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• • • Treatment Methods

      What can be done to Treat Lymphedema?

      It must be realised that lymphedema is an ongoing condition, resulting from a basic lack of lymphatic function and that it can never be completely "cured". However it can most certainly be very greatly improved, so that the limb often becomes essentially normal. Nevertheless, one must always remember that it still has this underlying deficiency and is at risk and must be protected from injuries. There are a number of possible different treatments, many of which can be used together.

      Complex Physical Therapy

      • A course of this treatment normally lasts about four weeks. It consists of four main pasts:
        • 1. Skin care to prevent any infection adding to the lymphatic load and to improve the skin condition.

          2. A special form of massage, each day, which removes teh excess fluid and protein and opens collateral lymphatics so that unaffected regions can help to drain the affected one in the future.

          3. Compression bandages during the course, followed by comperession garments after it, to stop the reduced limb from rapidly swelling back to its former size.

          4. Special exercises to supplement the massage.

        The special lymphatic massage first empties the lymphatics of the trunk (even of quite distant regions) and the normal areas adjacent to the lymphedematous one are further cleared. Then the limb is massaged. This is always in the direction of lymph flow, i.e. towards the body. It starts on the part of the limb adjacent tot he trunk. Gradually more and more of the limb is involved, until the hand or foot is reached. Reduction will only continue to improve after treatment if the drainage from the blocked area to the normal adjacent areas has been improved by enlarging the size of the lymphatics which join one drainage area to the next (the collateral lymphatics).

        This gives by far the most rapid reductions. In The Adelaide Lymphoedema Clinic an average reduction of 65 percent of the swelling was achieved in the first 78 arms which were treated and 55 percent in the first 125 legs. The best result so far has been a reduction of 95 percent and the worst one of 25 percent.

        Maintaining these reductions depends on the patient being willing to wear the compression garment at all times, looking after their limb and treating any infection promptly, and persevering with their exercises. With these precautions, after a year the limb is still the same size, or even somewhat smaller, and has softened further. Now another course of the therapy results in a further removal of about half of what swelling remains.

      Drug Therapy

      • Diuretics are not helpful in lymphoedema, except very rarely in very extreme conditions. They may of course be needed for some other diseases, e.g. heart failure.
      • A group of drugs has been shown to be successful in treating lymphoedema and elephantiasis. These are the benzo-pyrones - forms of vitamin P, but used in much higher doses than needed for normal health. Australian studies have shown that they make the body's own cells break down the excess of protein in the tissues. With the protein gone, the fluid also goes. The limb shrinks, the excess fibrosis is removed, and there are far fewer attacks of infection. Their effectiveness has been demonstrated in many countries (including Australia) and in trials for the World Health Organization in India and China.
      • However the benzo-pyrones are slow; they take years to gie the reductions obtainable in weeks with complex physical therapy. On the other hand, no compression garments are needed (which is helpful in hot or moist conditions), at least a slowly-worsening condition is converted into a slowly-imploring one. When used together with complex physical therapy, the results are signigicantly better than with either treatment alone.

      Pumps

      • These squeeze the swollen limb. They can be effective in early lymphoedemas, but are useless in long-standing ones with much fibrosis. Sequential (peristaltic) ones aare better than those which compress the whole limb at once. Any form of pump can squeeze all the fluid and protein into the region of the limb between the cuff and the body. This can cause fibrosis in this region. This is likely to constrict and block any remaining lymphatics, thus ultimately worsening the lymphoedema. This damage can be avoided if the lymphatics of the trunk are emptied first by massage specifically designed for this. If this is done, pumps are sometimes very helpful.

      Compression Garments

      • These are an essential part of complex physical therapy. If used by themselves, they may stop a lymphoedema getting worse, but are very unlikely to make it any better. Sometimes, if these are combined with the special exercises, the limb will slowly reduce, as it will if they are combined with the benzopyrones. Much more compression, and much longer garments, are needed for lymphoedema than for a venous problem.

      Exercise

      • Moderate exercise, especially if specifically designed for the treatment of lymphoedema, is helpful. Too much exercise (i.e. to the point of getting tired) will make lymphoedema worse.

      Surgery

      • There have been many operations for lymphoedema. In general, none of them work well in the long term; some make the condition much worse, and more difficult to treat in the ways mentioned above. In a very few, very unique situations, certain specialised operations are very successful, but such conditions are rare. Liposuction makes lymphoedema much worse.

      Elevation

      • Early, soft lymphoedemas benefit from simply keeping the lib elevated whenever possible. The more long-lasting the lymphoedema and the more excess fibrous tissue there is, the less use is this treatment.

      Diet

      • Patients sometimes think that, since excess proteins in the tissues cause the swelling, a low-protein diet should help. This is not so, since this would not reduce the proteins in the tissues; indeed protein is needed in the diet to maintain the tissues and prevent them swelling more! A normal well-balanced diet is best. However excess fat will make the effects of lymphoedema more severe and the condition harder to treat.

      When should treatment begin?

      • It should begin before there is lymphoedema! A patient with a limb at risk (e.g. after an operation involving the lymph nodes) should be advised of things to avoid. It has been shown that special exercises and/or benzo-pyrones can help to prevent lymphoedema, or at least delay its appearance. Since some 10 percent of the cases we know of started with an aircraft flight, we recommend wearing a compression garment in aircraft. Avoiding burns, carrying weights, etc. also helps. Needless to say, these rules also apply once lymphoedema is present.
      • Once lymphoedema has begun, the sooner it is treated the better the reduction that can be achieved. The longer the treatment is delayed, the more difficult it becomes and the less the reduction.

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