What is Chronic Lymphedema?
Lymphedema occurs when the lymph system is damaged or not properly functional. This leads to a chronic swelling of one or more body parts.The lymphatic system is similar to the blood system, and has the same number of vessels, but contain lymph, which is light in color and you can see (visible only if special dye injected). This system differs from blood as it circulates through the whole body, while only the draining lymph each of the parties.The lymphatic vessels draining the excess protein and water escapes from the blood in small amounts, along with some substances in tissues created, or any foreign substances that penetrate. The lymphatic system has its beginning and is present in all tissues from a tiny vessels that gradually join together forming larger ones. The lymph is pumped into and through these vessels by the motion of adjacent muscles and by contractions of the walls of larger lymph vessels. Finally the lymphatic system empties into the blood (this occurs mainly in the lower neck) On their way through the lymphatic system, the lymph is filtered in the lymph nodes (lymph nodes). They filter all foreign substance such as bacteria, thus beginning the necessary immune response.
EDEMA: The lymphatic system helps to remove excess fluid and proteins extravasate tissues damaged blood vessels, as in inflammation (axis: a burn or injury). If they are unable to remove completely, the member swells (edema). However this type of swelling is only temporary, because the tissues heal, and blood vessels and extravasate not excessively.
Lymphedema: If the lymphatic system is damaged or blocked, the protein will continue to enter into the tissue through the capillaries as usual, thus forming where there should be draining system. Protein accumulation in tissues causes excess fluid between them and begin to swell tissues.
The swelling decreases tissue oxygenation, and interferes with normal functioning, causing injury to heal more slowly than normal. This excess protein also acts as a stimulus for chronic inflammation. One result of this is that excessive tissue forming fibrosis. Chronic inflammation may cause more blood capillaries to form and dilate. This produce some elevated heat feeling in the affected limbs.
When the heat is combined with stagnant protein it becomes a perfect nest for bacterial growth (dermato-lymphangio-adentitis). The patient may be found very ill, with constant infections, and the need for hospitalization. Fungal infections are also very common, and often difficult to treat. These infections put an additional burden to the already existing, further worsening lymphedema. Any infection or inflammation of intervention or even a sunburn may worsen lymphedema.
It is often considered that lymphedema occurs only in the arms and legs, but any organ or body region can get it: genitals, lungs, intestine, liver resulting from chronic hepatitis, etc.
Lymphedema has other effects on patient mobility decreases, situations cause embarrassment to others, this may lead to depression, causing a worsening of the physical condition and quality of life of the patient. If lymphedema is severe, especially if more than one member is affected, the patient has a feeling of great heaviness steadily.
This condition can be confused with obesity, but dieting is useless if lymphedema itself, however, if there is obesity, dieting is recommended. Although only a single member suffers, excess weight can cause awkwardness, making the affected limb is more exposed to injury, and consequently to a bacterial infection.
Lymphatic drainage of the legs is more difficult than that of arms, because the walk is heavier, and it discourages overweight. So Lymphedema in the legs is worse than the arms.
When first appears lymphedema, it will be marked (fovea), if the affected limb is pressed with a finger. As Lymphedema increases gradually, and not mark the affected limb when pressed. If the disease persists for years, worsens inflammation and skin changes occur, there is a loss of hair, and an alteration in the nails. The skin may become thick, with large folds and ulcers: Elephantiasis. Although rare, some patients develop a chronic lymphedema: Lymphangiosarcoma (Cancer: Stewart-Treves Syndrome)
Any Lymphedema that is left untreated may gradually lead to additional complications
Symptoms of lymphedema
There are several causes that can cause failure of the lymphatic system, and are divided into two main groups: primary and secondary.
CLASSIFICATION: PRIMARY / SECONDARY
Primary lymphedema (lymphatic FAILURE) The disease is classified into primary lymphedema - rare or uncommon diseases, and differs from the more common type, Secondary Lymphedema, because it contracts due to an injury to the lymphatic system (explained in the next section). It is estimated that 1 in 6,000 people are born with primary lymphedema, affects twice as many women as men, and appears four times in the legs more than arms. In 70% of cases affects only one leg, starting first by foot. However it can also affect both legs, including thighs, torso, genitals, arms, and face. This happens simply too few lymphatic vessels, sometimes there are many, but they are too diffuse and not pump properly, and sometimes it's a combination of both. Here Lymphedema can occur before birth (connatal Lymphedema), during puberty, which is most often the case in the Primary Lymphedema (lymphedema praecox), or appear later in life from 30-40 onwards (lymphedema tarda). Occasionally you can also trigger a primary lymphedema after contracting Secondary lymphedema in another part of the body: eg. after mastectomy (which is secondary) Primary Lymphedema may start one in the leg, or on the same side.
SECONDARY LYMPHEDEMA (severed or blocked lymphatic vessels)Secondary lymphedema occurs Cundo Lymphatic drainage is blocked or severed because:
When it appears and how fast
Once the lymph vessels are damaged, lymphedema can occur at any time. Sometimes it starts immediately and remains for life, sometimes there is a swelling that lasts a few weeks and then disappear, and may or may not arise again, or sometimes comes years after the trauma. Once the lymph vessels are damaged, anything can cause their appearance, eg a bee sting, a sunburn, the load an excessive weights, or even a long plane ride.
Apart from the acute primary phase that occurs shortly after the blockade, and then disappears once you start lymphedema condition deteriorates progressively. This deterioration is generally slower in primary lymphedema, and is faster in secondary lymphedema. This is usually an ongoing and stable, only if there is some additional inflammation (eg, infection, injury, burns), when the situation is rapidly worsening.
GRADES in Lymphedema: As a guide lymphedema can be divided into three grades:
LOCATION AND AREAS AFFECTED
Primary lymphedema can affect this since only a portion of a member, to many parts of the body, including the gut (causing intestinal lymphagiectasia), and lungs. If one leg is affected, probably also suffer other lymphatic drainage insufficient, having also the risk of acquiring lymphedema. There is also the situation of General Lymphedema spread throughout the body and limbs. Often the patient is diagnosed as obese, but the combination of successive diets show any results for the patient (even following a strict adherence to the diet).
Secondary lymphedema Here this occurs in remote regions of the trunk (distal), and is drained through the lymphatic vessels damaged axle. if the lymph nodes have been removed by surgery, or become enfibrosado due to radiotherapy. Therefore, it usually appears in the arm after a mastectomy, in an arm or leg after an operation for a melanoma, or in one or both legs after surgery for cancer in the pelvic region. It is also quite common to appear after a serious accident (per axis. Motorcycle) that is causing many lymph vessels are damaged.
In Lymphedema Filariasis, swelling occurs depending on where ultimately stayed filarial larvae. If they are based on nodes that drain the leg, it will suffer the swelling. Staying at the nodes beyond along the lymphatic system, both legs and genital area may be affected. Filarial lymphedema can also occur in the arms (rarely).
Although usually considered lymphedema which affects only a limb, particularly in the skin and subcutaneous tissue, other regions may also be affected and organs. It is also quite common in lymphedema-joints causing arthritis lymphostatic, but once the rest of Lymphedema is treated, it also improves.The Primary Lymphedema is also mentioned, but occasionally can appear as Secondary Lymphedema. It is also likely that other organs may suffer lymphedema, but these rarely diagnosed, because a mechanism has still not been not developed for doing this, yet the swelling can be felt or seen by a trained clinician.
Number of Affected
In the USA within the Medicare age population, the number of persons afflicted with lymphedema, or at risk of developing it, is around 7 million individuals.
The number of people affected with lymphedema are many more of them than they think. In Australia became a statistic in 1995, with a population of 15 million: these statistics only counted cases of postoperative lymphedema by mastectomy, those affected or affecting some 100,000 people. Of these, about 10,000 it would suffer severely. This number also had to add all the other lymphedema, as they appear after other surgeries different, due to the accidental injury, those due to chronic venous disease, and everyone with primary lymphedema. With these data, it was estimated that there are approximately 300,000 people in Australia at the time, who had a different type of lymphedema. (In Spain not having a path of study and diagnosis of lymphedema, there is no reliable statistics on how many patients may have. Applying the same rule used in Australia to calculate and estimate the number of affected in Spain gives us a population of about 40 million, may have affected approximately 800,000 people of some kind and different degrees of lymphedema, and in Galicia about 54,000 patients.)
In 1982, WHO, World Health Organization, estimated that 90 million people were filariático lymphedema, elephantiasis, and hydrocele. It is estimated to have 500 million people suffering from some form of lymphedema in the world.
YOUR DIAGNOSIS
Often an experienced physician can diagnose lymphedema. However, additional methods are usually very simple, studying the history of the condition and the unaided eye. Sometimes though it can be difficult, especially if two conditions coexist. Special methods are available (eg CT scan and lymphoscintigraphy). In the past, lymphography (Lymphatic System Xray injected with an oil medium for contrast) was used, this sometimes blocked the remaining lymphatic system, and its use has now been completely suspended, except in special circumstances. If lymphedema occurs for no obvious reason, the possibility of cancer should always be investigated. A lymphoscintigraphy is still being the best and safest we have to measure lymphatic function and gives a fairly accurate picture of the system. The MRI and CT are very good to watch to see the nodes and edema and fibrosis (respectively). However, these tests are only really necessary in difficult cases.
At the International Congress of Lymphology, Washington, 1993, most specialists agreed that the clinical diagnosis was sufficient in 90 percent of cases.
Lipedema
This is sometimes confused with lymphedema. In the early stages there is no swelling in the feet, both legs being always involved. The lymphatic drainage of surface tissue is gradually affected by fatty deposits, leading to the formation of a real (but secondary) lymphedema. The deep lymphatic drainage, although present, is running slower than normal. They form large deposits of fat in the legs, thighs and buttocks. Pressing on the skin is often very painful. It may seem and have cellulite appearance. '
Initially swells and is soft at the lower leg and thigh, no knee pain and tissue are folded as a cushion on the normal foot. As you progress any associated lymphedema, the foot is involved. The Lipedema can appear on the arms, but usually with a lesser extent, the hand and the foot, not involved until later stages.
The Treatment of Complex Physical Therapy with Lymph Drainage is strongly indicated for lipedemas, but bear in mind that the reductions are not as great as with regular lymphedema.
EDEMA: The lymphatic system helps to remove excess fluid and proteins extravasate tissues damaged blood vessels, as in inflammation (axis: a burn or injury). If they are unable to remove completely, the member swells (edema). However this type of swelling is only temporary, because the tissues heal, and blood vessels and extravasate not excessively.
Lymphedema: If the lymphatic system is damaged or blocked, the protein will continue to enter into the tissue through the capillaries as usual, thus forming where there should be draining system. Protein accumulation in tissues causes excess fluid between them and begin to swell tissues.
The swelling decreases tissue oxygenation, and interferes with normal functioning, causing injury to heal more slowly than normal. This excess protein also acts as a stimulus for chronic inflammation. One result of this is that excessive tissue forming fibrosis. Chronic inflammation may cause more blood capillaries to form and dilate. This produce some elevated heat feeling in the affected limbs.
When the heat is combined with stagnant protein it becomes a perfect nest for bacterial growth (dermato-lymphangio-adentitis). The patient may be found very ill, with constant infections, and the need for hospitalization. Fungal infections are also very common, and often difficult to treat. These infections put an additional burden to the already existing, further worsening lymphedema. Any infection or inflammation of intervention or even a sunburn may worsen lymphedema.
It is often considered that lymphedema occurs only in the arms and legs, but any organ or body region can get it: genitals, lungs, intestine, liver resulting from chronic hepatitis, etc.
Lymphedema has other effects on patient mobility decreases, situations cause embarrassment to others, this may lead to depression, causing a worsening of the physical condition and quality of life of the patient. If lymphedema is severe, especially if more than one member is affected, the patient has a feeling of great heaviness steadily.
This condition can be confused with obesity, but dieting is useless if lymphedema itself, however, if there is obesity, dieting is recommended. Although only a single member suffers, excess weight can cause awkwardness, making the affected limb is more exposed to injury, and consequently to a bacterial infection.
Lymphatic drainage of the legs is more difficult than that of arms, because the walk is heavier, and it discourages overweight. So Lymphedema in the legs is worse than the arms.
When first appears lymphedema, it will be marked (fovea), if the affected limb is pressed with a finger. As Lymphedema increases gradually, and not mark the affected limb when pressed. If the disease persists for years, worsens inflammation and skin changes occur, there is a loss of hair, and an alteration in the nails. The skin may become thick, with large folds and ulcers: Elephantiasis. Although rare, some patients develop a chronic lymphedema: Lymphangiosarcoma (Cancer: Stewart-Treves Syndrome)
Any Lymphedema that is left untreated may gradually lead to additional complications
Symptoms of lymphedema
- Feeling of tightness and heaviness in the affected limbs.
- Pain bursts in the affected limb.
- Pain in the buttocks (leg lymphedema) or behind the shoulder (arm lymphedema).
- Tingling in affected members.
- Shooting pain through the affected limb.
- Sense of tension and looseness in the elbow or the back of the knee.
- Joint pain (ex. elbow, knee and ankle), similar to osteoarthritis, and often misdiagnosed as such.
- Numbness in the affected foot instep.
- Swelling of the abdomen if a leg is affected or extended Lymphedema.
- The limb or affected area has a warmer feeling than other parts, but not red, also indicating a possible infection.
- Gradual increase in the size of the affected limb. In some Primary lymphedema may increase, but without suffering any particular pain, just a feeling of heaviness in the affected limb. Not withstanding any infection is painful because of the rapid increase in the size of the affected limb and a worsening of lymphedema that it produces.
- The joints, especially the knee, may also become Linfadematosas-but it seems as if osteoarthritis (and often diagnosed as such)
- Lymph can sometimes pass through the skin, this being particularly vulnerable to infection.
There are several causes that can cause failure of the lymphatic system, and are divided into two main groups: primary and secondary.
CLASSIFICATION: PRIMARY / SECONDARY
Primary lymphedema (lymphatic FAILURE) The disease is classified into primary lymphedema - rare or uncommon diseases, and differs from the more common type, Secondary Lymphedema, because it contracts due to an injury to the lymphatic system (explained in the next section). It is estimated that 1 in 6,000 people are born with primary lymphedema, affects twice as many women as men, and appears four times in the legs more than arms. In 70% of cases affects only one leg, starting first by foot. However it can also affect both legs, including thighs, torso, genitals, arms, and face. This happens simply too few lymphatic vessels, sometimes there are many, but they are too diffuse and not pump properly, and sometimes it's a combination of both. Here Lymphedema can occur before birth (connatal Lymphedema), during puberty, which is most often the case in the Primary Lymphedema (lymphedema praecox), or appear later in life from 30-40 onwards (lymphedema tarda). Occasionally you can also trigger a primary lymphedema after contracting Secondary lymphedema in another part of the body: eg. after mastectomy (which is secondary) Primary Lymphedema may start one in the leg, or on the same side.
SECONDARY LYMPHEDEMA (severed or blocked lymphatic vessels)Secondary lymphedema occurs Cundo Lymphatic drainage is blocked or severed because:
- SURGERY, especially due to a carcinoma, when extracted much tissue or lymph nodes (i.e. surgery for a breast cancer, melanoma) when you have to cut or remove many lymph vessels.
- Radiotherapy to destroy any tumor, and also destroys the lymph nodes, blocking with fibrous tissue.
- Accidental trauma, can tear the lymphatic vessels that can not rejoin when they do the blood vessels; any fibrous tissue caused by a break, can contract and constreñirlas later.
- Parasites (i.e. filarial larvae) block lymph drainage. The swelling can occur when the larvae grow, they damage the lymphatic vessels, and destroy their lymph nodes. This usually happens after a few years after the larvae inyectasen when they die and are destroyed, causing inflammation that blocks the lymphatic system.
- Paralysis hinders a member pumping the lymphatic system, causing the edema
- Chronic Venous Insufficiency, often involves the lymph vessels that go together, eventually associating Lymphedema venous edema.
- Lipedema; (this is not in itself Lymphedema, but may be due to a secondary lymphedema)
When it appears and how fast
Once the lymph vessels are damaged, lymphedema can occur at any time. Sometimes it starts immediately and remains for life, sometimes there is a swelling that lasts a few weeks and then disappear, and may or may not arise again, or sometimes comes years after the trauma. Once the lymph vessels are damaged, anything can cause their appearance, eg a bee sting, a sunburn, the load an excessive weights, or even a long plane ride.
Apart from the acute primary phase that occurs shortly after the blockade, and then disappears once you start lymphedema condition deteriorates progressively. This deterioration is generally slower in primary lymphedema, and is faster in secondary lymphedema. This is usually an ongoing and stable, only if there is some additional inflammation (eg, infection, injury, burns), when the situation is rapidly worsening.
GRADES in Lymphedema: As a guide lymphedema can be divided into three grades:
- Grade 1, swelling mined here, Fovea sign appears, if the skin is pressed, and decreases if the affected limb is elevated.
- Grade 2, here have a lot more excess tissue enfibrosado, so no brand comes to pressure, and is not reduced by the elevation of the affected limb (eg in bed all night, or for 2-3 days). The member gradually hardens affected by excess enfibrosado tissue, due to chronic inflammation.
- 3rd grade, here called elephantiasis, is changing the thickness of the skin with many lumps and bumps protruding. Any Lymphedema, both primary and secondary, not receiving adequate care and proper medical care, may gradually reach this state of great disfigurement and disability.
LOCATION AND AREAS AFFECTED
Primary lymphedema can affect this since only a portion of a member, to many parts of the body, including the gut (causing intestinal lymphagiectasia), and lungs. If one leg is affected, probably also suffer other lymphatic drainage insufficient, having also the risk of acquiring lymphedema. There is also the situation of General Lymphedema spread throughout the body and limbs. Often the patient is diagnosed as obese, but the combination of successive diets show any results for the patient (even following a strict adherence to the diet).
Secondary lymphedema Here this occurs in remote regions of the trunk (distal), and is drained through the lymphatic vessels damaged axle. if the lymph nodes have been removed by surgery, or become enfibrosado due to radiotherapy. Therefore, it usually appears in the arm after a mastectomy, in an arm or leg after an operation for a melanoma, or in one or both legs after surgery for cancer in the pelvic region. It is also quite common to appear after a serious accident (per axis. Motorcycle) that is causing many lymph vessels are damaged.
In Lymphedema Filariasis, swelling occurs depending on where ultimately stayed filarial larvae. If they are based on nodes that drain the leg, it will suffer the swelling. Staying at the nodes beyond along the lymphatic system, both legs and genital area may be affected. Filarial lymphedema can also occur in the arms (rarely).
Although usually considered lymphedema which affects only a limb, particularly in the skin and subcutaneous tissue, other regions may also be affected and organs. It is also quite common in lymphedema-joints causing arthritis lymphostatic, but once the rest of Lymphedema is treated, it also improves.The Primary Lymphedema is also mentioned, but occasionally can appear as Secondary Lymphedema. It is also likely that other organs may suffer lymphedema, but these rarely diagnosed, because a mechanism has still not been not developed for doing this, yet the swelling can be felt or seen by a trained clinician.
Number of Affected
In the USA within the Medicare age population, the number of persons afflicted with lymphedema, or at risk of developing it, is around 7 million individuals.
The number of people affected with lymphedema are many more of them than they think. In Australia became a statistic in 1995, with a population of 15 million: these statistics only counted cases of postoperative lymphedema by mastectomy, those affected or affecting some 100,000 people. Of these, about 10,000 it would suffer severely. This number also had to add all the other lymphedema, as they appear after other surgeries different, due to the accidental injury, those due to chronic venous disease, and everyone with primary lymphedema. With these data, it was estimated that there are approximately 300,000 people in Australia at the time, who had a different type of lymphedema. (In Spain not having a path of study and diagnosis of lymphedema, there is no reliable statistics on how many patients may have. Applying the same rule used in Australia to calculate and estimate the number of affected in Spain gives us a population of about 40 million, may have affected approximately 800,000 people of some kind and different degrees of lymphedema, and in Galicia about 54,000 patients.)
In 1982, WHO, World Health Organization, estimated that 90 million people were filariático lymphedema, elephantiasis, and hydrocele. It is estimated to have 500 million people suffering from some form of lymphedema in the world.
YOUR DIAGNOSIS
Often an experienced physician can diagnose lymphedema. However, additional methods are usually very simple, studying the history of the condition and the unaided eye. Sometimes though it can be difficult, especially if two conditions coexist. Special methods are available (eg CT scan and lymphoscintigraphy). In the past, lymphography (Lymphatic System Xray injected with an oil medium for contrast) was used, this sometimes blocked the remaining lymphatic system, and its use has now been completely suspended, except in special circumstances. If lymphedema occurs for no obvious reason, the possibility of cancer should always be investigated. A lymphoscintigraphy is still being the best and safest we have to measure lymphatic function and gives a fairly accurate picture of the system. The MRI and CT are very good to watch to see the nodes and edema and fibrosis (respectively). However, these tests are only really necessary in difficult cases.
At the International Congress of Lymphology, Washington, 1993, most specialists agreed that the clinical diagnosis was sufficient in 90 percent of cases.
Lipedema
This is sometimes confused with lymphedema. In the early stages there is no swelling in the feet, both legs being always involved. The lymphatic drainage of surface tissue is gradually affected by fatty deposits, leading to the formation of a real (but secondary) lymphedema. The deep lymphatic drainage, although present, is running slower than normal. They form large deposits of fat in the legs, thighs and buttocks. Pressing on the skin is often very painful. It may seem and have cellulite appearance. '
Initially swells and is soft at the lower leg and thigh, no knee pain and tissue are folded as a cushion on the normal foot. As you progress any associated lymphedema, the foot is involved. The Lipedema can appear on the arms, but usually with a lesser extent, the hand and the foot, not involved until later stages.
The Treatment of Complex Physical Therapy with Lymph Drainage is strongly indicated for lipedemas, but bear in mind that the reductions are not as great as with regular lymphedema.
