Sunday, October 26, 2008
1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immunodeficient and the proein rich fluid provides an excellent nurturing invironment for bacteria.
2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.
3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.
4. Loss of Function due to the swelling and limb changes.
5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.
6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections. See also Thrombophlebitis
7. Sepsis, Gangrene are possibilities as a result of the infections.
8. Possible amputation of the limb.
9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.
10. Skin complications such as dry skin, splitting, plaques and nodules, susceptibility to fungus and bacterial infections.
11. Chronic localized inflammations.
12. Pain ranging from mild in early lymphedema to severe in late stage lymphedema.
13. Lymphatic cancers which can include angiosarcoma, lymphoma; Kaposi's Sarcoma; lymphangiosarcoma (Stewart_treves Syndrome); Cutaneous T-Cell lymphoma; Cutaneous B-Cell lymphoma; Pseudolymphomatous Cutaneous Angiosarcoma. See also: Primary Lymphedema and Cancer for a discussion and Lymphatic Cancers Secondary to Lymphedema.
Note: These cancers are rare and are usually associated with long term, untreated or improperply treated lymphedema. Typically occuring in stage three or four; quite rare in stage two.
14. Skin complications possible in stages 3 and 4 include papillomatosis; placques including “cobblestone” appearing placque; dermatofibroma; Skin Tags; Warts and Verrucas; Mycetoma skin fungus; dermatitis and many lymphedema patients report increased problems with psoriasis; eczema and shingles. I would suspect this may be due to again, the immunocompromised condition of the arm or leg afflicted with lymphedema.
15. Documented but rare complications in late stage also can include Lymphomatoid Papulosis; Cutis Marmorata; Acroangiodermatitis; Dermatolymphangioadenitis (DLA); Papillomatosis cutis carcinoides
16. Debilitating joint problems. This is caused by a combination of the excess fluid weight and the constant inflammatory process that accompanies lymphedema. As we have gotten older, many lymphedema patients are having total knee replacement, total hip replacement, or total shoulder replacement while others are experiencing carpal tunnel syndrome and are having carpal tunnel surgery or experiencing shoulder problems associated with lymphedema and must haverotator cuff surgery.
There are certain factors that can create a significant risk for the development of what is referred to as secondary leg lymphedema.
These risk factors include:
1.) Lymph node removal for biopsies
2.) Serious infections that include lymphangitis, cellulitis or erysipelas.
3.) Deep invasive wounds that might tear, cut or damage the lymphatics.
4.) Radiation treatments, especially ones that are focused in areas that might contain “clusters” of lymph nodes
5.) Morbid obesity can cause secondary lymphedema by “crushing” the lymphatics
6.) Serious burns, even intense sunburn
7.) Infection of the microscopic parasite filarial larvae, though this is more common in tropical countries
8.) For primary lymphedema any person who has a family history of unknown swelling of a limb
9.) Radiation and chemotherapy for cancer
10.) Insect bites
11.) Bone fractures and breaks
Symptoms of Leg Lymphedema
These symptoms may include:
1.) Unexplained swelling of either part of or the entire leg. In early stage lymphedema, this swelling will actually do down during the night and/or periods of rest, causing the patient to think it is just a passing thing and ignore it.
2.) A feeling of heaviness or tightness in the leg
3.) Increasing restriction on the range of motion for the leg.
4.) Unsual or unexplained aching or discomfort in the leg.
5.) Any change involving hardening and/or thicking of the skin or areas of skin on the leg.6.) Tingling or "Needles and pins" discomfort.
7.) "Compressible" swelling where when mashed there will be an endentation - called pitting edema
8.) Hardening and thickening of the skin on your leg
What are the symptoms of Lymphedema?
Lymphedema usually manifests as severe swelling of an arm or leg. For patients who have developed lymphedema as a complication of cancer treatment, the swelling is almost always on the same side as the treatment. In some cases, lymphedema may involve both of the limbs, typically the legs. The swelling commonly extends from the arm or leg into the fingers or the toes. In the early stages of lymphedema, the swelling is soft, and pressing on the limb may result in movement of the fluid. This is called “pitting edema”. In the later stages of lymphedema, scar tissue and fibrous tissue may develop in the swollen limb causing a more dense texture of the swelling and a cobblestoned or orange-peel like appearance of the skin. Patients with lymphedema may experience heaviness of the effected arm or leg and have difficulty with exercise or participation in other activities. In the most severe cases of lymphedema, swelling may be disfiguring and may lead to embarrassment and emotional distress and even difficulty in wearing clothes or shoes.
In addition to swelling, patients with lymphedema are at risk for developing certain types of skin infection in the swollen arm or leg known as cellulitis and lymphangitis. In mild to moderate infection, the skin will become warm, red, tender, and the patient may feel flu-like symptoms. Oral antibiotics and careful skin care should be started as soon as symptoms develop. In severe cases, high fevers and even shock may develop and require immediate hospitalization for intravenous antibiotics and close observation. Patients with severe, long-standing lymphedema are at increased risk for developing certain types of cancer, including certain skins cancers and lymphoma, although this is very rare.
Primary Leg Lymphedema:
Congenital (from birth) malformation of the lymph system or in the development of the lymph system; hereditary lymphedema in which lymph nodes may be missing
Secondary Leg Lymphedema:
Secondary leg lymphedema (also referred to as acquired lymphedema) is caused by or can develop as a results of:
1.) Surgeries involving the abdomen or legs where the lymph system has been damaged. This includes any intrusive surgery.
vein stripping surgery for peripheral vascular disease hip replacement knee replacement insertion of bolts, screws and other devices in orthopaedic repair lipectomy
2.) Removal of lymph nodes for cancer biopsy. These cancers include, but are not limited to prostate cancer testicular cancer ovarian cancer uteran cancer vulva cancer bladder lymphoma - both hodgkins and non hodgkins melanoma colon Kaposi Sarcoma
3.) Radiation treatment of these cancers that scars the lymph system and lymph nodes
4. Some types of chemo therapy. For example, tamoxifen has been linked to secondary lymphedema and blood clots.
5.) Severe infections/sepsis. Generally referred to as lymphangitis, this is a serious life-threatening infection of the lymph system/nodes.
6.) Trauma injuries such as those experienced in an automobile accident that severly injures the leg and the lymph system.
7.) Burns - this even includes severe sunburn. We have a member that acquired secondary leg lymphedema from this.
8.) Bone breaks and fractures.
9.) Morbid obesity - the lymphatics are eventually crushed by the excessive weight. When that occurs, the damage is permanent and chronic secondary leg lymphedema begins.
By Linda Fisher
The obstruction of the flow of lymph from a given area results in the accumulation of abnormally large amounts of tissue fluid in that area. Such an accumulation is called lymphedema.
Lymphadema is not only uncomfortable, it may cause such problems as pain, infection and recurrent infection, difficulty in movement, clothing restrictions, and air travel restrictions.
Remembering that the lymph moves upward in the body toward the heart, from the finger tips in toward the heart, and from the top of the head down toward the heart, we can see that the fluid moving furthest in the body is from the lower extremities. Some causes of lymphedema of the lower extremities is congestive heart failure, trauma to the back or lower abdominal area, blockage in the groin (inguinal nodes), or blockage behind the knee (popliteal nodes).
I often use the analogy of a traffic accident on the freeway to explain movement of lymph. At the point of the accident, all traffic either stops or slows to a near halt, until the accident is cleared away, thus allowing the traffic to again flow naturally. Anatomically, at the point of blockage, everything slows down and begins to accumulate backward along the path of flow. If the feet and ankles are swollen, it generally means that there is a blockage “up ahead.”
Even in slender young people, we sometimes see signs of lymphedema in the legs. This appears as “heavy ankles” or as a little pouch of fat on the inside curve of the knee area. When present in this portion of the population, we usually find that the individual is not getting the right exercise and eating largely of the wrong foods, or just the opposite. Many joggers, tennis players, and aerobic exercise enthusiasts exercise and eat properly, but they get this problem because repeated hard impact will slow lymph movement.
In the middle age and senior group, we may see a different, but very common, problem - shuffling the feet instead of walking comfortably. When you cannot lift your feet to step properly, you may just accept that you probably have an “arthritic problem.” Many times, you may have a large mass of lymph fluid behind your knee that has pooled, and then hardened. Imagine the pain this would cause. It would be like strapping a tennis ball behind your knee and then attempting to walk!
There is more than one cause of lymphedema in the lower extremities. The ones mentioned above are just some of the more common ones.
Tips to Avoid Blockage:
Do not wear tight jeans or tight under garments. Do not cross the knees when sitting; cross feet at the ankles instead. For the exercise enthusiast, integrate some form of slow, rhythmic exercise - yoga and pilates are excellent, as is walking. Bouncing on a trampoline is excellent - no need to jump. Bend your knees and get a gentle bounce going for a minimum of 12-15 minutes a day. If balance is a concern, hold onto a stationary item or purchase a balance bar that attaches to your trampoline. Also, if wheel chair bound, place your feet on the trampoline and have someone else bounce it for you - you will receive a positive benefit from this. Lie on a slant board. And, as always, drink plenty of clean water, practice deep belly-breathing, and eat plenty of fresh, unprocessed foods. Caution: In the case of congestive heart failure, be absolutely sure to check with your health care practitioner before attempting any form of exercise and, of course, no slant-boarding! “Creating free lymphatic movement through the body is a vital part of any healing process.”
Linda Fisher owns the Lympathic Wellness Center in Santa Maria.