Lymphedema is a deficiency of the lymphatic system whereby the lymph does not flow properly and remains in the interstitial spaces of the subcutaneous cellular tissue. As a consequence of this failure, there is an increase in the volume of the affected limb or the region of the body where the lymphedema is located.
There are two types of lymphedema:
- Primary lymphedema, which occurs when the lymph ducts and/or lymph nodes in an area have problems transporting large proteins and other molecules into the venous stream. The most common ones appear in the lower limbs.
- Secondary lymphedema is due to the removal or radiation of the lymph nodes in a given area, hindering normal lymphatic drainage. The most common, given the high incidence of breast cancer, appear in the arm. A relatively high incidence can also be seen in lower limbs due to various surgical interventions, such as melanomas.
Symptoms of lymphedema
The main symptom of lymphedema is an increase in the size of the affected area. In the case of primary lymphedema, it usually appears at the age of 30-35 years, although it can occur at any time of life spontaneously or after a trauma that triggers the premature onset, such as a small sprain. In addition, it is accompanied by discomfort, such as a feeling of heaviness, difficulty in mobility that is increased depending on the volume, fibrosis in general or localized in some points, and is commonly associated with vascular disorders.
Treatment of Lymphedema
To date there is no infallible cure for lymphedema, only treatments that help to slow the progression and increase in volume and that are accompanied by containment measures. The main treatment for lymphedema is lymphatic drainage. Although there are different schools, the one with the best results is the Godoy Method, a technique applied at the Instituto Fisiomédico with great success for years with results close to the normalization of the opposite limb.
Godoy Method for the treatment of Lymphedema
The Godoy Method is characterized by three phases:
- Cervical neurological stimulation
- Mechanical lymphatic therapy
- Manual lymphatic therapy
The worldwide trend in the treatment of lymphedema is to treat it in a global way with a multidisciplinary team, such as the Lymphedema unit of the Instituto Fisiomédico, where not only drainage therapy is used but also nutrition, physical activity, psychology, workshops and alternative therapies; this combination makes the treatment a success.
Sequelae of Lymphedema
The consequences of lymphedema are varied. The main one is associated with the increase in volume, which can become very limiting, especially in the physical aspect, which sometimes reduces the use of certain clothing, or makes the person become more reserved and reduce their social activities. On the other hand, throughout the day the affected limb usually feels heavy, so that physical activity is also reduced. In many cases, affected persons are granted occupational disability depending on the work they perform, and if it negatively affects the pathology, such as jobs in which they have to stand for long hours in the case of leg lymphedema, or manipulative or weight-bearing work in the case of arm lymphedema.
Lymphedema in breast cancer
In breast cancer, one of the most common sequelae and with the highest incidence is secondary lymphedema. This does not mean that whenever there is a process of breast cancer there must be a lymphedema as a result of it, with or without axillary node involvement with subsequent surgical treatment and radiotherapy and / or chemotherapy, in those cases that require it.
Whenever there is a surgical intervention at this level, the risk of developing lymphedema increases. The associated chemotherapy or radiotherapy increases the incidence. Lymphedema can appear from early stages of the disease, such as days after surgery until years after the entire treatment.
Secondary lymphedema has a different treatment approach because its causes are different, so in the Instituto Fisiomédico (national pioneers in oncological physiotherapy) face the approach of this sequela of cancer correctly.
The symptoms are those presented above; it usually begins with the swelling of a part of the arm. This does not always follow the same pattern; there are patients whose fingers and hand swell first and the rest of the arm remains well, while in others it begins at a more proximal level. This gradually tends to evolve towards an increase in volume that begins to generalize to the whole arm and usually presents areas with fibrosis or hardness, where the lymphatic fluid remains more stagnant.
Consequences of Lymphatic System Failure
The lymphatic system is part of the immune system, so its failure is associated with a higher risk of contracting infections. Good hygiene is important as a preventive measure, as well as proper nail care, preserving cuticles, do not wear rings, bracelets or watches on the affected arm, do not hang your bag on this side, and try to distribute the weight between both arms.
In the case of the legs the same thing happens, so the most important treatment in this case is prevention and the exquisite care of the affected limb.
Once an infection is present, it will be necessary to use antibiotics and other drugs that the doctor considers necessary depending on the type of infection.