Lymphedema

The Lymphatic System
Lymph is a colourless fluid which forms in the body and normally drains back into the blood circulation through a network of lymph vessels and lymph nodes. The lymphatic system plays an important part in the body’s defense against infection.

How Lymphedema Occurs: If the drainage routes through the lymphatic system become blocked or damaged, lymph accumulates in the tissues and swelling occurs. Unlike other edemas, lymphedema leads to changes in the tissues, such as fibrosis and an increased risk of infection. The swelling can then become even more difficult to control.


Types of Lymphedema
Primary lymphedema develops as a result of a malfunctioning lymphatic system, usually as a result of genetic underdevelopment, often seen as an onset around age 35 – primarily in women.

Secondary lymphedema is the result of damage to lymphatic pathways. This may be a result of treatment for cancer following surgery or radiation therapy. Lymphedema can also occur as a result of infection (commonly cellulitis), severe injury, burns, chronic venous insufficiency, obesity or any other trauma or surgery that causes damage to the lymphatic nodes and vessels. Lymphedema affects all ages and may occur months/ years after surgery, so it is important to understand and manage the life-long risk.


Lymphedema Symptoms
The signs and symptoms for lymphedema may include:

  • A full or heavy feeling in the affected limb
  • A feeling of tightness in the skin
  • Less movement or flexibility in the hand, wrist, shoulder or ankle
  • Clothing or jewelry feels tight in one specific area
  • Abnormal swelling in the affected area

Unfortunately, some people are told that nothing can be done to help. Many doctors are either not knowledgeable or are unaware of where to refer their patients for advice. Although there is no cure, there is help to manage this life-long condition.


Lymphedema Management
The goal of lymphedema treatment is to help reduce and control swelling, prevent it from getting worse and decrease the chance of complications. Ongoing self-care is crucial. The standard treatment is called Complete Decongestive Therapy (CDT). The individual elements, used in combination, are: Manual Lymph Drainage (MLD)—a specialized massage to redirect lymph fluid Compression therapy—elastic bandaging, compression sleeves, gauntlets or tights Exercise—to promote lymphatic flow by activating muscle and joint pumps Excellent skin care—the use of antibacterial cleansers and pH neutral lotions. The treatments must be performed by certified decongestive therapist. Click the following links to find a therapist near you:

Precautions & Recommendations

Infections – With damaged or blocked lymph drainage, you are at risk of infection (particularly cellulitis) in the affected area. Good skin care reduces the risk of infection. If you feel generally unwell or have any sign of infection (fever, nausea, vomiting or a hot, red, tender, swollen limb) do not delay in seeking medical attention immediately. In most circumstance you will require antibiotics.

AVOID • cuts • scratches • burns • razors • insect bites • fungal infection • sunburn

USE • rubber gloves • gardening gloves • oven gloves • electric shaver • insect repellents • hygiene/skin care • UPF rated clothing or strong sunscreen


Trauma
Any trauma or injury to the affected limb will increase your risk of infection and further swelling. AVOID whenever possible: injections, acupuncture, blood sampling and blood pressure readings from the affected limb AND tight or constricting clothing or jewelry PLUS extremes of heat or cold.


General Recommendations
It is important to keep your weight within normal limits as much as possible. 

  • Try to use the swollen limb normally, as muscular activity encourages lymph drainage, but avoid sudden overexertion, as that may increase swelling. 
  • If your arm is swollen, avoid lifting or carrying heavy objects. If your leg is swollen, avoid standing or sitting with your legs down for long periods. 
  • Wear a compression garment when flying to help reduce any increase in swelling.

For more information regarding Lymphedema, speak with your CDT therapist or go to the following links:

The Assistive Devices Program (ADP) of the Ministry of Health and Long-Term Care provides funding assistance for Pressure Modification Devices (PMD)—compression garments and sleeves—for chronic lymphedema management as well as sequential extremity pumps for primary lymphedema management. Any resident of Ontario with a valid Ontario health card is eligible to apply. The ADP pays 75% of the approved cost. Those receiving benefits from certain social assistance programs may be eligible for 100% funding of the approved cost. An Application for Funding Pressure Modification Devices form can be obtained from an ADP registered authorizer or vendor or downloaded and printed from the ADP website. You can find a printable copy of the form here (insert link to the form) or at the bottom right hand corner of the website.

More information regarding the ADP program can be found here:

Summary of Application Process

  1. Have an ADP Approved Specialist (not your family doctor) sign and date the application to confirm a diagnosis of Lymphedema. The list of approved specialists can be found in the link above and the first page of the ADP form, located here.
  2. Have an ADP Registered Authorizer sign and date the application to authorize the garments/pump (Stephanie Webb, RMT, CDT is a registered Authorizer to complete this for you at our office)
  3. Have an ADP Registered Fitter measure and provide garments appropriate for the client
  4. Have the registered vendor invoice ADP for 75% and invoice the client for the remaining 25%. The remaining 25% can be submitted to your personal benefit plan, sometimes this needs to be accompanied by a prescription and/or note from your physician or specialist.

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