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Active Living
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A Healthy Balance
Ankle Sprains
Active Kids, Healthy Kids
Active Kids in Winter
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Children, Nutrition & Exercise
Beat the Heat!
Cold Weather Workouts
Concussions
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Exercise and Menstrual Irregularities
Exercise in the Cold
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Exercise is Medicine
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FITT Prescription
Footwear for Running
From Surviving to Thriving
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Get Moving!
Get Motivated
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Jump Start Weight Loss
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Live Actively
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Plantar Fasciitis
Prehistoric Workout
Prevention of Sports Injury
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7 Wonders of Walking
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Childbirth
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Advice from the Maternity Clinic
Advice from the Maternity Clinic (Part 2)
Alcohol in Pregnancy
Building a Better Baby
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Bleeding in Pregnancy
Breastfeeding Benefits
Caesarean Section by Request
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Blue after Baby or Postpartum Depression
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Folic Acid in Pregnancy
High Blood Pressure in Pregnancy
Getting a latch on breastfeeding
Group B Streptococcus
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Low Birth Weight Babies
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Nausea & Vomiting in Pregnancy
Pain Relief in Labour
Prenatal Classes
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Planning a Pregnancy
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Prenatal Care Providers
Postpartum Repetitive Strain Injuries
RH Disease
Rupture of Membranes Before Labour
Sex During Pregnancy
Skin Changes in Pregnancy
Smoking and Pregnancy
Support During Labour
Travelling While Pregnant
Ultrasound for Fun & Photos
Natural Remedies in Pregnancy
Vaccinations During Pregnancy
Vacuum & Forceps for Delivery
Vaginal Birth After Caesarean
When Baby Comes Home
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Children and Sports Injuries
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Not Just Baby Fat
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Safe Summer Fun
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When to go to the Doctor
Whooping Cough
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Chronic Pain
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Introduction
Managing Your Pain
Movement Matters
Moving Forward
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Pacing
Pain Medications
Prevention
Returning to Work
Understanding and Goal Setting
When Pain Doesn't End
Dental Health
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Antibiotics and Dental Surgery
Baby Bottle Tooth Decay
Baby Teeth
Bad Breath (Halitosis)
Children's Dental Injuries
Choosing a Dentist
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First Dental Visit
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A Healthy Mouth
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Keeping it Clean
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Root Canal
Seniors Oral Care
Sensitive Teeth
The Smile You Want
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Snoring and Sleep Apnea
Smiling through the Senior Years
Teeth for Life
Temporomandibular Disorders (TMD)
Tobacco Risks to Oral Health
Tongue Piercing
Tooth Whitening
Travel Dentistry
Water Fluoridation
Wisdom Teeth
Your Healthy Smile
DIABETES
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10,000 Steps
A1C Test
Accurate Blood Glucose Testing
Alchohol and Diabetes
A Diabetes Success Story
ABCs of Diabetes Management
Alternate Site Testing
Artery Health
ASA Therapy
Benefits of Insulin
Benefits of Breakfast
Blood Glucose Medications
Blood Glucose Myths
Blood Glucose Testing
Blood Glucose Testing Tips
Blood Sugar Lows
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Canada Food Guide Revisited
Carbohydrate Counting
Catastrophic Drug Plan
CDA Guidelines for Diabetes
Celiac Disease and Diabetes
Childhood Diagnosis of Diabetes
Children and Type 2 Diabetes
Cholesterol-lowering Medications
Colds and Diabetes
Constipation
Continuous Blood Glucose Monitoring
Cutting Edge
Debunking Diabetes Myths
Driving and Diabetes
Diabetes and Menopause
Diabetes and OTC Medications
Diabetes Care Team
Diabetes and Celiac
Diabetes and Depression
Diabetes Diet
Diabetes Eating on a Shoestring Budget
Diabetes Etiquette
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Diabetes and Thyroid Disease
Diabetes and Your Mouth
Diabetes and Your Eyes
Diabetes in Cats
Diabetes in Dogs
Diabetes Management ABCs
Diabetes Meter Technicians
Diabetes Myths
Diabetic Ketoacidosis
Diabetic Retinopathy
Diet Tips for South Asians
Dining Out
Drinking and Diabetes
The Discovery of Insulin
Eating Disorders
Easing the Strain of Stress
Eating to Protect Your Kidneys
Eggs in a Diabetic Diet
Emotional Eating
Emotions of Diabetes Diagnosis
Erectile Dysfunction
Exercise Excuses
Why Fad Diets Fail
Fats
Fibre
Fill Your Day with Energy
Financial Support for Diabetes
Food Temptation
Foot Care
Footwear and Foot Health
Fruits and Veggies
Gastroparesis
Gestational Diabetes
Get Active
Get Physical
Gift Ideas
Glycemic Index and Glycemic Loads
The Glycemic Index
Going Green in the Kitchen
Grocery Shopping Tips
Guidelines for Diabetes Management
Holiday Party Survival Guide
Health Information on the 'Net
Healthy Happy Holidays
Healthy Beverage Choices
Health Benefits of Soy
Healthy Restaurant Meals
High Blood Pressure and Diabetes
High Blood Pressure
HbA1c Test
Healthy Eating for Active People
High Blood Lipids
Home from the Hospital
Home Alone and Sick
Hypoglycemic Unawareness
Impaired Glucose Tolerance
Immunization & Diabetes
Incretins-a Hormone Treatment
Injecting Insulin
Insulin Discovery-The Story
Insulin
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Insulin - the Key to Energy Management
Insulin Pumps
Insulin Pen Needles
Insulin Pump Infusion Sets
Insulin Pump Therapy
Immunization and Diabetes
Internet Health Sites
Islet Cell Transplantation
Insurance
Ketones
Kidney Disease - Reducing the Risk
Living with Diagnosis of Diabetes
Living Powerfully with Diabetes
Low Blood Glucose
Managing Diabetes
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Nutrition Food Labels
Meal Planning
Your Medication Expert
Medication Research Studies
Metabolic Syndrome
Microalbuminuria
New Diabetes Technologies
Natural Medicines and Diabetes
No Need for Insulin?
Not Snoozing
Over-the-Counter Medications
Oral Health and Diabetes
Osteoporosis and Diabetes
Diabetes and OTC Medications
Pedicure Precautions
Peripheral Arterial Disease
Pet Diabetes
Planning for Pregnancy
Prebiotics and Probiotics
Preparing for Activity
Putting off Insulin
Reducing Stress of Surgery
Safe and Successful Travel
Schizophrenia and Diabetes
Sensible Snacking
Setting Health Goals
Setting Goals for Physical Activity
Sharps Disposal
Shorter Insulin Needles
Sleep - a Missing Link
Smart Snacking
Smart Summer Nutrition
Snack Bars
Snacking with Diabetes
Sodium
Social Media & Diabetes
Solving the Insurance Puzzle
Stress and Diabetes
Success in School
Supplements
Supporting Spouse with Diabetes
Sweeteners
Sugar, Carbs and Blood Glucose Control
Think Positive with Diabetes
Tiny Bites Equal Big Calories
Traveling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
Type 2 Diabetes
Understanding Diabetes
Understanding Diabetes Medications
Understanding Ketones
Used Sharps
Urinary Incontinence
Vacationing with Diabetes
Vegetarian Eating for Diabetes
Vitamin D
Walking
Wise Choices About Natural Medicines
Wonderful Water
Natural Medicines & Diabetes
World Diabetes Day
Your Medicine Cupboard
Zimbabwe Hand Jive
Family Medicine
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ADHD in Children
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Antibiotic Use
Arthritis
Aspirin Every Day?
Asthma
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Back Pain Myths
Back Pain - Lower
Birth Control
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Check-Up
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Doctor Visit
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Does My Sore Knee Require an MRI?
Do I Need an Annual Physical?
Eczema
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Family Doctor
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Floaters and Flashes
Food Poisoning
5 Ways to Stay Healthy
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Get Active!
Glare
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How to Talk to Your Doctor
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Medical Digital Technology
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Stroke
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First Aid Travel Kit
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Get Active!
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Have Health, Will Travel
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Abuse
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Bisphenol A
Canada's New Blood System
Caring for a Loved One Dying at Home
Carpal Tunnel Syndrome
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Diabetes Epidemic
Discipline
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Physiotherapy Visit
Planning for End of LIfe
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Schizophrenia
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Swim to Survive
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5 Tips to Manage Weight
10 Ways to Cut Down on Fat
Battle the Bulge
Boost Your Bone Strength
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Breakfast is Important
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Celiac Disease
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Diet Reality Check
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Energy Drinks
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Food for Active Kids
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Healthy Diet, Healthy Smile
Healthy Eating for Boomers and Zoomers
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Healthy Eating on Business Travel
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Fruits & Veggies - 5-10 a Day
Fats
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Feeding Your Kids
Fibre
Food Chemistry 101
Food and Mood
Getting Kids to MOVE
Healthy Eating for Teens
Healthy Habits
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New Ingredients for Your Shopping Cart
Iron
Kid's Food
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Meal Planning with Planned Overs
Mercury Levels in Fish
Night Snacking
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Nutrition Questions Top 5
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Preventing Cancer Through Nutrition
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Power of Fruits & Veggies
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After a Heart Attack
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Changing Role of the Pharmacist
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Expanding Role of Pharmacies
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H1N1 Virus - Plan Ahead
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Preventing Cancer through Nutrition
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15 Great Reasons to Breastfeed
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Breast Cancer Screening Guidelines Changes
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Family Health Online / Pharmacy at Safeway
All Words Any Words Phrase
Family Health Magazine - MODERN LIVING

Managing Lymphedema
A practical approach to a chronic condition

Lymphedema is a condition where your body cannot properly drain lymph fluid. Most often, it is an arm or leg that swells with collecting liquid. This happens because your lymphatic system is not working the way that it should.

What does lymphedema feel like?

Lymphatic systemMost people with lymphedema complain that a limb feels heavy, achy or full. Clothes may suddenly not fit right or cut at the wrist or ankle. If feet are affected, it is difficult getting shoes to fit. Pain is reported by about half of patients and is very individual. It may interrupt both sleep and day-to-day activities.

Swelling can be visible and makes the limb look waxy. Tendons, bones and blood vessels may be hard to see. Joint stiffness is common, especially in small joints like those in the hand. Jewellery may feel tight, and should be removed if it indents the skin. Early on, swelling may get slightly worse during the day and disappear at night. Heat, travel, repeated activity and overuse can intensify symptoms.

Lymphedema is chronic. Left untreated, it may get worse. The limb may continue to gradually swell. Recurring infection, pain, and potential loss of use of the limb are all possible. Since swelling is not widely recognized as a medical concern, lymphedema often goes undiagnosed from months to years.

Why does it happen?

Lymph nodes are the body’s natural filtration system. They are key in removing waste, viruses, bacteria and dead cells from lymph, a protein-rich fluid. The lymph system collects lymph from tissue just beneath the skin. Gradually this fluid makes its way to the nodes, located mostly in the groin, armpits, deep abdomen and at the base of the neck. The lymph then moves on to end in the venous system just above the heart. Normally the lymphatic system transports and filters about 10 per cent of the fluid back to the heart. Two types of lymphedema, primary and secondary, can affect the system.

Primary lymphedema

This type occurs when a defect in the lymphatic system prevents lymph fluid from being collected and transported. Type I (Milroy’s) is hereditary, typically appearing at birth. Type II (Meige’s Syndrome) is also hereditary and shows up during puberty. Type III (lymphedema tardum) does not have a family link. It is more common in women than men, and appears after age 35. Around one in 6,000 people develop primary lymphedema. In about three-quarters of cases, it affects only one side of the body. In others, it appears on both sides but there is usually quite a visible difference. Of those who have it only in one leg, a quarter will eventually get symptoms in the other one.

Secondary lymphedema

What does lymphedema look like?The secondary type is by far more common. It is caused by blockage or interruption in the lymph system. Surgical removal of lymph nodes, radiation therapy, infection, trauma, cancer and chronic wounds are all common causes. Most often, secondary lymphedema affects those who have had breast cancer, and had lymph nodes removed in the armpit area. Having lymph nodes removed carries a 12 to 60 per cent chance of developing swelling. Lymphedema will affect the arm or leg that had lymph nodes removed. Most often, swelling appears within the first year after surgery. However, it can also emerge years later.

Secondary lymphedema can take other forms:

What should I do if I think I have lymphedema?

See your family doctor or oncologist. You may be referred to a certified lymphedema therapist. This specialist may be a physiotherapist, registered massage therapist, registered nurse, physician or licensed athletic trainer who also has special training in lymphedema. Your provincial lymphedema organization should be able to give you a listing of therapists in your area. Although most cancer clinics across Canada do treat lymphedema, often funding is only for cancer patients. Your family doctor can provide a referral.

Being assessed can help in many ways. It will confirm the diagnosis and the stage of your lymphedema. Your limbs will be compared so that you know the volume difference between them. Afterward, you will have a basic understanding of the lymph system. You will be given treatment options, strategies to help you manage, and ways to prevent related problems. Based upon your assessment, your therapist will make recommendations for your situation.

Recommended treatments

Complex decongestive therapy (CDT)

This treatment typically includes these five approaches:

Your therapist will give specific recommendations for all of these treatments. Ideally, you should treat large limbs daily for two to six weeks, an hour or so per day, until a stable reduction in volume is achieved. Since treatment is not always covered by insurance, this may not be possible for everyone. Talk to your therapist and make a plan that works for both of you. Your commitment is the most important factor. Lymphedema is managed very well by those committed to following the routine.

At the same time, remember the condition changes. You will realize certain daily activities make swelling worse. You may have concerns with your body image. Learning how to deal with and remain consistent in managing lymphedema is key to success. You are likely to see your therapist every six to 12 months for assessment or treatment.

Lymphatic compression garmentsFor instance, after a mastectomy you might experience a 20 per cent difference in arm size. Typical treatment would involve four to five sessions of one hour per day. During this time, the therapist would do manual lymphatic drainage and compression bandaging, teach strategies like self-bandaging and massage, and develop an exercise program. After a week of intense treatment, a custom or standard compression sleeve and perhaps a glove would be fitted.

Until daytime garments are fitted, it is vital to keep up with night bandaging. Otherwise, you will lose the gains you worked so hard to achieve. A custom garment typically comes from Germany and takes two to four weeks to arrive. Follow-up is recommended at two and six weeks to check that measurements are not increasing.

Daytime garments wear out after four to six months. Stay on top of reordering garments, as you will lose ground on swelling control without them. Generally, the larger and more changeable the limb, the more frequent assessments should be.

Many garments on the market can replace or simplify night bandaging. They are easy to put on, and apply accurate graded compression to your limb. If you are interested in alternatives to bandaging, ask your therapist. Many insurance plans cover all or part of the cost of these garments, but you must check.

Preventing infection

Lymph fluid is rich in protein. In a petri dish in the lab, it grows bacteria beautifully. This means that infection is a risk. We rely on our lymphatic system to help us fight infection. In lymphedema, lymph fluid takes longer to clear the affected limb. The lymphatic system in that limb does not work as well as it should, so steps must be taken to avoid infection.

Recommended books

Living Well With Lymphedema
Anna Ehrlich, Alma Vinje-Harrewijn, Elizabeth McMahon

Voices of Lymphedema
Anna Ehrlich, Elizabeth McMahon

Lymphedema: A Breast Cancer Patient’s Guide to Prevention and Healing
Jeannie Burt and Gwen White

Lymphedema: Understanding and Managing Lymphedema
after Cancer Treatment
American Cancer Society

Lymphedema: Diagnosis
and Therapy

Weissleder and Schuchhardt

Textbook of Lymphology
Foldi

Recommended article

Best Practice for the Management of Lymphedema
http://tiny.cc/tlyy5

Lymphedema Contacts

British Columbia
Lymphedema Association

www.bclymph.org or info@bclymph.org

Alberta Lymphedema Association
www.albertalymphedema.com or lymphnet@telus.net

Saskatchewan Lymphedema Learning Association
Eunice Mooney at sasklymph@yahoo.ca

Manitoba Lymphedema
Support Group

Kim Avanthay at kimavant@mts.net

Lymphedema Association
of Ontario

www.lymphontario.org
(click on ‘OntarioSite.htm’)

Dr. Vodder School™ International, Victoria, British Columbia
www.vodderschool.com

LANA - Lymphology Association
of North America

(listing of certified therapists)
www.clt-lana.org

Lymphovenous Canada
www.lymphovenous-canada.ca

National Lymphedema Network (U.S.)
www.lymphnet.org

If a break in the skin allows bacteria in, or a bacterial infection appears in the bloodstream, it may settle into the affected limb. This could develop into cellulitis or infection in the limb. A hot, swollen, painful and red limb is likely infected. This can develop within a matter of hours. You may also have fever or flu-like symptoms. If you ever notice symptoms of infection, it is essential to see a doctor that day. Antibiotics, either intravenous or oral, will be prescribed.

After one infection, you are more likely to have another. If you are going away on holiday, it is wise to carry a two-week supply of oral antibiotics.

You can prevent infection and manage lymphedema in several ways. Follow the advice below that applies to where your lymphedema is located.

Care for your skin well.

Avoid cuts, scratches and skin irritations.

Avoid mosquitoes, wasps, bees and other biting insects.

Avoid hot temperatures, burns and sunburns.

Avoid wearing clothing and jewellery that binds or leaves creases in your skin.

Your lymph system will try to create new pathways for fluid to move. Tight clothing can block these paths.

Avoid straining your affected limb.

Too much of anything can aggravate the problem.

Care for your garments.

Do not lie on your affected side at night.

Change your lifestyle if necessary and maintain a healthy body weight.

Exercise regularly.

Keep an eye on your condition

Lymphedema is a chronic condition that requires attention, but it should not rule you or limit your lifestyle. As your condition changes, you will need to keep up with care. It is possible to find a lymphedema routine that allows an active, rewarding life full of adventure.

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