Lymphedema is a common late effect of cancer treatment in the head and neck region and may develop in a variety of external and internal anatomical locations of the head and neck.

As with lymphedema affecting other areas of the body, most often the upper and lower extremities, secondary lymphedema of the head . . . → Read More: Secondary Lymphedema of the Head and Neck]]> Tweet 

Lymphedema is a common late effect of cancer treatment in the head and neck region and may develop in a variety of external and internal anatomical locations of the head and neck.

As with lymphedema affecting other areas of the body, most often the upper and lower extremities, secondary lymphedema of the head and neck is caused by a disruption of the normal flow of lymph following surgery and/or radiation for cancer treatment. Impaired lymphatic function is often exaggerated by the formation of scar tissue.

The swelling can be just as severe as those experienced by individuals following treatment of breast and other types of cancer. Lymphedema in patients with head and neck cancer can be very disfiguring, cause functional problems and severely impact the quality of life.

A recently published study on the percentage of the population (prevalence) affected by secondary lymphedema after head and neck cancer treatment from the School of Nursing at Vanderbilt University in Nashville, TN (1) included 81 patients with head and neck cancer who were three months or more post treatment. The study reported that of these 81 patients, 75.3% (61 of 81) had some form of late-effect lymphedema of the head and neck region. Of those, 9.8% (6 of 61) only had external, 39.4% (24 of 61) only had internal, and 50.8% (31 of 61) had lymphedema affecting both internal and external structures.

Another study from the University of Pennsylvania School of Medicine (2) reports that out of a study population of 270 patients, 30% of whom were treated with radiation therapy, 9% with surgery alone, and 61% with surgery and radiation therapy, the neck was the most common site of lymphedema (89%), followed by the submental (below the chin) (84%), facial (32%), and intraoral (6%) areas. Some patients had more than one affected area.

Lymphatic Drainage Pattern Head and Neck

The swelling may involve the eyes, face, lips, neck, or the area below the chin (submandibular), and is usually more pronounced at night or other times of the day when the patient is lying down. In many cases the swelling recedes somewhat during the day when the patient is in an upright position due to lymphatic fluid draining from the head and neck region following the forces of gravity.  The swelling is often associated with discomfort or tightness in any of the affected areas, nasal congestion, or decreased vision because of swollen eyelids.
Other functional sequelae may include difficulty swallowing, speaking, or breathing (airway obstruction), drooling or loss of food from the mouth while eating.

Secondary lymphedema of the head and neck, as well as other functional after-effects of cancer treatment in the head and neck region can be significantly improved with complete decongestive therapy (CDT) (2). CDT should be performed by a well-trained lymphedema therapist.
Therapists specializing in the treatment and management of head and neck lymphedema will use a combination of treatment options, to include manual lymph drainage to manually move stagnated lymphatic fluid from the head and neck area into other areas with sufficient lymphatic drainage, skin care, specific exercises and adequate compression therapy, which may involve compression bandages and specific compression garments.

Therapists will also give advice on prevention and managing lymphedema following the treatment phase and instruct patients in necessary self-treatment protocols.

The therapeutic benefit achieved with CDT can often be considerably enhanced by facial exercises, chewing (gum), and meticulous oral hygiene and sleeping in a semi-upright position to counter the negative effects of gravity during times of rest.

Depending on the location, severity and chronicity of the swelling compression garments for the face are available as neck and chin straps, and partial or full-face masks, which generally include openings for the eyes, nose or mouth.

Custom-made facemasks generally provide firmer and more durable compression, but often have a long turnaround time and are costly to produce. Facemasks made of other materials (often used in burn care and post-facial surgery) are available in a variety of standard sizes and offer a more cost effective solution if the edema is not severe, but tend to be less durable.

It is crucial that the patient’s airway is not obstructed with use of the garment and careful consideration must be given to the coverage chosen.

(1) http://www.ncbi.nlm.nih.gov/pubmed/21802897
(2) http://www.medpagetoday.com/MeetingCoverage/MHNCS/18779

FurtherReading:
1.http://www.cancer.net/patient/All+About+Cancer/Cancer.Net+Feature+Articles/Side+Effects/Head+and+Neck+Lymphedema%A+Swelling+After+Cancer+Treatment
2. http://www.medpagetoday.com/MeetingCoverage/MHNCS/18779
3. http://www.lymphedemapeople.com/thesite/lymphedema_of_the_neck.htm

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Manual lymph drainage (MLD) is a gentle manual treatment technique based on four basic strokes, which were initially developed in the 1930’s by Dr. Emil Vodder, a PhD from Denmark. These basic strokes known as the “stationary circle”, “pump”, rotary” and “scoop” techniques are designed to manipulate lymph nodes and lymphatic vessels with . . . → Read More: The Science behind Manual Lymph Drainage in the Treatment of Lymphedema]]> Tweet 

Manual lymph drainage (MLD) is a gentle manual treatment technique based on four basic strokes, which were initially developed in the 1930’s by Dr. Emil Vodder, a PhD from Denmark. These basic strokes known as the “stationary circle”, “pump”, rotary” and “scoop” techniques are designed to manipulate lymph nodes and lymphatic vessels with the goal of increasing their activity and promote the flow of lymph.

Movement of Lymph Fluid in Lymph Vessels

The common denominator of all strokes is the resting and working phase. In the working phase of the stroke lymphatic structures located in subcutaneous tissues are stretched, resulting in an increase of their activity (lymphangiomotoricity). In addition to increased lymphatic activity, the light directional pressure in the working phase of the strokes causes lymphatic fluid to move in the desired direction, thus contributing to the reduction of the swelling.

Certain MLD strokes are designed to manipulate lymph vessels located in the subcutaneous tissues of larger body surfaces, such as the trunk, other techniques are better suited to be applied on contoured surfaces, such as the extremities.

Stationary circle: This technique consists of an oval-shaped stretching of the skin with the palmar surfaces of the fingers or the entire hand. Stationary circles can be applied with one hand, or bimanually and are used on the entire surface of the body, but mainly on lymph node groups (axilla and groin), the neck and the face.

Pump technique: The entire palm and the proximal (upper) phalanges are used to apply a circle-shaped pressure on the skin, operating within almost the full range of motion in the wrist. Pumps are primarily used to manipulate lymph vessels located in the extremities and can be applied with one hand or bimanually.

Rotary technique: This stroke is used on large body surface areas, such as the trunk. The entire surface of the hand and fingers are used in an elliptical movement during the working phase. Like the scoop technique, rotaries are applied dynamically, meaning the working hand moves over the surface of the treated body part in a continuous fashion. If applied bimanually, the techniques are alternating.

Scoop technique: Scoops are applied mainly on the lower parts of extremities and consist of a spiral-shaped movement. During the working phase, which can be applied with one or both hands, the palmar surface of the hand moves dynamically over the skin. The hand movement is facilitated by transitional movement in the wrist, combined with forearm pronation and supination.

Lymph Vessels in the Skin

Compared to traditional massage, the pressure applied with manual lymph drainage is much lower in intensity. The goal of these techniques is to manipulate the lymphatic structures located in the subcutaneous tissues. In order to achieve the desired effect, the pressure in the working phase should be sufficient enough to stretch the subcutaneous tissues against the fascia (a structure separating the skin from the muscle layer) located underneath, but not to manipulate the underlying muscle tissue. The amount of pressure needed in MLD is sometimes described as the pressure applied stroking a newborn’s head.

In the resting phase of the stroke the pressure is released, which supports the absorption of lymph fluid into lymph vessels. To achieve the maximum effect with each technique, the working phase with every stroke should last about one second and should be repeated five to seven times.

The overall goal of MLD in the treatment of lymphedema is to re-route the flow of stagnated lymphatic fluid around blocked areas into more centrally located healthy lymphatic vessels, which eventually drain into the venous system.

In the case of upper extremity lymphedema caused by breast cancer surgery, it is necessary to re-route the flow of stagnated lymph in the subcutaneous tissues of the arm around the blocked axillary area towards and into the axillary lymph nodes on the opposite side and the inguinal lymph nodes on the same side the surgery was performed. These groups of lymph nodes represent the drainage areas for the stagnant lymph fluid located in the affected upper extremity and need to be manipulated prior to initiating the treatment of the arm itself.

In the case of lower extremity lymphedema the stagnated lymphatic fluid is generally re-routed around the blocked inguinal (groin) area towards and into the inguinal lymph nodes of the opposite side and the axillary lymph nodes on the same side of blockage. As with lymphedema affecting the upper extremity, these groups of lymph nodes represent the drainage area for the stagnated lymph fluid and need to be manipulated prior to starting treatment of the leg.

The manipulation of these drainage areas with MLD strokes creates a “suction effect” in the healthy lymph vessels located in the drainage areas, which enables accumulated lymph fluid to move from a region with insufficient lymphatic drainage into an area with normal lymphatic drainage, and eventually back into the venous system.

Following this preparation, the extremity itself is treated in segments; the proximal (upper) aspect of the affected extremity is decongested prior to expanding the treatment to the more distal (lower) aspect of the arm or leg. This segmented approach ensures that lymph vessels located in more proximal areas of the extremity are properly prepared to handle incoming lymphatic fluid from areas located more distally.

In order to prevent reaccumulation of the fluid evacuated from the extremity, it is necessary that the MLD treatment is followed up with compression, which depending on the stage of treatment, is applied either with specialized padded bandages or compression garments.

Manual lymph drainage presents a unique opportunity for health care professionals to specialize and opens the door to treat and manipulate a variety of conditions associated with dysfunctions of the lymphatic system. However, the unique techniques of manual lymph drainage deviate considerably from traditional manual techniques and therefore require specialized training.

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Lymphedema is considered one of the most distressing and debilitating complications of breast cancer treatment and affects at least three million Americans. The underlying problem of lymphedema is a lymphatic dysfunction, resulting in abnormal accumulation of water and proteins primarily in the subcutaneous tissues, which can cause the onset of visible and palpable . . . → Read More: The Role of Complete Decongestive Therapy in Breast Cancer Related Lymphedema]]> Tweet 

Lymphedema is considered one of the most distressing and debilitating complications of breast cancer treatment and affects at least three million Americans. The underlying problem of lymphedema is a lymphatic dysfunction, resulting in abnormal accumulation of water and proteins primarily in the subcutaneous tissues, which can cause the onset of visible and palpable swelling.

This condition underlines the crucial importance of a functioning lymphatic system, which returns water, protein and lipids from the interstitial spaces back to the venous bloodstream via the venous angles, located bilaterally on the subclavian-internal jugular vein junctions.

Lymphedema most often affects the extremities and while generally only one arm or leg is involved, sometimes both arms and legs may be swollen. In addition to the extremities lymphedema may also present in the trunk, abdomen, head and neck, external genitalia and inner organs.

Estimated numbers on the incident of lymphedema reported in the literature are inconsistent; 140-250 million cases of lymphedema are estimated to exist worldwide. Most individuals in developed countries develop lymphedema following surgery and/or radiation for various cancers. In the  United States the highest incidence is observed following breast cancer surgery (mastectomy, lumpectomy), particularly among those individuals who undergo radiation therapy following the removal of axillary lymph nodes.

Breast cancer is the leading type of cancer among women in the United States. Based on the National Cancer Institute’s cancer statistics report (2005-2007), 12% of women (or one out of eight) in the United States will develop breast cancer at some point in their lives. A women’s chance of developing breast cancer increases with age and the majority of breast cancer cases occurs in women over 50 years of age. Younger women tend to have more aggressive forms of breast cancer, which may be the reason why survival rates among younger women are lower.

Removal and/or radiation of axillary lymph nodes in the treatment of breast cancer can result in a disruption of the normal flow of lymph from the upper extremity and upper trunk quadrant, which represent the tributary areas for the axillary lymph nodes. This blockage can cause accumulation of lymph fluid in these areas, resulting in secondary lymphedema.

There is no consistency in reports concerning incidence and prevalence of lymphedema following breast cancer surgery. According to the National Cancer Institute, the overall incidence of upper extremity lymphedema can range from 8% to 56% two years following the surgery.

Post-mastectomy secondary upper extremity lymphedema may occur immediately following surgery, within a few months, a couple of years, or 20 or more years after surgery. Its onset is gradual in some individuals and sudden in others. In general it can be said that studies with longer post-operative follow-up show higher incidence and more severe swelling.

Lymphedema presents one of the most serious complications of breast cancer treatment because of its long-term physical and psycho-social consequences for affected individuals. Its cosmetic deformities are difficult to hide and if left untreated, the swelling continues to progress. Complications, such as cellulitis can occur frequently especially in untreated or mistreated cases of lymphedema.

Because of the progressive nature of lymphedema, it is of paramount importance to initiate treatment as soon as possible. While there is no cure for lymphedema, the condition of lymphedema can be effectively controlled and maintained with treatment focusing on reducing the swelling and controlling pain.

Complete decongestive therapy (CDT) represents the international gold standard for lymphedema therapy; it is a low-cost, highly effective and non-invasive modality specifically geared towards the reduction and management of lymphedemateous and related swellings. CDT is endorsed by all major national and international societies concerned with the management of lymphedema as the standard of care and consists of a combination of various treatment modalities, to include manual lymphatic drainage (MLD), compression therapy, decongestive exercises and skin care.

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Sheila H. Ridner, PhD, RN, FAAN, Associate Professor at the Vanderbilt University School of Nursing asked me to share with you a call to individuals affected by lower extremity lymphedema to participate in a fully on-line study regarding symptoms experienced by these patients. Anyone with lower limb swelling can participate; names are not . . . → Read More: Lower Extremity Lymphedema Symptom Online Survey]]> Tweet 

Sheila H. Ridner, PhD, RN, FAAN, Associate Professor at the Vanderbilt University School of Nursing asked me to share with you a call to individuals affected by lower extremity lymphedema to participate in a fully on-line study regarding symptoms experienced by these patients. Anyone with lower limb swelling can participate; names are not being collected with the data.

Lower Limb Lymphedema Symptom Survey

Vanderbilt University School of Nursing inNashville,Tennesseeis conducting a study to learn about symptoms related to lower limb lymphedema.

If you suffer from lymphedema or swelling in your legs and are over 18 years of age, you may be eligible to take part in this study. You will be completing a one-time survey for development of an assessment tool for lower limb lymphedema symptoms. This survey will take about 25 minutes to complete.

If you are interested, please contact Nancy Kidd at Nancy.Kidd@vanderbilt.edu or the Principal Investigator, Dr. Sheila H. Ridner, PhD, RN, FAAN, Associate Professor at Vanderbilt University School of Nursing, 525 Godchaux Hall, Nashville, TN 37240, 615-322-0831 at Sheila.Ridner@vanderbilt.edu

Anyone, anywhere who has access to the internet and is eligible can be in this study.

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As of this writing, HR 2499 has 62 cosponsors!  Please help us reach our goal of getting to 100 this year.  At the end of this newsletter you’ll find the cosponsor list as of this publication – if you do not see your Representative’s name please write again at your earliest convenience, using the . . . → Read More: A Message from the Lymphedema Treatment Act]]> Tweet 

As of this writing, HR 2499 has 62 cosponsors!  Please help us reach our goal of getting to 100 this year.  At the end of this newsletter you’ll find the cosponsor list as of this publication – if you do not see your Representative’s name please write again at your earliest convenience, using the link to the left.

You’ll notice that the template letter on the submission form has been changed to mention the March 6th Lymphedema Awareness Day, and that it makes a special plea for Representatives to sign on as cosponsors this month.  It is also shortened in the hopes that you will each personalize the letter – this makes such a difference.

In an effort to make sure every office is reached, we are looking for volunteers to write all of the Representatives in their state, in addition to their own. This can be done by simply submitting multiple letters through our website, selecting a different Representative each time.  Or, I can email you the template letter along with all of the email addresses for the offices in your state, so you can simply copy and paste and send these from your personal email.  Please let me know if you would like this information.

Regarding finding a sponsor for the bill in the Senate, we are still working on this.  Three offices have contacted Congressman Kissell’s office (our House sponsor) with interest.  They are Cardin of Maryland, Merkley of Oregon and Inouye of Hawaii.  But so far none have officially decided to sponsor a companion bill, so please also write your Senators using the link to the left, especially if you are a constituent of one of the three Senate offices I named.

And lastly, a big thank you to those who responded to last month’s call for volunteers.  As a result, one such person offered her services as a translator and we now have a Spanish version of our flyer, which can be seen and downloaded here:

http://lymphedematreatmentact.org/wp-content/uploads/2012/02/LE_Bill_1page_info_sheet_Spanish.pdf.  

Upon request, you can also now receive a copy of this Newsletter in Spanish.  

Thanks for your continued support,
Heather Ferguson
Chair, Lymphedema Advocacy Group
www.LymphedemaTreatmentAct.org
info@LymphedemaTreatmentAct.org

Cosponsors of HR 2499 as of March 1, 2012:

Rep Baca, Joe [CA-43] – 1/17/2012 
Rep Berkley, Shelley [NV-1] – 12/15/2011 
Rep Berman, Howard L. [CA-28] – 12/12/2011 
Rep Blumenauer, Earl [OR-3] – 7/12/2011 
Rep Brown, Corrine [FL-3] – 7/12/2011 
Rep Chu, Judy [CA-32] – 12/14/2011 
Rep Coble, Howard [NC-6] – 7/12/2011 
Rep Cohen, Steve [TN-9] – 12/7/2011 
Rep Connolly, Gerald E. “Gerry” [VA-11] – 7/12/2011 
Rep Conyers, John, Jr. [MI-14] – 8/23/2011 
Rep Courtney, Joe [CT-2] – 2/28/2012 
Rep DeFazio, Peter A. [OR-4] – 1/17/2012 
Rep Ellison, Keith [MN-5] – 2/27/2012 
Rep Farr, Sam [CA-17] – 12/8/2011 
Rep Filner, Bob [CA-51] – 1/17/2012 
Rep Frank, Barney [MA-4] – 7/12/2011 
Rep Gonzalez, Charles A. [TX-20] – 12/13/2011 
Rep Grijalva, Raul M. [AZ-7] – 7/13/2011 
Rep Gutierrez, Luis V. [IL-4] – 7/13/2011 
Rep Heinrich, Martin [NM-1] – 1/31/2012 
Rep Holt, Rush D. [NJ-12] – 7/12/2011 
Rep Honda, Michael M. [CA-15] – 11/14/2011 
Rep Israel, Steve [NY-2] – 8/9/2011 
Rep Jackson, Jesse L., Jr. [IL-2] – 7/12/2011 
Rep Johnson, Eddie Bernice [TX-30] – 1/23/2012 
Rep Kildee, Dale E. [MI-5] – 1/23/2012 
Rep King, Peter T. [NY-3] – 7/13/2011 
Rep Lance, Leonard [NJ-7] – 8/1/2011 
Rep Latham, Tom [IA-4] – 9/7/2011 
Rep LaTourette, Steven C. [OH-14] – 1/27/2012 
Rep Lee, Barbara [CA-9] – 7/20/2011 
Rep Loebsack, David [IA-2] – 1/17/2012 
Rep Lofgren, Zoe [CA-16] – 9/8/2011 
Rep Lowey, Nita M. [NY-18] – 9/29/2011 
Rep Lujan, Ben Ray [NM-3] – 2/1/2012 
Rep Maloney, Carolyn B. [NY-14] – 8/1/2011 
Rep McCollum, Betty [MN-4] – 1/31/2012 
Rep McDermott, Jim [WA-7] – 1/6/2012 
Rep McGovern, James P. [MA-3] – 11/18/2011 
Rep McIntyre, Mike [NC-7] – 10/26/2011 
Rep Michaud, Michael H. [ME-2] – 7/12/2011 
Rep Miller, Brad [NC-13] – 7/12/2011 
Rep Moore, Gwen [WI-4] – 7/12/2011 
Rep Norton, Eleanor Holmes [DC] – 7/12/2011 
Rep Paul, Ron [TX-14] – 7/12/2011 
Rep Payne, Donald M. [NJ-10] – 2/27/2012 
Rep Peterson, Collin C. [MN-7] – 9/7/2011 
Rep Posey, Bill [FL-15] – 2/27/2012 
Rep Price, David E. [NC-4] – 7/12/2011 
Rep Rangel, Charles B. [NY-15] – 7/12/2011 
Rep Richardson, Laura [CA-37] – 7/12/2011 
Rep Roe, David P. [TN-1] – 7/12/2011 
Rep Rothman, Steven R. [NJ-9] – 11/14/2011 
Rep Schiff, Adam B. [CA-29] – 7/12/2011 
Rep Smith, Christopher H. [NJ-4] – 12/6/2011 
Rep Speier, Jackie [CA-12] – 9/23/2011 
Rep Tonko, Paul [NY-21] – 9/14/2011 
Rep Towns, Edolphus [NY-10] – 2/6/2012 
Rep Tsongas, Niki [MA-5] – 11/16/2011 
Rep Walz, Timothy J. [MN-1] – 11/30/2011 
Rep Wasserman Schultz, Debbie [FL-20] – 11/14/2011 
Rep Woolsey, Lynn C. [CA-6] – 10/25/2011

The heart and blood vessels represent the main components of the circulatory system, which consists of an elaborate network of tubes throughout the body. The circulatory system involves the combined functioning of the heart, blood and blood vessels to deliver oxygen and nutrients to organ systems and tissues, and to remove waste products . . . → Read More: Comparison of Blood and Lymph Vessels]]> Tweet 

The heart and blood vessels represent the main components of the circulatory system, which consists of an elaborate network of tubes throughout the body. The circulatory system involves the combined functioning of the heart, blood and blood vessels to deliver oxygen and nutrients to organ systems and tissues, and to remove waste products resulting from metabolism.

The lymphatic system is composed of an intricate system of lymphatic vessels and lymphatic tissues including lymph nodes, spleen and thymus. The main purpose of lymphatic vessels is to absorb and return lymph fluid from the body back to the blood, and to assist in the body’s immune function.

Blood Vessels
Three types of blood vessels can be differentiated. Arteries carry blood away from the heart, and veins carry blood toward the heart. Capillaries are the smallest links between arteries and veins and are formed by small arteries, called arterioles branching out to become progressively smaller in diameter. The thin wall of the capillaries enables an exchange of oxygen and nutrients into the body tissues and absorption of carbon dioxide and waste products back into the blood circulatory system.
In order to withstand the high pressure of blood pumped from the heart, arteries have a thicker wall and a better developed system of smooth muscles in their walls compared to veins. The blood pressure in the veins is much lower, and the smooth musculature in the walls of veins is not as well developed as it is in arteries. Due to the lower pressure (compared to the pressure in arteries), there is a chance of pooling of blood in the venous system, which is prevented by functioning one-way valves inside the veins to support blood flow against gravity toward the heart.

Lymph Vessels
The lymphatic system is closely associated with the blood system and represents an accessory route by which lymph fluid can flow from the body’s tissues back into the blood stream. Lymph vessels can be categorized into lymph capillaries, precollectors, lymph collectors and lymphatic trunks. Lymph capillaries represent the beginning of the lymphatic drainage system and originate in close proximity to blood capillaries. Lymph capillaries resemble blood capillaries but have a more irregular cell structure, and their walls are more permeable than those of blood capillaries. Because of their unique structure, lymph capillaries are able to absorb larger particles from the tissues, such as proteins, cells, bacteria and other large substances, which cannot be absorbed by blood capillaries. These particles, together with water then travel through an intricate network of precollectors and larger lymph collectors and trunks back into the blood circulation via the venous angles, which are comprised of the internal jugular and subclavian veins on either side of the neck.
On its way back to the blood, lymphatic fluid travels through a successive number of lymph nodes, which filter out impurities from the lymph.

Main Differences between Blood and Lymph Vessels
The circulatory system represents a closed system with the heart as its central motor, and blood and blood vessels as the other structural elements. The main purpose of the blood vessels is the uninterrupted supply of all body tissues with nutrients and oxygenated blood, and the removal of metabolic waste and carbon dioxide from the tissue cells. The part of the circulatory system that delivers blood to and from the lungs is known as the pulmonary circulation, and the flow of blood throughout the rest of the body is administered by the systemic circulation.

The lymphatic system and its vessels do not form a closed circulatory system. It begins with small lymphatic vessels (lymph capillaries) in the body tissues, and continues with successively larger lymphatic vessels (collectors and trunks), which ultimately connect to the venous part of the blood circulatory system. There is no central pump, lymph vessels produce their own propulsion system with a network of smooth musculature located in the walls of lymph collectors and trunks. Since the lymph vessels work according to the one-way principle and not as a closed circulatory system, it is more appropriate to speak of lymph transport rather than lymph circulation. While the flow of blood through the blood vessels is uninterrupted, the transport of lymph fluid through the lymph vessel system is interrupted by lymph nodes.

Additional Resources:

Cancerquest: Anatomy of the Lymphatic System -
LymphNotes; Understanding the Lymphatic System

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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 skin tissues affected by lymphedema are damaged and unable to provide adequate resistance against the musculature working underneath, and the blood and lymph vessels . . . → Read More: The Role of Short-Stretch Bandages in the Management of Lymphedema]]> Tweet 

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 skin tissues affected by lymphedema are damaged and unable to provide adequate resistance against the musculature working underneath, and 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 lymphedemateous 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 provide 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.

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Manual lymph drainage (MLD) is one of the main components of complete decongestive therapy (CDT).  In combination with compression therapy, skin and nail care and decongestive exercises, MLD performs the crucial role of re-routing stagnated lymphatic fluid, which is essential in the treatment and management of primary and secondary lymphedema. This gentle manual . . . → Read More: Manual Lymph Drainage and it’s Role in the Treatment of Lymphedema]]> Tweet 

Manual lymph drainage (MLD) is one of the main components of complete decongestive therapy (CDT).  In combination with compression therapy, skin and nail care and decongestive exercises, MLD performs the crucial role of re-routing stagnated lymphatic fluid, which is essential in the treatment and management of primary and secondary lymphedema. This gentle manual treatment technique is based on four basic strokes, which were first described by Dr. Emil Vodder (1896-1986), PhD.

The goal of MLD is to stimulate healthy lymph vessels and lymph nodes, which generally are located adjacent to the area of non-functioning or blocked lymphatic drainage, and to re-route the lymph flow around these blocked areas into more centrally located healthy lymph vessels and nodes. This is achieved with specific stretches and manipulations – a common denominator in all MLD strokes – to the skin and those structures located directly beneath the skin, the subcutaneous tissues.

The resulting increase in lymphatic activity in the healthy areas creates a “suction effect”, which stimulates the accumulated fluid present in lymphedema to move into an area with normal lymphatic drainage.

What is the difference between MLD and traditional massage?

It is unfortunate that the term massage is often wrongly used to describe MLD. The origin of the word massage is derived from the Greek massain (to knead) and is used to describe such techniques as effleurage, petrissage, vibration, etc. Massage techniques traditionally are applied to treat ailments in muscle tissues, tendons and ligaments, and in order to achieve the desired effect, these techniques are generally applied with considerable pressure.

Cross section through skin, subcutis and muscle layer

MLD on the other hand is a very gentle manual technique, designed to have an effect on fluid components and lymphatic structures located in superficial tissues, i.e. the skin and the subcutis. Lymphedema almost exclusively manifests itself in the subcutis, which is a layer of connective tissue between the skin and muscle tissues.

The only commonality between MLD and traditional massage is that both techniques are applied manually. There are significant differences in technique, pressure and indications for which these two therapeutic measures are used.

There are a number of reasonable explanations why MLD and massage are often confused with each other. One is that there is a tendency to call any hands-on manual therapeutic technique a form of massage; the other is that massage can be very helpful if applied to treat edema.

However, lymphedema and edema are two very different conditions and it is important to understand the differences. Although both conditions involve swelling, edema and lymphedema have very different causes and are treated differently. A previous blog post “When is it Lymphedema?” compares these two conditions:

Additional Resources:
http://www.lymphedemapeople.com/thesite/edema_or_lymphedema.htm

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In a support group, members provide each other with various forms of help, usually non-professional and non-material. They can be a crucial tool for individuals who share the common diagnosis of lymphedema to come together and share coping tips, experiences, news, and most importantly emotional support.

The help and information received in lymphedema . . . → Read More: The Importance of Lymphedema Support Groups]]> Tweet 

In a support group, members provide each other with various forms of help, usually non-professional and non-material. They can be a crucial tool for individuals who share the common diagnosis of lymphedema to come together and share coping tips, experiences, news, and most importantly emotional support.

The help and information received in lymphedema support groups may take the form of providing and evaluating relevant information on treatment modalities, self-care, relating personal experiences, listening to and accepting others’ experiences, providing sympathetic understanding, and establishing social networks.

While providing important emotional support, support groups are more than just a safety net for the patient. In fact, they can even improve the physical health and wellness of participants. Members of an established support group not only serve as educators for individuals newly affected by lymphedema, but also inform the public about lymphedema, engage in advocacy, or can serve as a clearing house for disseminating news of important advancements or therapies.

The primary goal of most groups is to ensure that no one affected by lymphedema ever has to feel alone again.

Most support groups are facilitated by individuals who have personal experience with lymphedema and became advocates for others. These groups may have regularly scheduled meetings, or exchange information via online forums.

There are also professionally operated support groups, which are facilitated by professionals who do not share the problem of the members, such as lymphedema therapists, social workers, psychologists, or members of the clergy. In these settings the facilitator controls discussions and provides other relevant information; such professionally operated groups are often found in hospitals or lymphedema treatment centers.

Many times we receive phone calls and messages from individuals asking about lymphedema support groups in their area. If we are unable to locate a support group for the inquiring individual, we generally refer them to the National Lymphedema Network (NLN), which has a listing of ongoing support groups in their quarterly publication LymphLink and a Support Group Locator search function for groups in the U.S. and links to international support groups on their website.
The Support Group Locator can be accessed by clicking the “Support” tab on the top menu of this page.

Individuals can also list their support group with the NLN by submitting a support group listing application.

In order to increase access to support groups we urge you to list your support group with the NLN.

Other important resources include StepUp-SpeakOut, a support and advocacy group for individuals affected by lymphedema and Lymphedema People, a resource for people with lymphedema, created by people with lymphedema.

Please also feel free to share your support group information here on LymphedemaBlog, or on Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more.

Dear Practicing Lymphedema Therapist,

The American Lymphedema Framework Project (ALFP) invites you to participate in their second biennial online survey. The ALFP is a national initiative developed under the leadership of recognized clinical experts and investigators in the field of lymphedema. As a collaboration of health care providers, researchers, educators, patients, and industry . . . → Read More: Call to Lymphedema Therapists to Participate in Online Survey]]> Tweet 

Dear Practicing Lymphedema Therapist,

The American Lymphedema Framework Project (ALFP) invites you to participate in their second biennial online survey. The ALFP is a national initiative developed under the leadership of recognized clinical experts and investigators in the field of lymphedema. As a collaboration of health care providers, researchers, educators, patients, and industry representatives, the ALFP will develop and evaluate appropriate health care services for patients with all forms of lymphedema and advance the quality of lymphedema care both in theUnited Statesand worldwide.

This survey was developed under the leadership of the ALFP research committee chaired by Dr. Electra Paskett and co-chaired by Dr. Mei Fu with input by expert clinicians on the ALFP steering committee. The answers you provide on the survey will be used for research purposes only and are strictly anonymous. Your answers will be evaluated for statistical purposes only. Your input will assist the ALFP in understanding current practices of lymphedema care in the United States today, and will move forward the ALFP goals of evaluating appropriate health care services and improving quality of care for patients with lymphedema. As a practicing lymphedema therapist, your participation is valuable in this worthwhile endeavor. Please participate in 2011 whether you participated in 2009 or not. The survey will remain open until November 30, 2011.

To access the survey, please go to http://www.alfp.org and click on the “LE Therapist Survey” tab on the left. This website will provide directions for completing the survey online, via email, or by mail. The survey will take approximately 20 minutes to complete. The ALFP sincerely thanks you for your participation!