Sue joined our Concordia Visiting Nurses team in 1997 and had previously served our Concordia at Cabot skilled residents for two years at the beginning of her therapy career. She is a graduate of the University of Pittsburgh and is a certified lymphedema wound therapist.
Q: What is lymphedema and what causes the condition?
Lymphedema is the abnormal buildup of lymph fluid in the tissues under the skin. Lymph fluid is found throughout the body and carries white blood cells, proteins, fats, cancer cells, bacteria, and viruses through lymph nodes (filter the lymph) and lymph vessels (transports the lymph and helps to remove the waste from the body.)
The lymphatic system is part of the body’s immune system and also part of its sewage system. If the lymphatic system is damaged, which can occur due to a genetic or hereditary abnormality, cancer, surgery, injury, or issues with veins, the lymph fluid backs up and causes swelling. The lymphatic system has no pump, so lymph fluid relies on elevation and movement to drain properly. Lymphedema develops in stages that are categorized by severity:
• Stage 0: No swelling but feeling of fullness.
• Stage 1: Swelling that pits when touched and gets worse as the day goes on and improves with elevation.
• Stage 2: Swelling that becomes hard and thick, with little improvement with elevation. Additionally, tissue is more prone to infections.
• Stage 3: Swelling that becomes so severe that the limb is hard to move, with hard scaly skin that sometimes even leaks and lymph fluid leaks out. This can easily lead to infections and drastic changes in lifestyle.
Q: How do you treat lymphedema and is it curable?
Lymphedema is currently treatable and manageable, but does not have a cure. There are some surgical treatments that show promise, but for now Complete Decongestive Therapy is the best plan:
For Stages 0 and 1, lymphedema can usually be managed by elevation, exercises such as head and neck stretches, leg or arm movements, deep breathing, and compression socks or stockings for legs or a compression sleeve and glove for an arm.
Stages 2 and 3 require those strategies and more, including: multilayer bandaging with short stretch bandages, manual lymphatic drainage which stimulates lymph vessels to move fluid, good skin and nail care, proper diet low in salt and higher in protein, and a pneumatic compression pump which moves lymphatic fluid along.
Q: Can you talk a little bit about what compression does for the lymphedema patient?
Compression is absolutely essential to manage lymphedema for most people. The external support provided by the garments help to keep fluid from reaccumulating in the affected areas, and the graduated pressure helps to push the fluid towards the trunk, especially when worn while walking or exercising.
Ace wraps or TED (Thrombo-Embolic Deterrent) hose are generally not appropriate compression for lymphedema management. Some people prefer to use garments with Velcro straps to adjust, as they are often easier to put on and take off and can be adjusted throughout the day and allow for fluctuations in size. There are even garments specifically designed to be worn at night. Garments should be worn every day, possibly even at night, and ultimately to be successful, garments have to be strong enough to contain but possible to be put on and off, as they do no good sitting on a night stand.
While compression garments contain lymph fluid and keep it from reaccumulating, manual lymphatic drainage and/or pneumatic compression from a lymphedema pump are the other component(s) to continuously drain the accumulated fluid. These work very well together to keep the swelling under control and help remove it from the body.
Q: What does a typical treatment plan of a lymphedema home health patient look like for you?
On my initial visit, I like to provide education and a detailed explanation of how the lymphatic system works and then discuss with my patient where the lymphatic system is failing in their particular circumstances, based on stage of lymphedema as well as diagnoses and lifestyle issues that are contributing to their problems. I then discuss treatment options that are available and what may help them to successfully manage their lymphedema as well as the cost and effort required.
I work with the patient’s doctor, patient, family or caregiver, and insurance to prescribe a custom program including, as appropriate, exercises, garments, diet, skin and nail care, elevating legs in a recliner and sleeping in a bed if possible, and pump.
Q: Anything else that you’d like our readers to know about lymphedema?
Education is important, and remember that our bodies are designed to move and stretch, to take deep breaths, and to be nurtured with proper bathing and diet. If you need help, please reach out to medical professionals to try to get the help needed to keep you as strong and capable as possible. For more information on lymphedema, please speak with your doctor.
If you or a loved one receive doctor orders for home health care services, ask for Concordia Visiting Nurses and experience high quality care provided by specialty clinicians like Sue! For more information, call us at 1-877-352-6200 or contact us any time via our online contact form.