Complex lymphedema treatment

Symptoms and Treatment of Lymphedema

Lymphedema occurs when fluid between tissues, also known as lymph, accumulates abnormally. This can be congenital, which may cause symptoms for the first time even in adulthood, but it may also occur that we are born with fewer lymph vessels/lymph nodes, which our body can no longer compensate for after a certain time. It can develop following any serious injury or surgery where lymph vessels/lymph nodes are damaged, thus disrupting the drainage of lymph fluid.

Symptoms of lymphedema:

• The limbs gradually become thicker, shoes become tight, trouser legs become narrow.
• The back of the hand and foot thicken like dough, fingers become sausage-like.
• The swollen limb may feel heavy and painfully tight.
• Due to the swelling, movement of the affected limbs may become limited or difficult.

What condition may be behind lymphedema?

Lymphedema may be caused by numerous conditions, such as:

• Heart failure
• Kidney failure
• Thyroid problems, etc., the investigation of which is always within the competence of a specialist!

If symptoms persist, it is advisable to consult a general practitioner or internist, who, with knowledge of the examination results, can clearly diagnose lymphedema. It is important to know that this is a condition that cannot be eliminated, only maintained at a stable level, and further deterioration can be prevented!

How do we achieve an edema-free state?

In the case of a swollen limb, an edema-free state can be achieved with bandaging, which can be maintained with compression stockings! Therefore, it is FORBIDDEN to put compression stockings directly on a swollen limb, as the fluid is incompressible and may even lead to ulcer formation.

Initially, the bandage should be worn 23 hours a day, it can be removed for bathing, thus accelerating the achievement of results. When the limb becomes edema-free, a specialist prescribes compression stockings, which must be worn during the day, and at night, if the limb swells slightly, a bandage can be applied.

How does complex lymphedema treatment proceed and how long does it take?

The edema reduction treatment optimally takes a total of 1 hour. The treatment begins with manual drainage (approx. 30 minutes), followed by the application of specialized bandaging (10–15 minutes), which both the patient and family members need to learn (instructional booklets also assist with learning). The treatment concludes with physiotherapy, which takes approximately 15–20 minutes.

Manual lymphatic drainage is contraindicated in the following cases:

• Edema of cardiac or renal origin
• Malignant process with skin metastases (malignant tumor with metastasis)
• Ulcerated skin metastases
• Acute deep vein thrombosis
• Thrombophlebitis
• Acute skin inflammation (e.g., cellulitis, erysipelas)
• Infectious skin diseases
• Untreated decompensated heart disease
• Severe cardiac arrhythmia
• Untreated high blood pressure
• Severe, untreated asthma
• Untreated hyperthyroidism
• Pregnancy

What else is important to know:

• For the first treatment, you must bring all medical reports related to lymphedema.
• Reduction of lymphedema resulting from oncological disease can only be initiated with presentation of a negative report no older than 3 months.
• In the case of active oncological disease, the treatment may cause the spread of cancer cells, therefore in this case therapy is contraindicated.
• We will discuss in detail the course of therapy, the expected treatment duration, and the necessary bandage supplies.
• Therapy is only effective as a course of treatment; a minimum of 5 sessions is required (may vary depending on the severity of edema), which must be received on consecutive days. A family member may also be present, which facilitates learning home bandaging.
• Elastic bandages are prescribed by a specialist on prescription and are subsidized by health insurance.

These elements do not replace each other; the optimal result, an edema-free state, can be achieved as a complex whole. Neither manual lymphatic massage nor physiotherapy to enhance lymphatic circulation is effective on its own.

What can be prescribed with health insurance subsidy?

Every six months for 1 leg:

• 5 elastic bandages
• 2 stockings
• 2 toe caps

Every six months for 1 arm:

• 5 elastic bandages
• 2 stockings
• 2 gloves can be prescribed with subsidy

The following specialists have prescribing authority:

• Surgeon, pediatric surgeon, vascular surgeon
• Clinical oncologist
• Radiation therapy specialist
• Dermatologist
• Internist
• Orthopedic-Traumatologist

Elements of lymphedema treatment

• Manual lymphatic drainage, lymphatic massage
• Compression therapy with elastic bandages
• Specialized physiotherapy dermatological treatment
• Intermittent pneumatic compression, wave massage
• Dietary counseling, weight control
• Group patient education, psychological counseling
• Making treatment results permanent, prevention

What complaints and symptoms does lymphedema cause?

• Increase in limb volume, swelling of the hand and foot (dough-like foot)
• The limb becomes heavy: heavy leg / leaden leg sensation
• Fatigue under stress (e.g., prolonged standing)
• Skin changes: dermatitis, itching, peeling
• Recurrent erysipelas
• The patient with edema cannot put on shoes due to limb thickening, mobility limitation develops

Today, truly effective treatment exists for lymphedema and the improved condition can be maintained. This is the so-called complex edema reduction treatment. It is important to know that only a qualified, experienced specialist can perform this therapy; otherwise, symptoms and the disease may worsen.