Writer : JMBernardo
It is the abnormal buildup of fluid in the tissues just under your skin. Most of the times, it happens along the arms or legs but it can also affect other body parts like face, neck, body, belly or genitals.
Lyphedema when unrecognized can be chronic and leads to serious problems. This is why early diagnosis and correct management is necessary.
The lymphatic system is often called the third circulatory system or more correctly the third major part of our circulation which includes the more popular veins and arteries. In the Philippines, we have a general term “ugat” which can even refer to nerves not just lymphatics, arteries or veins creating ambiguity and confusion.
The lymphatics serves many functions including being a part of our immune system as it is formed by weblike network of lymphocoeles, vessels/ducts, nodes (kulani) and end organs like tonsils, adenoids, spleen and thymus.
Lymphedema usually happens when there is damage to our lymphatics like what is common in a tropical country like ours called “filiariasis’ a small worm like parasite endemic in some provinces in our country that blocks the lymphatics or recurrent bacterial soft tissue infections all causing microscopic scarring within the lymphatic system. Persistent long standing venous reflux disease (varicose veins) can also cause phlebolymphedema in some individuals. Cancer surgery, radiation or trauma are also common causes of lymphedema. Eventually, it can cause swelling, thickening of skin, fibrosis and deformity of affected arm or leg.
The common signs and symptoms also include feeling of tightness, hardness, redness and warmth of the affected area. It can cause tingling sensation, numbness, heaviness and discomfort with difficulty in movement or flexibility of nearby joints. Early on you migh notice jewelry, watches and sleeves or pants to be tight. There are 4 stages of lymphedema (from 0 to 3) and the earlier it is diagnosed the easier it is to manage.
There are some tests that your doctor might request including ultrasound of the limb and just plain good history taking and physical exam. More advanced tests like lymhoscintigraphy is reserved for hereditary or syndromic type of lymphedema or those who may require more invasive treatment.
How do we manage lymphedema? First, we should recognized who are prone to develop lymphedema--- cancer patients who underwent surgery and or radiation (like breast cancer patient), those with severe long standing vein disease (severe varicose veins), those with history of recurrent cellulitis, morbidly obese individuals especially with sleep apnea, etc. This is followed by appropriate tests to rule out active infection or deep vein thrombosis.
The corner stone of management is a combination of manual lymphatic massage done by certified therapists with bandaging or compression garments. This is of course coupled with exercise, maintaining healthy moisturized skin and healthy weight.
Finally, lymphedema makes you also prone to skin and soft tissue infection which can be life threatening and will need appropriate antibiotics. To prevent such complications, patients need to wear protective clothes when exposed to nature avoiding insect bites and skin trauma and damage. Lymphedema unfortunately is a chronic disease and at this time cannot yet be completely cured and reversed. So prevention when possible particularly of repeated infection is paramount in preventing this vicious circle. If you think you have lymphedema or is prone to lymphedema, see your vascular doctor.