By Molly Clarke. Ms. Clarke is a regular contributor to the Social Security Disability Help blog where she works to promote disability awareness and assist individuals throughout the application process.

Lymphedema and Social Security Disability Benefits: Do You Qualify?

Lymphedema is a condition that occurs when vessels in the lymphatic system become blocked.  Lymphedema . . . → Read More: Lymphedema and Social Security Disability Benefits: Do You Qualify?]]>  

By Molly Clarke.
Ms. Clarke is a regular contributor to the Social Security Disability Help blog where she works to promote disability awareness and assist individuals throughout the application process.

Lymphedema and Social Security Disability Benefits: Do You Qualify?

Lymphedema is a condition that occurs when vessels in the lymphatic system become blocked.  Lymphedema causes arms or legs to swell, reduces the amount of oxygen circulating the body, and affects the body’s ability to heal wounds.  Lymphedema can cause anything from mild irritation to severe disability.

If lymphedema has impaired your ability to work and earn a living, you may qualify for Social Security Disability benefits. Disability benefits can help cover everything from medical treatment to day-to-day expenses.

This article will provide you with a general overview of the different benefit options and will prepare you to begin the Social Security Disability application process.

Social Security Disability Benefits and Technical Eligibility Requirements
The Social Security Administration (SSA) offers two different types of disability benefits—Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).  To qualify for either program applicants must have a physical or mental health condition that prevents them from holding any type of job for at least one year. Each program also has its own set of technical requirements that applicants must meet.

SSDI is funded by Social Security taxes paid into the program by workers all over the country. SSDI is intended to offer financial assistance to disabled workers and their eligible dependents.  Typically, applicants must have earned income and paid Social Security taxes for at least five of the last ten years. However, this can change depending on an applicant’s age at the time they became disabled.  For more information regarding SSDI eligibility, visit the following page: http://www.disability-benefits-help.org/glossary/social-security-disability-insurance-ssdi.

SSI, on the other hand is intended for elderly, disabled, or blind individuals who earn very limited income. Eligibility for SSI is based on strict financial limitations put in place by the SSA.  For more detailed information regarding SSI technical eligibility, visit the following page: http://www.disability-benefits-help.org/glossary/supplemental-security-income-ssi.

Social Security Disability and Medical Eligibility Requirements
In addition to the SSDI and SSI technical eligibility requirements, applicants must also meet very specific medical requirements. Typically, medical requirements are listed in the SSA’s blue book. Essentially, the blue book is a publication maintained by the SSA that contains the medical criteria for all potentially disabling conditions.

Because lymphedema doesn’t always last the required 12 months, it is not listed in the SSA’s blue book.  However, individuals with severely disabling lymphedema may be able to qualify for benefits if they can meet the blue book criteria under a separate listing.

The following blue book listings may compare to the symptoms and side effects caused by lymphedema:

• Listing 1.02- Major Dysfunction of a Joint (Due to Any Cause): If lymphedema severely impairs your ability to use your arms or legs, you may qualify under this blue book listing.
• Listing 4.11—Chronic Venous Insufficiency: If lymphedema occurs in one or both of your legs and causes extreme swelling, you may be able to match this blue book listing.

If you do not match either of these blue book listings but are experiencing lymphedema as a result of cancer treatment, you may be able to qualify under the listing for your particular type of cancer.

See all blue book listings, here: http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

The Medical Vocational Allowance
If your condition does not match any blue book listings, you may still be able to qualify under something called a medical vocational allowance. Essentially, this means that based on your age, work history, and physical ability the SSA has decided that you are in fact disabled—despite failing to meet a blue book listing.
To learn more about medical vocational allowances, visit the following page: http://www.disability-benefits-help.org/glossary/vocational-factors.

Preparing for the Social Security Disability Application Process
The initial application for Social Security Disability benefits is made up of several forms. However, before you submit your application, it is important that you collect all of the medical and non-medical documentation that the SSA will look for. Having these documents prepared ahead of time can prevent any delays in your claim and potentially speed up the application process.
Non-medical documentation may include proof of birth, proof of citizenship or alien status, records of military service, and W-2 forms for the past year.
If you are applying for SSI, you will need detailed information regarding your financial income and assets. This may include pay stubs, tax returns, and any earning receipts. You will also be required to provide proof of your financial resources, including bank statements, insurance records, bonds, stocks, and vehicle registration. It is also smart to collect property tax bills, rent receipts, food bills, and utility bills.

Regardless of the type of benefits you apply for, you will need thorough medical documentation to support your claim. This should include record of your diagnosis, treatments, and the progression of your illness.  Collect any documentation of physical exams, surgical records, pathology reports, progress notes, lists of prescription medications, and any medical imaging tests.

Application Process
Once you are ready to begin the Social Security Disability application process, you will be able to do so online or in person at your local Social Security field office. After submitting your application, you may not receive a decision for several months.

While waiting for your decision, it is important that you are prepared to face the possibility of a denial. Continue with your prescribed medical treatments and collect copies of any new medical evidence.
While being denied is certainly overwhelming, it is not the end of the road. You are allowed to appeal this decision within 60 days of receiving your denial letter.
The appeals process is often a necessary step toward receiving disability benefits. In fact, many more individuals are approved during the appeals processes than during the initial application.  For more information about disability benefits, visit Social Security Disability Help (http://www.disability-benefits-help.org/blog).

Dear Lymphedema Blog Reader – if you like the contents on this website, please help to keep it going. A great amount of work and research is necessary to provide you with up-to-date information on this site. Your donation supports these efforts and associated administrative costs. Surplus funds will be donated to Lymphedema/Lipedema-related charitable endeavors. Please donate using the “Donate Now” button on the right upper hand of this page – Thank You!

Join Lymphedema Guru, a Facebook page solely dedicated to informing about all things related to lymphedema – news, support groups, treatment centers, and much more

Lymphedema affecting the chest, breast, and posterior thorax, also known as truncal lymphedema, is a common problem following breast cancer surgery, but is often difficult to diagnose, especially if the patient does not also present with lymphedema of the arm, or it may be dismissed as a side-effect of breast cancer surgery, which . . . → Read More: Lymphedema Affecting the Breast and Trunk]]>  

Lymphedema affecting the chest, breast, and posterior thorax, also known as truncal lymphedema, is a common problem following breast cancer surgery, but is often difficult to diagnose, especially if the patient does not also present with lymphedema of the arm, or it may be dismissed as a side-effect of breast cancer surgery, which will resolve by itself over time.

While truncal lymphedema is often not reported, poorly documented and available studies are not easy to compare, the literature suggests an incidence of up to 70% of lymphedema affecting the trunk and/or breast following breast cancer treatment.

Given the fact that the breast, anterior and posterior thorax and the upper extremity share the axillary nodes as regional lymph nodes, it is predictable that disruption of lymphatic drainage pathways by partial or complete removal of axillary lymph nodes, with or without radiation therapy can cause the onset of swelling in the chest wall and breast on the same side. The swelling can either be subtle or quite obvious in presentation and may be present with or without swelling in the arm.

The disruption of the natural lymphatic drainage pattern is further complicated by scars on the upper trunk wall following lumpectomy, mastectomy, and reconstructive breast surgery, biopsies or drain sites. Fibrotic tissues in the chest wall or armpit following radiation treatments may further inhibit sufficient lymphatic drainage.

Certain breast reconstructive procedures, such as the TRAM-flap reconstruction also disrupt lymphatic drainage in the abdominal area, which may cause the onset of additional swelling in the lower truncal (abdominal) area.

Like lymphedema in the extremities, swelling affecting the breast, chest and posterior thorax is typically asymmetrical in appearance if compared with the other side. However, there are often other symptoms present prior to the onset of visible swelling, which may include altered sensation (numbness, tingling, diffuse fullness and pressure, heat), pain and decreased shoulder mobility. Once lymphedema is visibly present, the swelling may include the entire thorax wall, or may be localized to the armpit, the scapula, the area over the clavicle or around mastectomy/lumpectomy scar lines, around the reconstructed breast or implants, or it may be limited to the breast tissue only.

The breast in patients who underwent lumpectomy or reconstructive surgery may be larger and heavier, or the shape and height of the breast tissue may change due to fibrotic tissue, resulting in added psychological distress due to problems involving clothing, bra fit and body image issues.

Post-operative swelling following breast cancer surgery is to be expected and generally lasts up to about three months; it appears almost immediately following surgery and places additional stress on the lymphatic system by contributing to the lymphatic workload. The difference between “normal” post-operative edema and lymphedema is its perseverance following the completion of treatment, and the presence of changes in tissue texture, such as lymphostatic fibrosis.

skin fold caliper

While several methods are available to assess truncal and breast edema (skin fold calipers, bio-impedance), subjective examination of the anterior and posterior aspect of the thorax and breast focused on the observation of signs of swelling (asymmetry, bra strap and seam indentations, orange peel phenomenon, changes in skin color), palpation of the tissue texture and comparison of skin folds between the affected and non-affected side, remain the most practical means for assessment of lymphedema affecting the trunk. Serial photographs depicting the anterior and posterior view are helpful tools in assessing changes before and after treatment.

Most of the symptoms associated with truncal lymphedema can be treated successfully with Complete Decongestive Therapy (CDT), to include Manual Lymph Drainage (MLD), especially if combined with self-MLD, skin care, exercises and compression therapy. Fortunately, truncal swelling responds well to treatment, often with markable improvement within 10 treatments. Treatment may be necessary only during the initial period following breast cancer treatment to facilitate edema removal and wound healing, or it may be applied at a later point; truncal lymphedema with or without the involvement of the arm may appear at any time following surgery for breast cancer.

Manual Lymph Drainage: In case of localized truncal lymphedema without involvement of the arm, MLD techniques concentrate on the neck, the anterior and posterior aspects of the upper trunk, as well as the inguinal lymph nodes, followed by techniques focused to redirect lymphatic fluid from congested areas into areas with sufficient lymphatic drainage. If necessary, additional techniques aimed to soften fibrotic tissues may also be applied.

For patients who underwent TRAM-flap procedures, careful attention should be given to address scar tissue that could lead to trapping of lymphatic fluid.

During the initial stages of the treatment, patients should be instructed in self-MLD and encouraged to perform self-treatment for at least 20-30 minutes daily.

Skin Care: Patients who have lymphedema are susceptible to infections of the skin; areas between skin folds or the underside of the breast are particularly prone to skin damage and infections. Edematous areas should be kept clean and dry and suitable ointments or lotions formulated for sensitive skin, radiation dermatitis and lymphedema should be applied.

Exercises: Truncal lymphedema is often associated with restrictions in thorax and shoulder movements, which should be evaluated by a Physical or Occupational Therapist. Specific exercises addressing these issues and to increase range of motion and function with daily activities should be performed.

Depending on the location and quality of scars, mobilization of adhered scar tissue by a qualified therapist may be necessary to improve range of motion. Breathing and aerobic exercises further facilitate decongestion by improving drainage in superficial and deep lymphatic pathways.

Compression Therapy: Oftentimes compression of the affected area may be challenging due to tenderness of the tissue, or irritated skin secondary to

compression bra

radiation therapy. However, in order to address fluid accumulation and to avoid worsening of the swelling, the application of compression bandages and/or compression bras or vests is very important. Compression bandages are applied circumferentially around the chest with special care not to impair blood supply to grafts and/or healing scars.

Due to the lack of muscle pump activity in the truncal area, the use of wide-width (15-20cm) medium and long-stretch bandages is preferable over the normally used short-stretch bandages for lymphedema affecting the extremities.

Custom cut or commercially manufactured foam pads or foam chips may be inserted underneath the bandages or compression bra/vest to increase localized pressure in areas of excess fluid pooling, or to soften localized fibrotic tissue. Flat foam pieces can be used to shape and stabilize the compression bandages and to distribute the pressure evenly over a greater surface area.

The patient should be fitted with a specially designed lymphedema bra or compression vest following decongestion of the trunk to assist with maintaining the positive results of CDT. Compression bras and vests have minimal seams and wide straps, are available as off-the-shelf or custom-made garments and ensure that the trunk and breast tissues are properly supported. Compression bras and vests should fit comfortably, provide sufficient support around the trunk and not squeeze breast tissue; pockets to accommodate a prosthesis can be sewn into these garments.

Patients using regular bras or sports bras should make sure to avoid narrow bra straps and obtain bra strap pads or wideners, if necessary, to avoid restriction of lymphatic pathways on the shoulder.

Additional Resources:
http://www.stepup-speakout.org/breast_chest_trunckal_lymphedema.htm

tp://www.lymphnet.org/membersOnly/dl/reprint/Vol.%2016/V16.N1.%20Truncal%20LE.pdfht

Dear Lymphedema Blog Reader – if you like the contents on this website, please help to keep it going. A great amount of work and research is necessary to provide you with up-to-date information on this site. Your donation supports these efforts and associated administrative costs. Surplus funds will be donated to Lymphedema/Lipedema-related charitable endeavors. Please donate using the “Donate Now” button on the right upper hand of this page – Thank You!

Join Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more

Endemic regions for filariasis

Lymphatic Filariasis (LF) is the primary cause for lymphedema worldwide and is a painful and extremely disfiguring disease, which has been identified by the World Health Organization (WHO) as a leading cause for permanent and long-term disability in the world. It is a tropical disease, endemic to more than . . . → Read More: What is Lymphatic Filariasis?]]>  

Endemic regions for filariasis

Lymphatic Filariasis (LF) is the primary cause for lymphedema worldwide and is a painful and extremely disfiguring disease, which has been identified by the World Health Organization (WHO) as a leading cause for permanent and long-term disability in the world. It is a tropical disease, endemic to more than 80 regions in Africa, India, Southeast Asia, and South America, as well as in the Pacific islands and the Caribbean. Lymphatic Filariasis is rare in the United States, but may be contracted by visiting endemic regions, such as tropical and subtropical regions of sub-Saharan Africa, Southeast Asia, India, the Pacific islands, and parts of the Caribbean and South America.

According to the WHO, 1.3 billion individuals are threatened by the disease and over 120 million people are currently affected, with about 40 million being disfigured by lymphedema and suffering from recurrent infections and other secondary conditions.

Filariasis is caused by three types of round parasitic filarial worms with Wucheria bancrofti being the most common type. The other types, Brugia malayi and Brugia timori are endemic to Southeast Asia.

Lymphatic Filariasis is transmitted to humans by different types of mosquitos that carry infective-stage larvae and bite an individual. During the bite, the larvae enter the wound and are deposited in the individuals’ skin; from there the parasitic larvae migrate to the lymphatic system, where over a period of 6-12 months they develop into adult worms and mate. Male and female worms live together and form “nests” in the nodes and vessels of the lymphatic system. Adult worms live for a period of about 4-6 years; male worms can grow 3-4 centimeters in length, whereas females can reach 8-10 centimeters.

Filariasis Transmission Cycle

The females produce millions of microscopic worms (microfilariae) during their lifetime, which circulate in the host’s bloodstream and are then again ingested by biting mosquitos. Once inside the mosquito, the microfilariae develop into infective-stage larvae, which then again are transmitted to other individuals, thus completing the transmission cycle.

Wucheria bancrofti

During the worms’ lifetimes inside the host’s lymphatic system, they produce dilation and damage to the lymphatics, restricting the normal flow of lymph, causing swelling, fibrosis and infections to lymph vessels and nodes (lymphangitis, lymphadenitis).

While infection with the larvae generally occurs in childhood of individuals living in endemic areas, the painful and disfiguring symptoms of this condition typically manifest later in life.

Lymphatic Filariasis may present asymptomatic, with no external signs of disfigurement or infection but sub-clinical lymphatic damage, acute (infections, fever, swelling), or chronic.

The chronic stage includes lymphedema, which can grow to monstrous proportions and may affect the extremities (most often the legs), breasts and the external genitalia (labia, scrotum and penis) causing pain, disability and sexual dysfunction.

Lymphatic Filariasis is typically diagnosed through blood tests detecting the presence of microfilariae in the blood, and antigen detection tests (ICT).

The primary treatment approach to individuals affected by Lymphatic Filariasis is pharmaceutical (diethylcarbamazine [DEC], albendazole and ivermectin) and aimed at the elimination of adult worms and circulating microfilariae, thus interrupting the transmission cycle.

Lymphatic Filariasis affecting the legs

Another important goal is to eliminate Lymphatic Filariasis as a public health problem by preventative measures using mass drug administration covering the entire at-risk population of a country. The goal of the Global Alliance to Eliminate Lymphatic Filariasis (GAELF) is to stop the spread of filarial infection and to eradicate this disease through distribution of free medication.  In order to interrupt the transmission of infection, mass drug administrations should be implemented in endemic regions for a duration of 4-6 years.

Foreigners visiting endemic countries are rarely infected; however, as a preventative measure mosquito bites should be avoided by sleeping under a mosquito net, using insect repellants, wearing long-sleeved shirts and long pants and refrain from being outside between dusk and dawn, when mosquitos are most active.

Lymphedema caused by Lymphatic Filariasis can be treated effectively with Complete Decongestive Therapy, if available. Other measures to improve lymphedema and infections are patient education in self-care including hygiene, skin care, compression therapy, exercises and elevation of the affected extremity.

Dear Lymphedema Blog Reader – if you like the contents on this website, please help to keep it going. A great amount of work and research is necessary to provide you with up-to-date information on this site. Your donation supports these efforts and associated administrative costs. Surplus funds will be donated to Lymphedema/Lipedema-related charitable endeavors. Please donate using the “Donate Now” button on the right upper hand of this page – Thank You!

Join Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more

Additional Resources:
Video from the Carter Center on the eradication of Lymphatic Filariasis

Video Lymphatic Filariasis by IAD

WHO Factsheet on Lymphatic Filariasis

Center for Disease Control and Prevention

Compression therapy, like manual lymph drainage (MLD), exercises, and skin care, is a main element of Complete Decongestive Therapy (CDT). In most cases of lymphedema, the elastic fibers in the skin tissues affected are damaged and unable to provide adequate resistance to the musculature working underneath and to the blood and lymph vessels . . . → Read More: The Role of Short-Stretch Bandages in the Management of Lymphedema]]>  

Compression therapy, like manual lymph drainage (MLD), exercises, and skin care, is a main element of Complete Decongestive Therapy (CDT).
In most cases of lymphedema, the elastic fibers in the skin tissues affected are damaged and unable to provide adequate resistance to the musculature working underneath and to the blood and lymph vessels within these tissues. External compression compensates for the elastic insufficiency of the affected tissue, providing the resistance necessary to maintain the reduction of the swelling and to prevent re-accumulation of lymphedematous fluid.

Compression bandages are used during the decongestive (intensive) phase of CDT. In this sequence of the treatment the volume of the affected limb changes almost on a daily basis, and it is necessary that external compression adapts to these changes. Bandages are much better suited for this task than compression garments (sleeves, stockings), which would have to be re-fitted constantly. Garments are used in the second phase of CDT, when the limb is decongested and volume changes are minimal.

Why short-stretch bandages?
Crucial in lymphedema management is to provide the skin tissues with a solid counterforce against the muscles working underneath, particularly while standing, sitting, walking, or performing therapeutic exercises. The subsequent increase in the tissue pressure during muscle activity promotes lymphatic and venous return and prevents fluid from accumulating in the skin. It is equally important to prevent the bandages from exerting too much pressure on the tissues during rest, which could cause a tourniquet effect and effectively prevent adequate return of these fluids.

There are two distinct types of compression bandages – short-stretch and long-stretch bandages. The difference refers to the extent the bandages can be stretched from their original length. Short-stretch bandages are made from cotton fibers, which are interwoven in a way that allows for about 60% extensibility of its original length, whereas long-stretch bandages, commonly known as “Ace” bandages contain polyurethane, which allows for an extensibility of more than 140% of the bandages’ original length.

The extent of which a bandage can be stretched specifies the two main qualities of pressure in compression therapy – the working pressure and the resting pressure. The working pressure is determined by the resistance the bandage provides against the working musculature underneath, and is active only during muscle activity, and therefore temporary. The pressure the bandage exerts on the tissues at rest, i.e. without muscle contraction is known as the resting pressure, which is permanent. Relevant to these pressure qualities are the number of bandage layers, the tension with which these layers are applied, and most importantly the type of bandage used.

The high working pressure of short-stretch cotton bandages provides the necessary solid counterforce and make them the preferred compression bandage in the management of lymphedema. Due to the low resting pressure of short-stretch bandages, tourniquet effects are prevented – provided these bandages are applied correctly.

Long-stretch (“Ace”) bandages have the exact opposite effect and are not suitable for lymphedema management. The low working pressure these bandages provide does not offer adequate resistance, and fluid would inevitably accumulate. In addition, the high resting pressure of long-stretch bandages could constrict veins and lymph vessels during rest.

Dear Lymphedema Blog Reader – if you like the contents on this website, please help to keep it going. A great amount of work and research is necessary to provide you with up-to-date information on this site. Your donation supports these efforts and associated administrative costs. Surplus funds will be donated to Lymphedema/Lipedema-related charitable endeavors. Please donate using the “Donate Now” button on the right upper hand of this page – Thank You!

Join Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more

During the past several years various techniques of elastic taping have become popular adjunct treatment modalities for lymphedema. While elastic taping has been applied for many years to treat conditions such as sports injuries or orthopedic problems, recent studies and patient reports indicate that this technique may also be a useful tool in . . . → Read More: Elastic Taping in Conjunction with the Treatment of Lymphedema]]>  

During the past several years various techniques of elastic taping have become popular adjunct treatment modalities for lymphedema. While elastic taping has been applied for many years to treat conditions such as sports injuries or orthopedic problems, recent studies and patient reports indicate that this technique may also be a useful tool in the treatment and management of lymphedema.

The original technique, Kinesio Taping®, was developed in the 1970s by the Japanese chiropractor Kenzo Kase. Based on this original technique a number of other taping variations have evolved, and different taping products were developed by a number of manufacturers. All taping products have very similar properties; manufactured with woven cotton fibers, the material has characteristic stretch properties that closely resemble the stretchability of the skin. It is held in place by a hypo-allergenic and latex-free medical-grade acrylic adhesive, which is heat-activated.Perforated with numerous holes the tape allows air to circulate, and while the tape’s cotton fabric will absorb water, the acrylic adhesive next to the skin is waterproof. This enables the patient to shower and swim with the material in place.

The idea behind the tape is to apply a gentle lift on the skin, which then allows the lymphatic vessels underneath to absorb and drain lymphatic fluid from the edematous area into an area with sufficient lymphatic drainage. The goal of this method is to re-direct the flow of lymph from a congested area into an area with sufficient lymphatic flow, thus reducing the volume of the edematous area.

Elastic tape is available in rolls of various widths, or pre-cut shapes; the length and pattern of the application depends on the individual situation and drainage pattern, and takes into consideration additional barriers such as scars and other defects on the skin.

The tape is applied to the skin with slight stretch (just to the tension required to remove the backing) and with the patient’s skin in stretched position. Once the skin returns to the resting position, the tape rebounds, and if applied correctly, rippling convolutions in the tape will become visible. This desired effect deforms the skin and slightly lifts it from the fascia below in order to create a pull force on the filaments anchoring the small lymph vessels within the tissues. This pull force creates openings in the wall of these vessels, which allows more fluid to enter the lymphatic system and subsequently increase lymphatic flow away from the swollen area. By positioning the tape correctly, it is possible to facilitate and channel the lymphatic fluid in the desired direction without restricting muscle and joint movements.

Additional stimulation of the lymphatic system is achieved as the patient performs movements in daily activities, or performs decongestive exercises as instructed by the lymphedema therapist. The tape can be worn several days as long as there are no negative reactions on the skin.

The fact that elastic tape can be worn underneath compression bandages and garments makes it an attractive addition to the gold standard for the treatment of lymphedema, complete decongestive therapy. It is particularly useful in areas affected by lymphedema where bandaging is difficult, or not possible, such as lymphedema affecting the head and neck (see also link “Use of elastic taping in the treatment of head and neck lymphedema” below).

As with any treatment modality for lymphedema, it is important to understand that the tape should be applied by a trained therapist with a thorough understanding of lymphedema. Local contraindications, such as adverse reactions to the tape, radiation fibrosis, wounds, lymphatic cysts and fistulas, as well the risk of damaging the fragile skin of lymphedema patients is a concern to be considered when using elastic taping.

The therapist will instruct the patient to properly remove the tape after several days. The adhesive bond of the tape is best broken by holding up an edge of the tape and gently pushing down on the skin to dislodge it from the adhesive. The use of oil helps to neutralize the adhesive, and removal of the tape in direction of the body hair minimizes the risk of skin irritation.

Dear Lymphedema Blog Reader – if you like the contents on this website, please help to keep it going. A great amount of work and research is necessary to provide you with up-to-date information on this site. Your donation supports these efforts and associated administrative costs. Surplus funds will be donated to Lymphedema/Lipedema-related charitable endeavors. Please donate using the “Donate Now” button on the right upper hand of this page – Thank You!

Join Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more

The Risk of Breast Cancer Related Lymphedema (BCRL) Over Time

Most women developing breast cancer-related lymphedema (BCRL) will do so within three years after breast cancer diagnosis.  Survivors not developing near-term BCRL retain a small lifetime risk. Norman et al (2009) found the five-year cumulative incidence of BCRL was 42%. Of the affected . . . → Read More: The Risk of Breast Cancer Related Lymphedema (BCRL) Over Time]]>  

The Risk of Breast Cancer Related Lymphedema (BCRL) Over Time

Most women developing breast cancer-related lymphedema (BCRL) will do so within three years after breast cancer diagnosis.  Survivors not developing near-term BCRL retain a small lifetime risk. Norman et al (2009) found the five-year cumulative incidence of BCRL was 42%. Of the affected women, 80% developed lymphedema within two years and 89% within three years (1). Petrek et al (2001) followed 263 patients after mastectomy and complete axillary dissection. At 20 years after treatment, 49% reported lymphedema. Of those, 77% noted onset within three years after surgery, and the remaining women developed arm swelling at a rate of almost 1% per year (2).

Breast cancer treatments and BCRL risk

BCRL risk factors seem to be additive: A woman with breast conserving surgery and no other treatment has less BCRL risk than a woman receiving breast conserving surgery with axillary node dissection and radiation. Increasing the number of nodes removed also increases BCRL risk (Paskett et al)(3). Sentinel node biopsy, which removes one to seven nodes, brings a lower risk than axillary node dissection, when 25 or more nodes might be removed. Shah and Vicini (2011) summarized incidence ranges with various treatments, in their BCRL-study review: (4)

ALND = axillary node dissection   SLN=sentinel node   RT=radiation therapy

Most BCRL studies focus on arm lymphedema, which is readily measured once past Stage 0, or subclinical BCRL. However, many breast cancer patients develop lymphedema of the breast or trunk, with or without arm lymphedema. One year after surgery, Ronka et al (2004) found breast edema identified by clinical examination in 48% of patients with axillary clearance/ positive nodes; in 35% with axillary clearance/ negative nodes; and in 23% with sentinel node biopsy. Using ultrasound, they found subcutaneous breast edema in 69-70% of the axillary clearance node patients and 28% of the sentinel node biopsy patients (5). Sentinel node biopsy reduces arm lymphedema risk compared to axillary clearance, but it poses a significant risk for breast lymphedema.

Additional cancer and related factors that influence BCRL risk

Additional factors include cancer stage at diagnosis, chemotherapy, seroma, and cording. Kwan et al (2010) found both advanced stage breast cancer and chemotherapy to be associated with increased BCRL risk (6).  Fu et al (2011) found that patients with seroma requiring needle aspiration had 7.78 and 10.64 times the odds of developing arm swelling and chest/breast swelling, respectively, compared to patients without symptomatic seroma (7). Cording (axillary web syndrome) is the appearance of painful cord-like structures below the skin in an affected arm.

Getting Breast Cancer Related Lymphedema (BCRL) on patients’ and providers’ radar screens: The benefits of education plus early diagnosis and treatment

Providing patient education, coupled with appropriate surveillance and intervention post-breast cancer treatment, can limit the incidence and progression of BCRL, preventing needless impairment of patient quality of life and reducing direct . . . → Read More: The Benefits of Education Plus Early Diagnosis and Treatment of Breast Cancer Related Lymphedema]]>  

Getting Breast Cancer Related Lymphedema (BCRL) on patients’ and providers’ radar screens: The benefits of education plus early diagnosis and treatment

Providing patient education, coupled with appropriate surveillance and intervention post-breast cancer treatment, can limit the incidence and progression of BCRL, preventing needless impairment of patient quality of life and reducing direct and secondary treatment costs.

Fu et al (2010) (1) determined that breast cancer patients who received information about BCRL had significantly reduced BCRL symptoms when compared with patients who did not receive information. The researchers concluded that patient education is one predictor of BCRL outcome. Women who received information about BCRL were significantly less likely to report arm swelling, arm heaviness, impaired shoulder mobility, seroma formation and breast swelling. This raises the question of whether BCRL education may help patients circumvent avoidable risk factors and subsequent development of BCRL.  In an earlier study of the link between patient education and lymphedema risk-reduction behaviors, Fu et al (2008) (2) found that only 57% of breast cancer patients had been given any information about lymphedema.

In a discussion of BCRL risks, Torres et al (3) found that post-surgical intervention including manual lymph drainage, scar massage, and shoulder exercises reduced the incidence of lymphedema after breast cancer surgery.  Todd et al (2008) (4) found that delaying shoulder exercises by one-week post-surgery reduced BCRL incidence, suggesting that the timing of ‘early’ exercise has significant implications for managing BCRL risk after breast-cancer surgery.

Stout Gergich et al (2008) (5) demonstrated the effectiveness of using preoperative baseline measures, coupled with early and very frequent postoperative measures to identify BCRL using Bioimpedance Spectosgrophy (BIS) and perometry, a very sensitive measurement technology. They also determined that  women placed in compression sleeves at the earliest sign of swelling (a 3% volume increase compared to the preoperative baseline measure) could achieve significant volume reductions in about four weeks, and these reductions were sustained through the study follow-up period (averaging 4.8 months). The researchers concluded that a short trial of compression garments effectively treated subclinical lymphedema.

No studies are available to quantify the medical cost savings of early diagnosis and treatment, but it is clear that a diagnosis of BCRL adds significantly to breast cancer patients’ medical care costs.  Shih et al (2009) (6) used insurance claims data to study the cost of treatment of breast cancer patients with BCRL, compared to medical costs of breast cancer patients without BCRL. The study was limited to a period of two years after initiation of each patient’s cancer treatment. Researchers found that the BCRL group had significantly higher medical costs ($8,290 more) and was twice as likely to have lymphangitis or cellulitis compared to the non-BCRL group.

Patients studied by Shih undoubtedly continued to incur costs to treat BCRL and infections, beyond the study period, because BCRL that advances becomes a chronic condition.

Key Points:

• Patient education about BCRL and its risks may help patients avoid certain risk factors and reduce associated symptoms.
• Early post-surgical intervention with MLD, scar massage, and appropriately timed exercise has been shown to reduce BCRL incidence.
• Detecting BCRL when pre-clinical, and providing conservative compression therapy have been shown to result in speedy, sustained volume reductions.

The costs to treat advanced BCRL are significant, and of course, when BCRL advances, it impairs patients’ quality of life.

Dear Lymphedema Blog Reader – if you like the contents on this website, please help to keep it going. A great amount of work and research is necessary to provide you with up-to-date information on this site. Your donation supports these efforts and associated administrative costs. Surplus funds will be donated to Lymphedema/Lipedema-related charitable endeavors. Please donate using the “Donate Now” button on the right upper hand of this page – Thank You!

Join Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more

1. Fu, MR, Chen, CM, et al (2010) The effect of providing information about lymphedema on the cognitive and
symptom outcomes of breast cancer survivors, Annals of Surgical Oncology, 17:1847-1853.

2. Fu, MR, Axelrod, D, Haber, J. (2008) Cancer-related lymphedema: Information, symptoms, and risk-reduction behaviors, Journal of Nursing Scholarship, 40(4):341-348.

3. Torres Lacompa, M, Yuse Sanches, MJ, et al.(2010) Effectiveness of early physiotherapy to prevent lymphedema after surgery for breast cancer: randomized, single blinded, clinical trial, BMJ 340:b5397.

4. Todd J, Scally A, et al. (2008) A randomized controlled trial of two programmes of shoulder exercise following axillary node dissection for invasive breast cancer, Physiotherapy, 94: 265-273

5. Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P. (2008) Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer, 112:2809-2819.

6. Shih YC, Xu Y, Cormier JN et al. (2009) Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: A 2-year follow-up study, Journal of Clinical Oncology, 27 (12).

7. Bioimpedance Spectroscopy for Assessment of Breast Cancer-Related Lymphedema: A Systematic Review. Plast Surg Nurs 2020 Apr/Jun;40(2):86-90.doi: 10.1097/PSN.0000000000000306.

I would like to share with you an excellent video covering Lipedema.

Lipedema is a painful fat disorder and if left untreated can cause multiple secondary health problems, to include mobility issues and Lymphedema.  The quality of life, emotionally and physically, for individuals affected by Lipedema is often decreased due to the fact . . . → Read More: Lipedema – Video and Information]]>  

I would like to share with you an excellent video covering Lipedema.

Lipedema is a painful fat disorder and if left untreated can cause multiple secondary health problems, to include mobility issues and Lymphedema.  The quality of life, emotionally and physically, for individuals affected by Lipedema is often decreased due to the fact that the condition is typically dismissed as simple obesity by clinicians unfamiliar with the symptoms.  Many women are affected by this disorder, often without knowing why their legs and hips are growing bigger with lumpy, painful fat.

This short video on Lipedema (Lipoedema in the UK) covers the causes of this disorder, the effects of Lipedema on the lymphatic system and current treatment options.  It includes patients,  researchers  and medical personnel who are on the leading edge of creating awareness and treatment options.

Watch this video by clicking here

Another good video on the symptoms of Lipedema

More articles:
A closer look at Lipedema and it’s effects on the lymphatic system

Differences between Lipedema and Lymphedema

You can also go to  Lipedema-simplified  for more information.

Dear Lymphedema Blog Reader – if you like the contents on this website, please help to keep it going. A great amount of work and research is necessary to provide you with up-to-date information on this site. Your donation supports these efforts and associated administrative costs. Surplus funds will be donated to Lymphedema/Lipedema-related charitable endeavors. Please donate using the “Donate Now” button on the right upper hand of this page – Thank You!

Join Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more

Chronic lymphedema is considered a progressive condition, regardless of whether it is classified as primary or secondary, and cannot simply be described as an accumulation of protein-rich fluid. It is a chronic degenerative and inflammatory process affecting the soft tissues, skin, lymph vessels, and nodes, and may result in severe and often disabling . . . → Read More: Stages of Lymphedema]]>  

Chronic lymphedema is considered a progressive condition, regardless of whether it is classified as primary or secondary, and cannot simply be described as an accumulation of protein-rich fluid. It is a chronic degenerative and inflammatory process affecting the soft tissues, skin, lymph vessels, and nodes, and may result in severe and often disabling swelling.
Lymphedema may present in the extremities, trunk, abdomen, head and neck and external genitalia and can develop anytime during the course of a lifetime in primary cases; secondary cases may occur­ immediately following the surgical procedure or trauma, within a few months, a couple of years, or twenty years or more after treatment.

Lymphedema progresses through stages, and treatment intervention in early stages (stage 0 and stage I) has been shown to result in very good treatment outcomes if managed appropriately (1).

There are four stages of lymphedema

Click here for a short video explaining the stages of lymphedema

Stage 0, also known as latent stage or subclinical stage of lymphedema

In this stage the transport capacity of the lymphatic system is reduced, but the remaining lymph vessels are sufficient to manage the flow of lymph, and swelling is not visibly present.

Examples include individuals who underwent surgeries for malignancies, such as breast cancer, cancer affecting the genitourinary and gynecologic systems, cancers in the head and neck region, melanoma or soft tissue malignancies. These procedures generally include the removal of lymph nodes with subsequent disruption of lymphatic pathways.
A condition known as lymphangiopathy is present if the reduction in the transport capacity of the lymphatic system is caused by pathology affecting the lymphatic system directly in form of a developmental abnormality (malformations, as in primary lymphedema). In this case lymphedema is not clinically present as long as the lymphatic system is able to cope.

In stage 0 patients may experience early symptoms, such as the feeling of numbness, tingling or fullness in a limb, which is often accompanied by low-grade discomfort. It may be difficult to fit into clothing, and watches, rings or bracelets may feel tight. This subclinical stage can exist for months, or years, before any more serious signs appear. The onset of lymphedema correlates to the ability of the lymphatic system to compensate for the reduced transport capacity and any added stress to the system that may cause an increase in the volume of lymphatic fluid.

Perometer

Early diagnosis and appropriate treatment of lymphedema is of paramount importance to limit progression of the swelling and to avoid complications often associated with untreated or incorrectly treated lymphedema; several studies have shown that patients’ self-reported symptoms are very accurate indicators of early lymphedema. While subclinical lymphedema can be detected using methods such as bioimpedance (2) and perometry (3), these technologies are not yet widely available.

Treatment intervention in this early and easily manageable stage has been shown to result in very good treatment outcomes using simple, non-custom compression garments (4).

Stage I, also known as pitting or reversible stage

Body parts such as the arms or legs are visibly swollen as protein-rich fluid starts to accumulate in the tissues. In many cases, the swelling subsides with elevation and the limb may appear normal in the morning; however, as soon as the limb is in a dependent position, the swelling returns. Pitting is easily induced by pressing with the thumb, and the indentation produced by this pressure is retained for some time.

While an increase in proliferating cells (increase in fibrous connective tissue) may be present, this early stage lymphedema is considered reversible because the skin and tissues have not yet been permanently damaged. With proper management it is possible for the patient to expect reduction of the extremity to a normal size (compared with the uninvolved limb). Without proper treatment, progression to the next stage is unavoidable in the vast majority of the cases.

Stage II, also known as spontaneously-irreversible stage

It is important to point out that the stage of lymphedema is not defined by size, but rather by the consistency of the tissues. This stage is primarily identified by tissue proliferation with subsequent thickening and hardening of the soft tissues. In many cases the swelling increases and elevation of the limb rarely reduces the swelling; pitting is evident. Over time, the tissue continues to harden and excess fatty tissue begins to form and pitting becomes difficult to induce.

A reduction in volume can be expected if proper treatment is initiated in this stage. In most cases, the excess fibrotic tissue typical in this stage will not recede during the intensive phase of complete decongestive therapy (CDT). Reduction in tissue fibrosis is mainly achieved in the second phase of CDT with proper compression and good patient compliance.

Stage III, also known as lymphostatic elephantiasis

Lymphedema often stabilizes in stage II. However, if lymphedema remains untreated, protein-rich fluid continues to accumulate, leading to further increase of swelling, sometimes resulting in extreme proportions. Hardening of the tissue continues and further deposition of fat it present. In this state, pitting is absent and the swollen body part becomes a perfect culture medium for bacteria and subsequent recurrent infections (lymphangitis) are frequent. Moreover, untreated lymphedema can lead into a decrease or loss of functioning of the affected extremity, skin breakdown and sometimes irreversible complications.

Reduction can still be expected if treatment starts in this stage. In most cases the duration of the intensive phase of complete decongestive therapy has to be extended and repeated several times. In extreme cases the surgical removal of excess skin following the conservative therapy may be indicated (5).

Dear Lymphedema Blog Reader – if you like the contents on this website, please help to keep it going. A great amount of work and research is necessary to provide you with up-to-date information on this site. Your donation supports these efforts and associated administrative costs. Surplus funds will be donated to Lymphedema/Lipedema-related charitable endeavors. Please donate using the “Donate Now” button on the right upper hand of this page – Thank You!

Join Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more

1. Torres Lacompa, M, Yuse Sanches, MJ, et al.(2010) Effectiveness of early physiotherapy to prevent lymphedema after surgery for breast cancer: randomized, single blinded, clinical trial, BMJ, 340:b5397.

2. The use of bioimpedance analysis to evaluate lymphedema

4. Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P. (2008) Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer, 112:2809-2819.

5. Chronic Lymphedema – Treatment and Surgical Options

Lipedema is a chronically progressive, symmetrical accumulation of fat in the subcutaneous tissue occurring almost exclusively in women. Primarily, the lower extremities are affected, but lipedema may occur in combination with the upper extremities as well. Lipedema is characterized by symmetric enlargement of the limbs, combined with tenderness and easy bruising.

Lipedema is . . . → Read More: Differences between Lipedema and Lymphedema]]>  

Lipedema is a chronically progressive, symmetrical accumulation of fat in the subcutaneous tissue occurring almost exclusively in women. Primarily, the lower extremities are affected, but lipedema may occur in combination with the upper extremities as well. Lipedema is characterized by symmetric enlargement of the limbs, combined with tenderness and easy bruising.

Lipedema is not caused by a disorder of the lymphatic system; however, it is commonly misdiagnosed as bilateral primary lymphedema.

Several marked differences between lipedema and primary lymphedema can be distinguished; these differences are highlighted in the table below.

Lipedema

While lipedema always affects both legs symmetrically (bilateral appearance), primary lymphedema usually affects one leg only. If both legs are involved in primary lymphedema the swelling appears asymmetric (see image on bottom of this article). The feet are not involved in pure lipedema; the symmetrical distribution of fat is located between the hips and the ankles.
In contrast, the feet in lymphedema are involved in the swelling, and a diagnostic indicator known as the Stemmer sign is positive (see image below).
The Stemmer sign is a diagnostic test that involves pinching the skin on the upper surface of the toe (usually second toe) or fingers. If a fold of skin can be pinched and lifted up at the base of the second toe or middle finger, the Stemmer sign is negative. The Stemmer sign is positive and indicative of lymphedema when a skin fold cannot be lifted, but can only be grasped as a lump of tissue. This sign  will become positive if lipedema develops into lipo-lymphedema. Circumstances that can lead to lipedema developing into lymphedema are explained in a previous post.
Tissue in lipedema has a soft rubber-like feel in early stages and may include small fatty lumps (nodules) within the tissues in

Fatty nodules in lipedema

later stages. Pressure with the thumb does not leave an indentation (no pitting) in lipedema. Lymphedema is pitting and the tissue feels firmer that the one in lipedema, especially with fibrotic tissue typically being present starting in stage 2. The cause for the onset of lymphedema are malformations of the lymphatic system, while he underlying cause for the development of lipedema remains unknown; it is thought to be associated with hormonal disorders.

Differences at a Glance

Stemmer sign; positive on left

Primary bilateral lymphedema

Dear Lymphedema Blog Reader – if you like the contents on this website, please help to keep it going. A great amount of work and research is necessary to provide you with up-to-date information on this site. Your donation supports these efforts and associated administrative costs. Surplus funds will be donated to Lymphedema/Lipedema-related charitable endeavors. Please donate using the “Donate Now” button on the right upper hand of this page – Thank You!

 Join Lymphedema Guru, a Facebook page solely dedicated to informing about all things related to lymphedema – news, support groups, treatment centers, and much more

Additional Reading:

https://wellroundedmama.blogspot.com/2015/06/lipedema-part-1-lipedema-vs-lymphedema.html?m=1&fbclid=IwAR1bSy81LRZfbDGlrfrMfL9v2mJLMlptrDt8N4O2WZvuSvRYrHrZ4SFOsAc