Secondary Leg Lymphedema Help Needed

leg pain, leg bleeding, Farrow Wraps, Compression Stockings, cold feet, Reid Sleeve, Restless Leg Syndrome, Leg Cramps, Compression Pumps, Shoes, lower limb lymphedema, secondary leg lymphedema, leg wrapping, Cold Feet, Compression socks, nerve pain, self leg massage, right leg lymphedema

Moderators: Birdwatcher, Cassie, patoco, Senior Moderators

Secondary Leg Lymphedema Help Needed

Postby patoco » Sat Jun 10, 2006 3:33 pm

Secondary Leg Lymphedema Help Needed

From Harland 02/20/2005

I have secondary lymphedema due to bladder cancer. When they removed my lymph nodes near my right leg it caused my leg to be quite large. I also have a blood clot in that leg, therefore I can't use compression garments. They due have me on lasix, which seems to help. I do not have any pain. I also have neuropothy in the ends of my fingers and in my feet due to the chemotheropy given during my cancer treatment. The major question is about the redness and discolorization of the skin on the lower part of my leg. Has anyone else had this problem, and if so what type of skin cream or treatment do you use. I use a moisturerizer every morning, but it doesn't help the redness.

..........

Responses

Pat

Hi Harland

Welcome to our family

The discoloration you mentioned comes from two sources.

First, with a blood clot, you are going to have a certain amount of redness. This discoloration should fade as the clot is resolved. Have they given you any ideas on how long it is going to take? Is the lasix the only treatment you are on for it.

Once the clot is dissolved, you should have your doctor immediately refer you to a lymphedema therapist for decongestive therapy on the legs....but not before.

The other discoloration can come from the lymphedema. It is actually common and I have an extensive amount of it. Unfortunetly, this discoloration doesn't fade away. Don't stop using the moisterizer though, as it is terribly important to keep the skin from becoming dry and irritated. It is essential to skin health and will help avoid infections by preventing any chafing or cracking of the skin.

Here are a couple pages that may help with some info:

LYMPHEDEMA DEEP VENOUS THROMBOSIS

http://www.lymphedemapeople.com/thesite ... mbosis.htm

LEG LYMPHEDEMA

http://www.lymphedemapeople.com/thesite ... hedema.htm

Hope this helps.... please don't hesitate to post any further questions. Wonderful family here and someone is always jumping online to answer questions and share!

Kind regards,

Pat

..........

Harland

Pat, thanks for the fast reply to my question. My blood clot will probably be there awhile. They have installed what is called a "Greenfield Filter". This prevents the clot from breaking loose and going to my heart. Do you know of any good medicational cream that can be applied to the discolored area of the skin? My doctors are mostly concerned about making sure that the cancer doesn't come back. They hardly ever ask about or look at the lymphedema.

..........

Pat

Hi Harland

I think the most important thing with skin lotions is what they have in them. I've spent so much time in the hospital and always paid attention to what they put on burn patients. The lotion I use contains Vitamin E, Zinc, and Aloe.

All three have incredible healing and nurturing properties for the skin. By the way, I use a store brand too. Found out by reading the ingrediants, name brand doesn't necessarily count.

I apply my lotion the minute I get out of the shower, that way, the skin on my legs is already soften up by the warm water.

Know what you mean about the oncologist and lymphedema. My situation is reversed from many. I got lymphoma, they suspect as a direct result of the lymphedema. My oncologist admits to not having a clue about lymphedema. Amazing since so much is caused by node removal for biopsy, radiation damage and such.

The greenfield filter is good and I have heard good response about it. Until you can get into therapy, there are other things you can do that will help.

The usual is of course,leg elevation - even while sitting.

But, if you are allowed to do any exercise and have access to a pool, swimming is a big help. Even gentle swimming brings the swelling down a bit.

Pat
User avatar
patoco
Site Admin
 
Posts: 2175
Joined: Thu Jun 08, 2006 9:07 pm

lasic and LE

Postby SteveB » Fri Jun 16, 2006 9:49 pm

Hi Pat,
For Harland, and others placed on fluid reduction medications due to their LE.
In the beginning of my LE-- 1997, I specifically asked about doing Lasics, or some other form of fluid reduction drugs. I was told, emphatically, NO. In questioning them at the time they only said that the swelling we experience was different than that experienced by people with water weight gain. I've since learned why this is dangerous.
Lymph fluid, as many of you know, is a protein rich fluid that carries the toxins, debris, and other substances to the kidneys, and removes it from our bodies. The primary purpose is to capture proteins that "leak" from the venous-artery boundary in the capillaries back to the heart. Secondary, but no less important tasks include manufacturing white blood cells, and other powerful antibodies to reduce infections, along with lymph nodes trapping toxins in our bodies.
According to the works of Foldi, and some others, this fluid once trapped by lymphatic system failure builds up behind "dams" as it were, and increases the likelihood of major infection.
To reduce the water in the lymph fluid only increases the protein concentration in the fluid-- something Foldi calls- "Lymph load" (a ratio of protein to water volume per unit volume of total fluid), and thereby increases the risk of infections, as well as reducing the overall mobility of the fluid-- its capacity to flow through regions that do remain viable as pathways.
Dr Foldi, in his 2003-4 Lymphology text, and Dr. Olszewski in his Lymph Stasis text from 1991, describe this in detail. Admittedly, perhaps a bit over the top for us non-medical types, but still an important discussion to be aware of as people whose lymph system has failed for whatever reasons- primary, or secondary.
So, before you run off and start taking fluid reduction medications, consult with an LE specialist as to the dangers associated with this practice.
Our bodies are now limited in their ability to function correctly. While some technologies can fix that, others can only compound the problem. From all that I've been taught, fluid reduction medications will seriously compound the issues we face.
As for blod clots-- again an issue for medical doctors-- a simple aspirin once daily has the necessary components to resolve this over time.
As for a disclaimer-- I am not a medical doctor. While I have studied the lymphatic system for personal/academic reasons, I have no formal, graduate-level medical training in it. The items mentioned above are obtainable through two texts that I've mentioned (for anyone with the fortitude to read through pages of boring technical language), and they can be accessed through one's university medical school library, or through inter-libary loans. Both are avenues through which I've accessed both texts.
Best Regards,
SteveB.
SteveB
 
Posts: 11
Joined: Fri Jun 16, 2006 9:20 pm
Location: western edge of sanity

Postby Evelyn Alvir » Thu Jul 20, 2006 4:53 am

I developed lymphedema after having a kidney transplant. Four months after the transplant I started having swollen feet. My neph. couldn't explain it, but changed my blood pressure pill from Norvasc to Cozaar. The swelling went away for a few months, then back again. After a year my thigh swelled up twice its size. My other neph referred me to a general surgeon who advised prescription hosiery and elevation of leg when in bed. On June 10th 2006, real lymphedema became very evident. The gen. surgeon prescribed a Sequential Circulator Pump which I've been using twice a day for a hour or more each time. It's helping very little, but I'm hoping it is just slow but help subside the swelling. My son is getting married on August 26th and I earnestly hope I can dance a little bit, even for just that one special occasion.

Question: how much walking does one do with leg lymphedema? In spite opf my thick stocking, the swelling gets worse at the end of the day.

Thank God for this forum and bless you all.
Evelyn Alvir
 
Posts: 4
Joined: Fri Jul 14, 2006 11:00 am
Location: New York

Postby patoco » Thu Jul 20, 2006 8:17 am

Hi Steve and Evelyn :)

Steve,

Don't know how I missed your post...many many thanks. It was excellent and I hope that it will help someone who is thinking of going on diuretics or has a doc who thinks that is the way to treat lymphedema.

Evelyn,

There are a couple instances in which diuretics may be used.

First, in an critical/life threatening situation some physcians use diuretics during an emergency intensive. This may be imperative because of the amount of fluid build-up in the cardio-pulmonary cavity.

The other situation is when lymphedema patients have other medical conditions that may require diuretics themselves.

I hope you have been able to get treatment through manual decongestive therapy. Because of the long term potential complications and because of the damage that pumps cause to the cutaneous lymphatics, I am not a proponent of pumps. Even the sequential ones have shown to cause complications.

The amount of walking you can do will depend on your individual situation. I used to walk a lot - and lot it....loved hiking and that type of activity.

Since the lymph fluid moves as a result of muscular action, walking actually can be beneficial. What I find to be horrible in terms of causing more swelling is standing. The fluid doesn't move then and just collects more and more in the legs.

Swimming is a great exercise and acts much like masage therapy. It always amazes me how much fluid simple swimming can move.

Congrats on the wedding :wink: ...I hope too you'll be able to participate.
My daughter got married a couple years ago and I'll never forget walkng her down the aisle and that wonderful/beautiful father-daughter dance. One of the memories of a lifetime.

:D

Pat
User avatar
patoco
Site Admin
 
Posts: 2175
Joined: Thu Jun 08, 2006 9:07 pm

Postby Evelyn Alvir » Thu Jul 20, 2006 6:38 pm

Thanks Pat ....I must do some walking then....and thank you for wishing me a great day at my son's wedding!

I have so much to learn abut lymphedema. There's a Center that gives therapy including the manual massage, but my doctor won't fill out the forms so my insurance would pay for it. He says these are just money-making mills.

Good weekend to all!

Evelyn
Evelyn Alvir
 
Posts: 4
Joined: Fri Jul 14, 2006 11:00 am
Location: New York

Postby joanne johnson » Fri Jul 21, 2006 10:30 am

Hi Evelyn,
Welcome! I also have lymph in both legs. A daughter and a son both got married in 2004. I had your same concerns about the days of the weddings. I was able to dance with my handsome son for the mother son dance and it was very special for both of us. I was also able to dance at my daughter's wedding a little bit. It doesn't take much to make me happy and I was very happy at those weddings. Good luck Evelyn, you will dance too!
joanne johnson
 
Posts: 165
Joined: Sat Jun 10, 2006 12:23 am

new to this world of Lymphedema

Postby Shirley Hogan » Mon Jul 24, 2006 8:38 am

Hello everyone, My name is Shirley and just diagnosed by myself searching the web, that I had this disease. I am a cancer survivor
and had major operations on lungs, kidney, and colon. Had chemo and radiation to the colon area in 2004, and about a year ago my right leg began to swell. The doctor just told me to elevate it, and gave me antibiotics for an infection, plus dieretics, and sent me on the way. I thought at that time it must be nothing to worry about cause he made so light of it. But a year and half later it was still swollen and the skin looked like it was dying and leathery looking. Not much pain, but I was taking low grade narcotics for other conditions that I have, so really dontknow if there is pain. Just a feeling of heavyness and slowing of my walking. I am 61 and weigh about 115. So here I am, and glad to find all of you. I was scared to death when I first read how bad this could get, and family seems to think its nothing. I have stopped trying to tell them about it. You know the attention getter type accusations. So glad to be able to be around others who know how it is. Thanks for letting me say hi. Love Shogie{ my nick name.}
Shirley Hogan
 
Posts: 12
Joined: Mon Jul 24, 2006 7:33 am

oh those swollen legs to crown our other ordeals

Postby Evelyn Alvir » Mon Jul 24, 2006 9:49 am

Shogie - you're a remarkable survivor. I second your praise of this well-
monitored site. I was on the kidney forum and you should see the abuse going on there and the monitors just useless zombies. Some unkind people even sneak in pages upon pages of nonsense and vulgarities.

I will remain faithful to this website and be reporting significant changes/cures of my right leg lymphedema.

Luv and good luck to you all!
Evelyn
Evelyn Alvir
 
Posts: 4
Joined: Fri Jul 14, 2006 11:00 am
Location: New York

Lower leg redness

Postby ppaesch » Wed Aug 23, 2006 12:18 am

I have had secondary lymphedema of the legs for 20 years and also
have the continuous redness and slight warmth in the lower legs. I've
been through complete decongestive therapy, wear waist high Elvarex,
and Reidsleeves at night. I recently tried a new machine on the market
which mimics manual lymph drainage and possibly holds some promise.
ppaesch
 
Posts: 19
Joined: Wed Aug 23, 2006 12:03 am

Postby patoco » Wed Aug 23, 2006 5:24 am

Hi Ppaesch

Super welcome to our family here. Have the doctors indicated whether or not the constant redness is inflammation or infection? Have you been on antibiotics at all?

I was wondering if the new machine you mentioned is the Flexitouch.

Last year I did a demo for it as I was curious how safe and effective it was. Here's my article:

The Flexitouch Device - Initial Observations

http://www.lymphedemapeople.com/phpBB2/ ... .php?t=155

I also did a page on its use for the arm:

Arm lymphedema and the Flexitouch

http://www.lymphedemapeople.com/phpBB2/ ... .php?t=273

Look forward to getting to know you and please don't hesitate to post any questions or concerns...we are all here for ya!

Pat
User avatar
patoco
Site Admin
 
Posts: 2175
Joined: Thu Jun 08, 2006 9:07 pm

Lower leg redness

Postby ppaesch » Wed Aug 23, 2006 10:56 am

I have, through the years, had bouts of cellulitis which never fail to get my
attention very promptly because of the characteristic signs & symptoms.
For this, I always get treatment, consisting of Cipro, which is effective in
resolving the acute infection. The redness in my legs is ongoing and always present. The doctors & therapists are aware. The therapist did
raise the question of possible daily low dose antibiotic and felt that an
Infectious Disease consult may be helpful in reducing the number of
recurrences of cellulitis. Once again, thanks for your input. I appreciate
your words of welcome, and it's good to know that there are others out
there with day-to-day concerns such as mine.

Pat, have you tried Elvarex garments? I don't have a problem with the
bunching you describe, but I really believe that this all depends on the
knowledge of the fitter, don't you?
ppaesch
 
Posts: 19
Joined: Wed Aug 23, 2006 12:03 am

Postby joanne johnson » Wed Aug 23, 2006 11:04 am

Hi papech,
I have had problems with cellulitis infections for 25 years. About 5 years ago I went to an infectious disease doctor and he put me on 1000 mg of pen vk antibiotic daily and it has helped tremendously. It is not uncommon to take this precaution. Many members on this site do this. Good luck to you!
joanne johnson
 
Posts: 165
Joined: Sat Jun 10, 2006 12:23 am

Antibiotics

Postby ppaesch » Wed Aug 23, 2006 12:24 pm

Thank you very much, Joanne. It is so good to hear from people like myself who have experienced similar difficulties. We have to help each
other and hope that the medical community will someday put lymphedema
on the front burner! Pat
ppaesch
 
Posts: 19
Joined: Wed Aug 23, 2006 12:03 am

Article on Secondary Leg Lymphedema

Postby patoco » Mon Jul 16, 2007 8:15 pm

Secondary Leg Lymphedema

In recent newsletters, we discussed secondary arm lymphedema. Secondary lymphedema, developing in response to another medical diagnosis or intervention, may develop in any region of the body. An individual may develop lymphedema in the legs for a variety of reasons. Lymphedema associated with Filariasis, a parasitic infection is the most common cause of secondary lymphedema worldwide. Filariasis infections may be one of the largest medical conditions contributing to individuals developing leg lymphedema. Secondary leg lymphedema may also develop from cancer related treatments including radiation therapy and surgery involving inguinal (groin) and pelvic lymph node involvement. Individuals may also develop secondary leg lymphedema associated with trauma, infections, and vascular issues.

In these conditions, a disruption of normal lymphatic flow can inhibit the movement and drainage of lymph fluid. Accumulation of lymphatic fluid may promote swelling and lymphedema.

If you or someone you know is experiencing any type of leg swelling, it is advisable to consult with their family physician, specialist, or surgeon. Your lymph therapist can be consulted only after you’ve seen a medical doctor for diagnosis. Your physician can complete a physical assessment, and order appropriate testing to clarify the diagnosis. Leg swelling may occur for various medical reasons. If the diagnosis is secondary leg lymphedema, there are several ways one can manage it. First and foremost being that the individual seek a prescription for “combined decongestive therapy”, sometimes called “complex decongestive therapy” (CDT).

Once the patient has his or her prescription for CDT, they can then consult with a lymphedema therapist who specializes in CDT. The therapist must be trained and certified in CDT to treat lymphedema. CDT includes compression bandaging, skin care, manual drainage techniques, and specialized exercises. Patients should be taught a self-management program to give them tools to manage this condition on their own and promote independence. Both the treatment frequency and the self-management techniques will vary according to specific patient needs.

Self-management includes exercise, wearing a daytime compression garment, and compression bandaging while sleeping.

Patient education on impeccable skin care is valuable. Patients may be taught strategies to gradually soften hardened, fibrotic skin tissues that may develop from lymphedema. Fungal infections are common in leg lymphedema. These infections pose an increased risk for skin deterioration. Some helpful suggestions to combat fungus are to make sure that one’s hygiene is excellent. Routine washing and drying skin after bathing, changing into clean, dry socks, and use of properly maintained footwear all promote good skin integrity. Loosely fitted clothing that breathes well may also help reduce the chance of fungal and lymphatic complications.

Proper management of secondary leg lymphedema through assessment, treatment, and long-term management may help reduce complications and promote better quality of life. By consulting with a medical doctor and CDT therapist, individuals can begin their journey of learning how to manage their secondary leg lymphedema.

Denny Paccagnan and Kirsten Hausmann

FROM:

The Alberta Lymphedema Association

ALA is an association helping to optimize health for lymphedema patients by supporting, educating and empowering individuals, as well as informing the general public. We are always happy to hear your feedback in written form via old-fashioned hand written letters or email to:

55 Brookpark Crescent SW
Calgary, AB T2W 2W6
or
Email: lymphnet@telus.net

Further information may be obtained by calling (403) 281-9205

HomePage:

http://www.albertalymphedema.com

Article Page:

http://www.albertalymphedema.com/news/ACF184.doc
User avatar
patoco
Site Admin
 
Posts: 2175
Joined: Thu Jun 08, 2006 9:07 pm

Causes of Secondary Leg Lymphedema

Postby patoco » Mon Jul 16, 2007 8:24 pm

Causes of Secondary Leg Lymphedema

Related terms: leg swelling, leg edema, leg lymphoedema

Introduction

If you ask most people that are familiar with lymphedema the question, "Are you aware of secondary lymphedema," most would reply that "yes, it is where the arm swells after the lymph system has been damaged by breast cancer biopsy and treatment."

Even if they are aware that such a condition as secondary lyg lymphedema exists, their response might well be that it is a small group of afflicted men who have prostate cancer.

Thus shows how little awareness there is about this particular form of lymphedema. Even in the lymphedema world it is a poor step-child.

However, if the membership of Lymphedema People and the posts in the online lymphedema support groups are an indication, this condition is increasing dramatically.

The reasons for this increase are multiple. They include:

1. increased survival rates of cancer
2. improved treatment of trauma injuries that previously would have been terminal
3. increase in antibiotics for infections and treatment for other conditions that previously might have resulted in death.

It is also important to note that secondary leg lymphedema does not necessarily start immediately after the injury/trauma. It may not start for years.

What is secondary leg lymphedema?

Secondary lymphedema is a condition where the lymphatic system has been damaged. The main job of this system is to move excess through and out of our bodies. When it becomes damaged or impaired, it is no longer able to accomplish this function and these fluids (lymph fluids) collect in the interstitial tissues of our legs. This causes leg swelling.

Another important function of the lymph system is to help our bodies fight infections. With lymphedema, this ability is also weakened and the patient becomes more susceptible to infections.

What causes secondary leg lymphedema?

Secondary leg lymphedema (also referred to as acquired lymphedema) is caused by or can develop as a results of:

1.) Surgeries involving the abdomen or legs where the lymph system has been damaged. This includes any intrusive surgery.

Examples are

vein stripping
surgery for peripheral vascular disease
hip replacement
knee replaement
insertion of bolts, screws and other devices in orthopaedic repair
lipectomy

2.) Removal of lymph nodes for cancer biopsy. These cancers include, but are not limited to

prostate cancer
testicular cancer
ovarian cancer
uteran cancer
vulva cancer
bladder
lymphoma - both hodgkins and non hodgkins
melanoma
colon
Kaposi Sarcoma

3.) Radiation treatment of these cancers that scars the lymph system and lymph nodes

4. Some types of chemo therapy. For example, tamoxifen has been linked to secondary lymphedema and blood clots.

5.) Severe infections/sepsis. Generally referred to as lymphangitis, this is a serious life-threatening infection of the lymph system/nodes.

6.) Trauma injuries such as those experienced in an automobile accident that severly injures the leg and the lymph system.

7.) Burns - this even includes severe sunburn. We have a member that acquired secondary leg lymphedema from this.

8.) Bone breaks and fractures.

9.) Morbid obesity - the lymphatics are eventually crushed by the excessive weight. When that occurs, the damage is permanent and chronic secondary leg lymphedema begins.

10.)Insect bites

11.)Parasitic infections

What are some of the symptoms of secondary leg lymphedema?

These symptoms may include:

1.) Unexplained swelling of either part of or the entire leg. In early stage lymphedema, this swelling will actually do down during the night and/or periods of rest, causing the patient to think it is just a passing thing and ignore it.

2.) A feeling of heaviness or tightness in the leg

3.) Increaseing restriction on the range of motion for the leg.

4.) Unsual or unexplained aching or discomfort in the leg.

5.) Any change involving hardening and/or thicking of the skin or areas of skin on the leg.

Can secondary leg lymphedema be prevented?

While it may not be possible to totally avoid getting leg lymhpedema once you are at risk, there are ways you can help yourself delay it.

Here are 18 preventative steps for secondary leg lymphedema from the National Lymphedema Network:

Absolutely do not ignore any slight increase of swelling in the toes, foot, ankle, leg, abdomen, genitals (consult with your doctor immediately).

Never allow an injection or a blood drawing in the affected leg(s).

Wear a LYMPHEDEMA ALERT Necklace.

Keep the edemic or at-risk leg spotlessly clean. Use lotion (Eucerin, Lymphoderm, Curel, whatever works best for you) after bathing. When drying it, be gentle, but thorough. Make sure it is dry in any creases and between the toes.

Avoid vigorous, repetitive movements against resistance with the affected legs.

Do not wear socks, stockings or undergarments with tight elastic bands.

Avoid extreme temperature changes when bathing or sunbathing (no saunas or hottubs). Keep the leg(s) protected from the sun.

Try to avoid any type of trauma, such as bruising, cuts, sunburn or other burns, sports injuries, insect bites, cat scratches. (Watch for subsequent signs of infection.)

When manicuring your toenails, avoid cutting your cuticles (inform your pedicurist).

Exercise is important, but consult with your therapist. Do not overtire a leg at risk; if it starts to ache, lie down and elevate it. Recommended exercises: walking, swimming, light aerobics, bike riding, and yoga.

When travelling by air, patients with lymphedema and those at-risk should wear a well-fitted compression stocking. For those with lymphedema, additional bandages may be required to maintain compression on a long flight. Increase fluid intake while in the air.

Use an electric razor to remove hair from legs. Maintain electric razor, properly replacing heads as needed.

Patients who have lymphedema should wear a well-fitted compression stocking during all waking hours. At least every 4-6 months, see your therapist for follow-up. If the stocking is too loose, most likely the leg circumference has reduced or the stocking is worn.
Warning: If you notice a rash, itching, redness, pain, increase of temperature or fever, see your physician immediately. An inflammation or infection in the affected leg could be the beginning or a worsening of lymphedema.

Maintain your ideal weight through a well-balanced, low sodium, high-fiber diet. Avoid smoking and alcohol. Lymphedema is a high protein edema, but eating too little protein will not reduce the protein element in the lymph fluid; rather, this may weaken the connective tissue and worsen the condition. The diet should contain easily-digested protein such as chicken, fish or tofu.

Always wear closed shoes (high tops or well-fitted boots are highly recommended). No sandals, slippers or going barefoot. Dry feet carefully after swimming.

See a podiatrist once a year as prophylaxis (to check for and treat fungi, ingrown toenails, calluses, pressure areas, athelete's foot).

Wear clean socks & hosiery at all times.

Use talcum powder on feet, especially if you perspire a great deal; talcum will make it easier to pull on compression stockings. Be sure to wear rubber gloves, as well, when pulling on stockings. Powder behind the knee often helps, preventing rubbing and irritation.

Unfortunately, prevention is not a cure. But, as a cancer and/or lymphedema patient, you are in control of your ongoing cancer checkups and the continued maintenance of your lymphedema.

Revised (c) January 2003 National Lymphedema Network. Permission to print out and duplicate this page in its entirety for educational purposes only, not for sale. All other rights reserved. For more information, contact the NLN: 1-800-541-3259

What are the complications of secondary leg lymphedema?

LIST OF COMPLICATIONS

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immuno-deficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

12. Angiosarcoma, a cancer of the soft tissues

13. Lymphangiosarcoma which is a rapidly progressive, non curable cancer of long term lymphedema patients.

14. Lymphoma, new research indicates a possibility of this with hereditary lymphedema. I have been diagnosed with two forms of lymphoma.

15. Septic arthritis

Long Term effects include:

There are numerous side effects and long term affects you may experience with lymphedema. Some of these include fatigue, weight gain, pain (sometimes to the extreme), depression, continued swelling of the limbs or abdomen. Some have experienced cardio cavity and pleural edema. Lymphedema can also cause fibrosis. This is where the limb becomes very hard and can become nonresponsive to available treatment options. With extensive fibrosis also comes heightened risks of blood clots in the affected areas.

Lymphedema also cause localized immunodeficiency problems. It also may be suspect in long term immunity problems, especially in very long term primary lymphedema patients. This may be a controversial statement, but I have known of primary lymphedema patients who's immune system seems to have collapsed from unknown reasons. In my personal situation, mine did just that with the result I acquired two different lymphomas. Hopefully, research will be done in this area.

Lymphangiosarcoma is another possible complication of lymphedema. While many LE'ers worry about contracting this, it is extremely rare. Risk factors are extreme fibrosis, radiation on fibrotic areas and continued infections.

What are the stages of secondary leg lymphedema?

There are three basic stages active of lymphedema. The earlier lymphedema is recognized and diagnosed, the easier it is to successful treat it and to avoid many of the complications.

It is important as well to be aware that when you have lymphedema, even in one limb there is always the possibility of another limb being affected at some later time. This "inactive" period referred to as the latency stage. It is associated with hereditary forms of lymphedema.

LATENCY STAGE

Lymphatic transport capacity is reduced
No visible/palpable edema
Subjective complaints are possible

STAGE I
(Reversible Lymphedema)
Accumulation of protein rich edema fluid
Pitting edema
Reduces with elevation (no fibrosis)

STAGE II
(Spontaneously Irreversible Lymphedema)
Accumulation of protein rich edema fluid
Pitting becomes progressively more difficult
Connective tissue proliferation (fibrosis)

STAGE III
Accumulation of protein rich edema fluid
Non pitting
Fibrosis and sclerosis (severe induration)
Skin changes (papillomas, hyperkeratosis, etc.)

STAGE IV -(new clinically recognized stage)
(Lymphostatic Elephantiasis)

The limb is so densely fibrotic that it is not possible to make any indentation when pressed. It becomes impossible for ultrasound testing to pick even the blood pulse. The skin becomes brittle and
even the slight of bumps causes a serious, extensively weeping wound.
Because of the hardness of the tissue, it has become a total septic foci for bacteria and constant cellulitis and systemic infections become the norm. The only treatment for cellulitis is an extended period of IV antibiotics.

There is no treatment option for Stage Four. The complete focus is on management, containment of infections, prevention if at all possible of amputation.

Can Secondary Leg Lymphedema be Treated?

Yes - absolutely and the sooner treatment begins, the better is going to be the outcome in terms of reducing the swelling and in preventing the complications from arising.

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment.

It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.

With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.

On the left side of Lymphedema People, we have a index of articles. Under the heading "Therapists" we have lists and links to certified medical professional called Lymphedema Treatment Therapists.

After you have received profession treatment, it may also be valuable to learn to do self manual lymph drainage at home.
User avatar
patoco
Site Admin
 
Posts: 2175
Joined: Thu Jun 08, 2006 9:07 pm

Self Manual Lymph Drainage for Secondary Leg Lymphedema

Postby patoco » Mon Jul 16, 2007 8:34 pm

Self Manual Lymph Drainage for Secondary Leg Lymphedema

Self Manual Lymph Drainage for the Lower Extremity

v Rules for MLD:

o The strokes should be made with arcing motions or half circle motions.

o Do not slide over your skin, but rather, keep your fingers in contact with your skin and stretch it gently over the underlying tissues.

o You should have NO PAIN.

o Each stroke should be done 10-15 times SLOWLY, taking about 2 seconds for each stroke.

o If redness occurs, you are pressing too hard.

o For lymphedema of BOTH legs, perform all moves on both sides.

o The best position to be in for this is seated reclined, or lying
down and propped up slightly.

o Make sure you can make skin-to-skin contact for all of these strokes. They won't work when done over clothing.

-----------------------

1. Neck: Place the flats of your fingers on your opposite shoulder, in the triangular part just above the collarbone and next to your neck. Move your hand in an arcing motion stretching the skin forward and down towards your chest. Repeat this on the other side.

2. Armpit: Raise your arm (on the same side as the leg in which you have lymphedema), bend you elbow, and place the hand behind your head. Place the flat of your opposite hand in your armpit. Stretch the skin in an arcing motion up towards the neck.

3. Above the waist: Place the flat of your opposite hand on the side of your body (on the side on which you have lymphedema) below the breast, but above the waist. Move your hand upwards in an arcing motion in the direction of your armpit, stretching your skin.

4. Below the waist: Place the flat of your opposite hand on the side of your body (on the side on which you have lymphedema) on or just below the waist, but above your hip. Move your hand upwards in an arcing motion in the direction of your armpit, stretching your skin.

5. Deep (diaphragmatic) breathing: Place both open palms on top of each other below the belly button. Take a slow breath in and feel your belly rise up into your hands as it expands to take in the air. Then breath out and feel your belly sink in as the breath leaves you. As you get better at this you can use your hands to resist your stomach slightly as you breath in, and press in slightly with your hands as you breath out. Don’t get dizzy. Start with only 2 or 3 breaths and work up to 10 as you get stronger.

6. Groin: Place the flat of your hand on the front of your groin, right where your underwear falls. Make a scooping motion in the groin, rolling your hand from the thumb to the little finger. Imagine that your hands are the bottom of a water wheel.

7. Back of knee: Place the flat fingers of both hands behind your knee. Perform a scooping motion up towards the body.

8. Repeat steps 3, 4 and 6 (waist and groin areas)

A very special Thanks to Katy from

Lymphedema Therapists
User avatar
patoco
Site Admin
 
Posts: 2175
Joined: Thu Jun 08, 2006 9:07 pm

Compression Bandaging for Secondary Leg Lymphedema

Postby patoco » Mon Jul 16, 2007 8:37 pm

Compression Bandaging Secondary Leg Lymphedema

One of the best posts on how to wrap a leg...from LLLymphedema2@yahoo.com

Since you have the swelling in the feet (and toes), it is probably lymphedema, perhaps compounded with lipedema. The traditional bandaging technique is with a stockinet, then some artiflex (cotton padding), and lastly, the bandages. I bandage directly over the skin. The padding is supposed to even out if you should constrict some part of the bandaging, causing the lymph not to flow, but the bandages are really not like rubber bands -- properly spaced and overlapped, they will not cause constriction -- and the artiflex is a pain. The stockinet is just another thing to wash and dry. I went to www.bandages.com and found that they have new bandages that are thick enough to be used without layering (e.g. the stockinet and padding). Perhaps this is the way to go, or perhaps you want to bother with stockinets and padding. If you were seeing a therapist, they would also use foam instead of artiflex (just cotton padding). Some pictures of bandaging look absolutely monstrous. My so called therapist used some foam, etc., but I soon discovered that the leg went down more without it. The pad is supposed to "spread" the compression so there is no binding -- but what really happens is all the elasticity of the bandages goes to compressing the FOAM -- not compressing your leg. A little compression trickles down to the actual leg, but my experience was that the swelling went down better without the extra stuff. However, since this is against tradition, you should at least be aware if any part of your leg feels too tight, and, if so redo the bandages (which is at least an hour for two legs -- and bandages that were OK while you were up and around can suddenly become too tight in the middle of the night -- which means you have to get up and do it again.) Anyway, with or without stockinet and padding, here is one technique for bandaging:

materials (1 large leg not grossly larger than normal (I am 5'9" and the calf measure is 21" and I have wide, swollen feet - if you are substantially larger, you may need more)

optional: stockinet, artiflex, foam

required:

1 roll 1" professional strength masking tape.
1 ea 3" strip of heavy padding around the ankles
1 ea 1" x 5m medi-rip
2 ea 8 cm. x 5 m short stretch bandages
1 ea 10 cm x 10 m short stretch bandages
1 ea 6 cm x 5 m short stretch bandages.

Double for 2 legs, if you are very much larger than me, add another 1 ea 10 cm. x 5 m short stretch bandage for each leg.

I sit on my bed and have a low table I can rest my foot on, but two chairs will work also (one to sit on and one to put your foot on).

Wrap the 3" strip of heavy padding (or chock pads) around the ankles. The figure 8's you are making around your foot and from the foot onto the leg will tend to bind right at the intersection of the foot and leg (where the 90" turn is made. This is the only place padding is essential. Secure it with masking tape. Secure all the bandages after they have been wrapped with masking tape. Cut a lot of 5" strips of masking tape and have them ready. Stick them on the edge of the table, or a windowsill, or something.

First hold all the bandages so that you are drawing from the bottom of the bandage cylinder (the bandages rolled up are a cylinder), not the top. A little experimentation will show you that this is much easier.

Start with the 1" medi-rip (it is a self cohesive bandage, but looses some of the self cohesion with laundering). Use this tiny bandage to bandage along the toe line. That is, make the same arc that the joints of the toes to the feet make. Do not bind the toes. If you can, wrap each toe with it, but I find that this binds the toes and hurts, so I leave my toes unwrapped, even though they swell, but if you start with the larger short stretch bandages, there will be a half moon that swells even more (Since if you make a straight circle from just below the little toe to just below the big toe, this will leave some area of foot not bandaged and the lymph will be pushed into this area, and it will be worse than before. The little 1" medirip can be wrapped in a curved path that covers all of the foot. Overlap this 1" medirep by 1/2 and continue winding it around your foot until you get to the end of the arch, then take it up diagonally over the top of the foot, and you will still have enough bandage to wrap again just under the toe line again for a few wraps. The medi wrap has strands of elastic in an otherwise cotton strip, so pull the medirip tight (that is the elastic is extended, but not to the point of discomfort).

When you wrap the bandages, pull a bit at the end of each circle, but do not stretch them too hard, or with constant tension as far as they will stretch. You want them to exert a little spring, but don't strangle your legs. If you get them too tight, it will hurt, and you must undo your wrapping and redo it (a big pain). If you don't stretch them a little, they won't have much compression. Of course, it's always the bottom bandages on the feet that hurt, so you have to unwrap the whole deal to get to them.

Next,step 2 take a 8 cm. x 5 m short stretch bandage, and start at the tip of the foot, but do not bind any toes, and since you already have the medi-rip, allow a little breathing space to make sure you don't bind toes. Then wind around your foot overlapping the bandages by about 1/2 to 2/3 (I probably overlap 2/3) until you have gotten almost to the leg (your foot should be at a 90 degree angle to the leg, and for me this is 2 or 3 wraps), then go around the heel itself, and, as you come off the other side of the heel, take the bandage diagonally up on the top of the foot to just below the top of the first wrap (just under the bottom of the big toe), go around the bottom of the foot, and then bring the bandage back around the ankle just above the heel, then around the ankle, and back up diagonally across the top of the foot just like before, overlapping 1/2 to 2/3 of the previous path. This will make large figure 8s. Continue with the figure 8's each layer a little higher around the ankle, until you again are wrapping just in front of the leg (no more space to do another figure 8) and use the rest of the bandages going in straight circles (not figure 8's) around the ankles.

Next,step 3 take the second 8 cm x 5 meter short stretch bandage, and start at the base of the leg (around the ankles), go around once or twice, to anchor the bandage, then on the next turn go down around the bottom of the foot close to the heel, and then around the bottom of the foot and then over and up around the leg, then continue making figure 8's up the leg overlapping by about 2/3. To make a figure 8 around the leg, on one side of the front of the leg, the bandage is going uphill (or towards your knee), then it goes more or less straight around the back of the leg at the high end of the 8, then goes downhill (or towards the foot), as you come across the front of the leg again, then more or less straight across the back of the leg at the low end of the 8 and then up again for the next figure 8. On me, this bandage is finished just about at the beginning of the calf (a little above the bottom of the muscle -- it would be ideal if this bandage ended just before the muscle begins, but it will be a bit different for everyone depending of how much they overlap and how large their leg is.

Next,step 4 do figure 8's with the 10 cm x 10 m bandage. Begin at the bottom of the leg with the beginning of the bandage facing upward, so the first direction is in a downward direction, (the end pointing up) coming around and then going up again. The 10 cm x 10 m bandage should take you up to just below the knee, but if the legs are very large, you may need another 10 cm. bandage. Each course of the figure 8 should overlap a little less or evenly, but not more than the previous course. The more you overlap the greater the compression, and you must always have less compression proximally (towards your heart) than distally (towards your toes).

Finally,step 5 take the last 6 cm. x 5 meter short stretch bandage and start at about mid calf or a little higher, and wind in straight circles until just below and as close as possible to the knee. This last bandage gives compression over the tops of the top 8's where there is not as much overlap, and sort of holds it all up, as the circumference of the leg is actually smaller at the knee than at the mid calf (doesn't slide down because a smaller circle would have to slide over a larger circumference of the leg).

I have been complemented on my ability to wrap, but It is hard to know if a novice can make much sense of my directions -- but I tried. Look at some photographs of the bandaging while you are at www.bandages.com. You don't see to many photographs of the figure 8's, but they give more compression and stay up better, and bind less. You will get the general idea of winding up the leg, and overlap by looking at the photographs, however. It may seem complicated to follow my directions (I tried to be clear), but the real technique is not very hard at all.

The new thick bandages that do not need padding (padding is included) are : KomprimED. They are located on the bandagesplus web site under bandages, then under two way stretch bandages. I think you should start with these, as the padding may be more important for someone who is just beginning bandages. This is much simpler than all those stupid layers.

*Soft and comfortable directly on patient's skin
*Thicker texture avoids application of foam and padding in many cases
*Suitable for lymphedema and venous ulcers
*Patient-friendly application requires less layers
*All bandages are short-stretch/low stretch
KomprimED 4cmx5m

Other wise, the standard short stretch bandages are rosidal or comprilan. I use rosidal. The medi-rip is under the section
cohesive bandages on page 2 under the more general category bandages.

...............

Special Thanks to: Linda :)
User avatar
patoco
Site Admin
 
Posts: 2175
Joined: Thu Jun 08, 2006 9:07 pm


Return to Leg Lymphedema

Who is online

Users browsing this forum: No registered users and 6 guests


cron