels. For those with severe lymphedema, removal of fibrous tissue can be helpful. It’s often done through liposuction and can improve the limb’s ability to move. The hardened tissue may need to be removed with a scalpel in very severe cases.
While there isn’t a way to prevent lymphedema, there are things that you can do to minimize your risk for complications. The most important is to avoid injury to the affected limb. Since cuts, scrapes, and burns make it easier for infection to enter your body, you want to protect yourself from sharp objects. Some examples are shaving with an electric razor or wearing gloves when gardening or cooking. You also want to clean your skin daily. While doing this, you should look at all parts of the affected limb for signs of trouble, such as cracks and cuts. It’s a good idea to apply lotion to prevent dry skin. Additionally, you need to take care of your whole body because this will give you more energy and encourage healing. To do this, eat a diet rich in fruits and vegetables, get some form of exercise daily, reduce stress, and get enough good quality sleep.
Lymphedema can definitely be worrisome if you’ve never heard of it before. The good news is that with the proper management, you can decrease its impact on your life. If you have any questions or concerns about lymphedema, please speak with your doctor. If you would like more information, please visit Cleveland Clinic’s Lymphedema page at https://my.clevelandclinic.org/health/diseases/8353-lymphedema