Lymphoedema

Lymphoedema is an accumulation of fluid and protein in the tissues. It is a chronic condition which can occur when the lymph system is unable to fulfill its function, or when lymph vessels are absent, underdeveloped or obstructed. Lymphoedema can be Primary (no known cause) or Secondary (due to trauma, removal of lymph nodes, radiation therapy, etc.).

Lymphoedema Treatment

You may be asked to bring a letter from your Doctor or Consultant to your first treatment.

Treatment involves an intensive phase of 2-4 weeks, followed by maintenance.

There are 4 cornerstones of treatment for lymphoedema:

• MLD – 3-5 times weekly (intensive phase), or as required (maintenance phase)
• Compression – MLLB (multi-layered lymphoedema bandaging) or cohesive bandaging during the intensive phase when volume reduction is rapid, or compression garments during the maintenance phase
• Exercise – done at home yourself, to further promote lymphatic flow
• Skincare – again, done at home yourself, to keep the skin soft and supple and to minimise the risk of infection

Intensive Phase

The goal of the intensive phase is to reduce the swelling as much as possible, and to promote the flow of lymph. Where necessary, lymph is re-directed to unaffected lymph nodes. This involves MLD plus MLLB (multi-layered lymphoedema bandaging) 3-5 times weekly. In some cases, a less bulky cohesive bandaging is used. Instruction is given on exercise, skincare, fluid intake and good nutrition. The limb is regularly re-measured and treatment continues until maximum reduction is achieved. This course of treatment is also known as CDT (combined decongestive therapy or complete decongestive therapy), or DLT (decongestive lymphatic therapy).

In some cases MLLB is unsuitable (e.g. frailty, or complex medical problems) or unwarranted (e.g. a less severe lymphoedema) so MLD without MLLB (or cohesive bandages) may be advised.

Maintenance Phase

Once the intensive phase is complete, maintenance begins. The goal of maintenance is for you to keep your limb volume down yourself. You will be fitted with appropriate compression garments, and will continue by yourself with exercises, skincare, good fluid intake and good nutrition. You may be re-measured every 6 months for new compression garments, and to make sure your volume does not increase again. More severe lymphoedemas may require further CDT treatment.

Compression Bandaging

We are trained to use multi-layered lymphoedema bandaging. We are also trained to use a less bulky cohesive bandaging system.

Compression Garments

We are trained to measure for custom-made and off-the-shelf medical compression garments from Medi, Jobst, Elvarex, Juzo and Jobskin. We are also trained to assess and fit you for the Circaid and Readywrap compression systems.

Medical card holders are usually entitled to two compression garments per annum.

Severe Cases

Severe lymphoedemas are treated here and may also be referred for treatment abroad, where treatment is done in a hospital setting twice daily. Maintenance treatment is continued here following your treatment abroad. After treatment abroad is complete, volume is often further reduced during maintenance treatments done here.

Avoid temperature extremes, such as:

• Hot baths, hot showers, Turkish baths, saunas

• Burns (cooking, sunburn)

• Travel in extremely hot or cold climates

Avoid infection by avoiding:

• Insect bites (use insect repellent)

• Vaccinations or acupuncture in the affected limb

• Skin punctures or cuts (pet scratches, manicures)

• Gardening (wear gloves)

• Cuts on the feet (wear shoes on the beach)

Avoid blunt traumas to the affected limb, such as:

• Blood pressure cuffs (use other arm)

• Tight clothing (like bra straps, or tops of socks)

• Heavy breast prostheses

• Jewellery which could be constrictive

General Advice:

• Drink plenty of water

• Add a slice of lemon to your water

• Excellent nutrition – avoid table salt and fatty foods. Eat lots of fresh fruit and vegetables.

• Selenium – a dietary mineral sourced in garlic, eggs, brazil nuts, cabbage

• Avoid alcohol (drink water to counteract the effects), caffeine and nicotine

• Maintain optimal weight

• Meticulous cleanliness – use pH balanced cleansers and lotions

• Sleep with limb elevated – let gravity help

• Gentle exercise – walking, swimming

• Seek treatment for even the slightest infection

• Treat cellulitis immediately with antibiotics.

Here is a link to the BLS/LSN Cellulitis Consensus Document” https://www.lymphoedema.org/images/pdf/CellulitisConsensus.pdf