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Σάββατο, 24 Μαΐου 2003 00:00

How does lymphoedema affect a person?

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Lymphoedema may cause the following symptoms in the affected area:

• Swelling
• Heavy or full sensation
• Tightness and stretching of the skin

How does lymphoedema affect a person?

Lymphoedema may cause the following symptoms in the affected area:

lympho

• Swelling
• Heavy or full sensation
• Tightness and stretching of the skin
• Reduced movement of the joints
• Thickening and dryness of the skin
• Discomfort and pain
• Rarely, in cases of severe lymphoedema, the skin may become broken and the colorless lymph may leak out onto the surface.

The Prevention of Lymphoedema.

If a woman belongs to a high-risk group, she can improve her chances by trying not to put too much strain on her lymph system. This can happen by avoiding infections or inflammation in the treated area, which means avoiding any sort of cuts or grazes.

What is the treatment for lymphoedema?

The aim of treatment for lymphoedema is to relieve discomfort by reducing swelling and thus preventing further build-up of fluid. There are four types of therapy:

1. Skin care
2. Support using compression sleeves, stockings or compression bandages.
3. Positioning and movement of the limp.
4. A particular type of massage called manual lymphatic drainage (MLD) or simple lymphatic drainage (SLD)


There is a great deal that can be done to help lymphoedema patients, but we should bear in mind that it is a long-term problem. Although the swelling can usually be reduced, there is always a risk of it recurring. It may take several weeks or months before the patient notices any real improvement in the swollen area; an affected limp, however, should become more mobile within a few weeks.

1. Skin care.

Good skin care plays a vital part in the treatment of lymphoedema. Any break in the skin, however small, can become an entry point for germs. The protein-rich fluid in the swollen arm acts as an ideal breeding ground for bacteria. If an infection develops the swollen part will become red, hot and very sore. In this case immediate treatment with antibiotics is called for in order to fight the infection. It is important to stop all lymphoedema treatment and rest the swollen part in a supported, comfortable position so that the hand is not hanging downwards.
Severe lymphoedema may cause the skin to become thickened and scaly. This increases the risk of breaks in the skin. However, good moisturizing can prevent it. 
Here are some simple tips to help skin care, prevent damage and reduce the risk of infections:

• Do not have blood samples or blood pressure taken on the affected limp. 
• Treat even small grazes and cuts straight away.
• Moisturize skin every day by gently applying non-perfumed cream. This helps the skin to remain supple and in good condition.
• Avoid excessively hot baths, as they tend to increase swelling. Avoid saunas, steam rooms and sun beds.
• Don’t allow sitting too close to a fire or other source of heat.
• Wear gloves for washing up and other household tasks in order to avoid cuts.
• Wear gloves and long-sleeved clothing when handling animals or gardening.
• Avoid sunburn.
• Cut the nails with nail clippers and apply hand cream regularly.


2. Compression sleeves and stockings.

This is an important way of controlling swelling. The sleeve or stocking works by compressing the swollen tissues and preventing fluid from building up. The support allows the muscles to pump fluid away more effectively. If the sleeve or stocking causes pins and needles, pain, or a change in colour of the fingers and the toes, then it is too tight. Remove the garment as soon as you notice any of these signs. If it is too loose it will not control the swelling and will need to be refitted.
A compression sleeve should be worn all day but usually it should be removed at night. If the patient travels for a long distance, especially by air, she should wear her compression garment for the full duration of the journey and keep it for some hours after the end of the trip.

Helpful hints for putting on a compression sleeve.

• Keep your nails short, and remove all jewelry when applying or removing the garment.
• Try to put it on first thing in the morning, preferably before getting out of bed.
• If you are having difficulty putting it on apply a little unperfumed talc to your arm before fitting. 
• Don’t try to put the sleeve on immediately after a bath or a shower.
• Moisturize your skin at night after you have removed your garment.
• If your arm is very swollen it may be difficult to fit a compression sleeve. In this case elastic bandages are used as the first part of the treatment.

3. Limp positioning and movement.

Careful positioning of an affected limp at resting or sitting can help to prevent full swelling. We can use gravity to help drain away excess fluid, as well as movement of the muscles helps to push fluid around the body.

These guidelines will help someone to position an affected limp correctly:

• When sitting down, rest your arm fully supported on a cushion paced on the edge of a chair.
• Never rest your arm above shoulder height – it may reduce blood flow and increase discomfort. 
• She might find it helpful to raise her arm slightly on a pillow when she lying down. 
• Never carry heavy shopping or other loads with an affected arm.
• Don’t use an affected arm for activities, which involve a lot of repeated stress.
• Do not wear clothes or jewelry that are tight fitting.


4. Exercises

Gentle exercises play a vital part in a self-care routine. Exercises will be more effective if they are done when the patient is wearing the sleeve.

Exercises will help in three ways:

• To help drain away lymph and reduce swelling.
• To maintain or improve flexibility of the joints.
• To improve posture.

However, too much exercise can increase swelling. For that reason Simple Lymphatic Drainage exercises for lymphoedema should always be done in a gentle manner and feels comfortable.

5. Massage.

Massage is an important part of the treatment of lymphoedema, but it is important to use the correct technique. The aim of massage is to stimulate or move the excess fluid away from the swollen area, so that it can drain away normally. A very specialized form of massage called Manual Lymphatic Drainage (MLD) is used to this effect. Emile Vodder developed manual lymphatic drainage in Austria in the 1930’s. Since then, other variations have become recognized, from countries such as Australia, Germany and Belgium.
Its difference from ordinary massage is that it is performed in a gentle manner and aims at encouraging movement of the lymph in the right direction. MLD re-routes the lymph flow around the blocked areas into more centrally located lymph vessels that eventually drain into the venous system.

Moreover, it is a rhythmical and deeply relaxing massage where the skin is methodically stretched towards the direction of the lymphatic flow. The therapists performing Manual Lymphatic Drainage must learn to apply gentle, firm pressure with their hands and fingers in a "scooping-up-collecting-pumping" motion. They learn how to detect irregularities in the skin's texture, and make proper judgments about the need and course of M.L.D. technique. The lymphatic vessels contain valves, which direct the lymphatic fluid flow. The circular hand-finger pressure motion follows this direction in order to account for appropriate lymphatic flow. The M.L.D. technique includes various circular finger pressure motions covering small sections of the skin, as well as circular hand motions covering larger areas of the skin. All circular pressure motions move the elastic tissue without stimulating increased blood flow or damaging the tissue. MLD eliminates metabolic wastes, toxins and excess fluid from the body as well as transporting nutrients to cells. MLD also regulates the immune system, which helps protect the body against infection, illness and disease.

When is Lymphatic Drainage contra-indicated?
• When there is ACTIVE infection; 
• When swelling is due to congestive heart failure; 
• In cases of Thrombosis

Simple Lymphatic Drainage (SLD) is a modified form of Manual Lymphatic Drainage that can be taught to the patient for self-treatment.


6. Compression pumps.

The pumps made up of a power unit and an inflatable sleeve, which is used to cover the arm. The sleeve is available in various sizes. When switched on, it will inflate and deflate in turns. Low pressures are always used (never higher than 40mmHg). Do not use higher pressures than this, as it will not help to reduce the swelling and it might even make it worse.
While the pump is in operation we have to remove the garment, but put back on as soon as we have finished.

Guidelines for using a pump:

• Do not use the pump if you have an infection.
• While using the pump, support your arm, as this will help drainage.
• If you feel pain stop immediately and consult your doctor.


7. Surgery.

Surgery is hardly ever used in the case of lymphoedema, although it can be useful in cases of swelling of the face or the genitals. Surgery to an affected arm or leg is not sufficient on its own and the patient will have to continue the other forms of treatment described above.

8. Diet.

Swelling is harder to treat in the case of overweight patients. Hence, it is advisable to keep the weight on a reasonable level. For certain patients spicy foods may cause an increase in swelling, whereas for others alcohol has the same effect.

9. Follow-up.

It is important for the patient to have regular check-ups with her doctor. Measurements of her arm should be taken and any change in size recorded. Progress may be slow, particularly at the beginning of the treatment, but there should be a noticeable improvement in the arm after a few weeks.

Having lymphoedema may bring about a variety of feelings, which arise not only from the discomfort of the condition itself but also from the cancer and the side effects of its treatment.


• Embarrassment
• Anger
• Resentment
• Depression

It is important that the “therapeutic team” provide information on all aspects of cancer and its treatment, as well as all the practical and emotional problems of living with the illness.


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