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!

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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!

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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!

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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!

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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

Lipedema is characterized by symmetric enlargement of the limbs, generally affecting the lower extremities extending from the hips to the ankles secondary to the deposition of fat; upper extremities are affected in 30% (1) of the cases.

Lipedema is not rare and not caused by a disorder of the lymphatic system, but is . . . → Read More: A Closer Look at Lipedema and the Effects on the Lymphatic System]]>  

Lipedema is characterized by symmetric enlargement of the limbs, generally affecting the lower extremities extending from the hips to the ankles secondary to the deposition of fat; upper extremities are affected in 30% (1) of the cases.

Lipedema is not rare and not caused by a disorder of the lymphatic system, but is commonly misdiagnosed as bilateral lymphedema, extreme cellulitis, or morbid obesity.

Most commonly used synonyms for lipedema include:

• Adiposalgia/Adipoalgesia
• Adiposis dolorosa
• Lipalgia
• Lipomatosis dolorosa of the legs
• Lipodystrophia dolorosa
• Painful column leg

This condition almost exclusively affects women; according to an epidemiologic study by Földi E. and Földi M.(2), lipedema affects 11% of the female population, and literature suggests that lipedema is associated with extensive hormonal disorders or liver dysfunctions if present in males.

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.

The underlying cause for the development of lipedema remains unknown; it is thought to be associated with hormonal disorders and can be hereditary with 14% of affected individuals having a family history of lipedema (3). Lipedema can develop early in puberty; however, the mean age of diagnosis is approximately 35.

Lipedema can be diagnosed based on clinical criteria (history, typical clinical features) and by physical examination rather than with diagnostic tests.

Clinical Features:

• Symmetrical distribution of fat between the hips and ankles, the feet are not involved
• Ring of fatty tissue overlapping the tops of the feet
• Tissue has a soft rubber-like feel in early stages
• Initially, the skin color is normal
• Typical bulges of fatty tissue on the medial thigh (above the knee and close to the groin) are seen in later stages
• Small fatty lumps (nodules) within the tissues start to form in later stages
• In the early stages of lipedema the upper part of the body may be slender
• Weight loss does not have an effect on the areas affected by lipedema
• Swelling (edema) is common in the second half of the day and includes the feet but decreases in the early stage with elevation and night-time rest.
• Pain, tenderness, sensitivity to pressure
• Easy bruising

The additional swelling that develops in the later hours of the day in lipedema is of particular interest and is indicative for the involvement of the lymphatic system if lipedema remains without proper management.

Corkscrew-like appearance of lymph collectors in lipedema

The excessive amount of fatty tissue present in lipedema compresses the lymph collectors of the superficial lymphatic system, which are embedded in the fatty subcutaneous tissue. Lymphangiographic imaging shows that the lymph collectors within the proliferated fatty tissue have a coiled or corkscrew-like appearance rather than passing fairly straight towards the lymph nodes as is the case in healthy tissue. This can result in a reduced transport capacity of the lymphatic system in the affected area.

If the capacity of the lymphatic system is reduced to such an extent that it becomes unable to perform one of its basic functions, the removal of water from the tissues, fluid will accumulate and “real” edema develops in addition to lipedema.
In the initial stages the swelling may recede with elevation and rest, but over time and without adequate treatment (compression, elevation, exercise), the constant strain on the lymphatic system may cause damage to the lymphatic vessels, leading to further reduction of its transport capacity, and swelling may be constantly present.

Lipo-lymphedema

As a result of prolonged overstrain of the lymphatic system, lymphedema may develop secondary to lipedema (lipo-lymphedema), thereby increasing the complexity of treatment. If lipo-lymphedema remains without treatment, it will progress through the same stages as primary or secondary lymphedema.

Treatment

Active treatment for lipedema is necessary; early diagnosis and treatment can determine long-term prognosis. Therapy for lipedema can be largely divided into conservative treatments to reduce edema, and surgical treatments such as liposuction.
Main goals in the conservative treatment of lipedema are to decrease pain and hypersensitivity, increase mobility and to prevent, or if already present, to address the edematous component associated with lipedema. If lipedema, or lipo-lymphedema is associated with obesity, nutritional guidance must be provided to reduce weight and avoid further weight gain.

Conservative approaches include complete decongestive therapy (CDT); CDT does not address proliferated fatty tissue but contributes to the reduction of edema and the prevention of the manifestation of lipo-lymphedema. The various components of CDT also contribute to reducing pain and hypersensitivity to pressure.
In most cases it is necessary to apply a lower level of compression (bandages and compression garments) due to pain and hypersensitivity in the affected areas. Compression garments generally have to be custom-made to the individuals’ measurements; however, some manufacturers offer lipedema garments in a number of standard sizes (4). If the use of compression garments is discontinued, edema will return.

Surgical treatment may be considered for patients with lipedema who do not respond to conservative treatment. Liposuction is currently the standard surgical treatment method; however, this procedure may cause bleeding and secondary damage to lymph vessels resulting in persistent swelling. New and more advanced techniques may reduce these risks; however, individuals considering this approach should ensure that the performing physician is experienced and follows internationally established guidelines.

Postoperatively, there is generally an increased tendency for swelling, thus CDT should be initiated or continued within a few days of the procedure.

In the presence of additional lymphedema (lipo-lymphedema) the treatment protocol for complete decongestive therapy corresponds with that for primary lymphedema. CDT shows good long-term results in lipo-lymphedema; however, affected individuals need to understand that although the lymphedemateous component responds well and generally relatively fast to CDT, the lipedema itself, i.e. the reduction of fatty tissue responds more slowly, and sometimes not at all. According to several authors, reduction of the excessive fatty tissue in lipedema is possible if compression garments are worn constantly.

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) Herpertz, U. (1995) Das Lipödem. Lymphologie19, 1-11

(2) Földi, E., and Földi, M. (2006) Lipedema. In Földi’s Textbook ofLymphology (Földi, M., and Földi, E., eds) pp. 417-427, Elsevier GmbH,Munich,Germany

(3) Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S, Mortimer PS. Lipedema: an inherited condition. Am J Med Genet A. 2010;152A:970–976. [PubMed]

(4) BRSENSATION.pdf

Additional Reading:

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309375/

Lymphedema is caused by a blockage or dysfunction of the lymphatic system, causing a disruption of the normal flow of lymph fluid, which may result in swelling affecting various parts of the body. Lymphedema most commonly presents in soft tissues of arms and legs; however, it may also affect the trunk, abdomen, head . . . → Read More: Complications of Lymphedema]]>  

Lymphedema is caused by a blockage or dysfunction of the lymphatic system, causing a disruption of the normal flow of lymph fluid, which may result in swelling affecting various parts of the body. Lymphedema most commonly presents in soft tissues of arms and legs; however, it may also affect the trunk, abdomen, head and neck, exterior genitalia and inner organs.

Individuals affected by lymphedema may encounter a number of problems, which can be either attributed to other pathologies (comorbidities) that may be present in addition to existing lymphedema and further exacerbate its symptoms, or secondary complications which may develop as a result of stagnated lymphatic fluid. Secondary complications are common to lymphedema, especially if the swelling is left untreated, and often contribute to the progression of this common and serious disorder.

Comorbidities that may aggravate existing lymphedema
The presence of certain comorbidities may worsen or aggravate the symptoms associated with lymphedema or may present an added obstacle in the treatment for lymphedema. Additional fluid retention associated with cardiac or venous insufficiencies frequently cause an increase in swelling, especially in lymphedema affecting the lower extremities. Certain orthopedic comorbidities, Cording (Axillary Web Syndrome) or obesity limiting the mobility of joints or affecting musculoskeletal activity may negatively impact the decongestive exercise regimen, which is an imperative part in the treatment and management of lymphedema. To successfully treat lymphedema, it is necessary to address the symptoms associated with comorbidities and to incorporate appropriate modifications to the treatment protocol.

Complications resulting from bacterial or fungal infections
The lymphatic system plays an important role in the body’s immune defense; any disruption in lymph flow may result in reduced immune surveillance. Lymphedema is defined as a high-protein swelling; the accumulation of water and protein molecules creates an ideal breeding environment for pathogens in the affected tissues. This often results in a high susceptibility to infections in tissues affected by lymphedema.

Cellulitis, an acute infection of the skin and subcutis, is a common complication associated with lymphedema. Cellulitis is characterized by fever, diffuse redness, tenderness, pain and edema, and is treated with antibiotics. Lymphedema patients suffering from recurring episodes of cellulitis may be placed on prophylactic antibacterial therapy and be required to use antibiotics as a preventative.

Fungal infections are also common in lymphedema and most often affect the skin and nails in lower extremities. In order to avoid spreading, treatment of any fungal infection precedes lymphedema therapy.

Complications on the skin
When lymphedema remains untreated, protein continues to accumulate and contributes to a progressive hardening of the soft tissues, known as lymphostatic fibrosis. This hardening is caused by a proliferation of connective tissue cells and can be compared to scar tissue. This hardening of the soft tissue can be successfully reversed with appropriate lymphedema treatment.
Other skin complications include lymphatic cysts, blister-like formations on the surface of the skin, which develop due to lymphatic blockage. Lymphatic cysts contain lymph fluid and can easily break open, thus presenting an entryway for pathogens. It is recommended to cover lymphatic cysts with sterile gauze to avoid damage and possible secondary infections.

Lymphedema and the risk of malignancies
Angiosarcoma is a rare form of a malignant tumor that may develop as a result of long-standing lymphedema. It may involve the upper or lower extremities and has a tendency to metastasize quickly. Angiosarcoma initially appears as a bruise-like discoloration on the surface of the skin, progressing into ulcerations and tissue necrosis involving the skin and surrounding soft tissues.

Psycho-social implications
Lymphedema is disfiguring and often painful and disabling. It can negatively impact the emotional, vocational, recreational and financial aspects of the patient’s life.  Most individuals affected by lymphedema are able to continue a normal life; however, some patients experience depression, anxiety, and impairments related to their intimate, work, and social relationships.
While lymphedema may be caused by developmental abnormalities of the lymphatic system (primary lymphedema), the highest incidence of lymphedema in the United States is observed following cancer surgery including the removal and/or radiation of lymph nodes (secondary lymphedema). The fact of being diagnosed with cancer and the often sterile and impersonal nature of cancer care can be devastating and exact an additional toll on the patient’s emotional well-being.

Group and individual counseling by the lymphedema therapist or physician can be helpful to patients coping with lymphedema. Counseling should include specific information about preventive measures, the role of diet and exercise, advice for selecting comfortable and concealing clothing, and emotional support.

Risk reduction
Lymphedema caused by surgery and/or radiation may occur directly after or months, even years following the procedure. Certain activities and situations may trigger the onset of lymphedema, exacerbate the symptoms of existing lymphedema, or cause infections in the affected tissues. Caregivers, to include physicians, lymphedema therapists and nurses play a crucial role in the prevention of complications associated with lymphedema by educating the patient about signs and symptoms of acute inflammatory episodes and risk reduction guidelines.

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!

Additional Resources:
Mayo Clinic – Complications of Lymphedema
U.S. National Library of Medicine: Incidence and Complications of Lymphedema
The Psycho-Social Impact of Lymphedema: S. Ridner, Ph.D.
Breastcancer.org: How to avoid Lymphedema
E-Medicine: Treatment of Lymphedema
National Cancer Institute: Treatment of Lymphedema
National Lymphedema Network: What is Lymphedema
National Lymphedema Network: Treatment of Lymphedema

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Compression therapy, applied using padded short-stretch bandages, compression garments, along with alternative materials such as adjustable compression devices or sequential compression devices, is an integral part of lymphedema management. The goal of compression therapy is to maintain and improve the reduction of the swelling achieved during lymphedema treatments.

It is significant to recognize that . . . → Read More: Compression Therapy and its Role in the Treatment of Lymphedema]]>  

Compression therapy, applied using padded short-stretch bandages, compression garments, along with alternative materials such as adjustable compression devices or sequential compression devices, is an integral part of lymphedema management. The goal of compression therapy is to maintain and improve the reduction of the swelling achieved during lymphedema treatments.

It is significant to recognize that although the swelling in lymphedema may be reduced to a normal or near normal size during treatments, the damage to the lymphatic system, which caused the onset of lymphedema, is permanent. In addition to the underlying damage to the lymphatic system, the elastic fibers in the tissues affected by lymphedema are damaged as well. These fibers lose their elasticity and tend to harden, especially in extreme cases (lymphostatic elephantiasis) and untreated lymphedema present over a long period of time. Without correct long-term management the evacuated fluid, in most cases, will reaccumulate in the affected body part.

Compression garments by themselves will not reduce existing swelling and should therefore not be worn on an untreated, swollen extremity. Patients with lymphedema graduate from padded short-stretch bandages, which are applied by the lymphedema therapist in the intensive phase of complete decongestive therapy (CDT) to elastic compression garments only when the affected extremity is decongested.

Compression garments, much like hearing aids or eyeglasses, become part of the patient’s life and have to be worn on a daily basis in order to preserve the treatment success achieved during the decongestion of the edematous limb.

Bandage Liner

Some individuals may benefit from alternative and adjunct compression systems that can be used in combination with traditional compression garments or bandages. Short-stretch bandages applied by the therapist during the intensive phase of CDT may be combined with bandage liners that are filled with foam particles and “built-in” channels to help direct the flow of lymph; swell spots can be used underneath compression bandages for added compression in localized swelling, or to protect bony prominences.

Strapping systems, which provide gradient compression by use of low-stretch adjustable bands, can be used as an alternative for individuals having difficulty donning compression garments.

Adjustable Strapping System

Manufacturers of compression garments provide a wide variety of styles and variations, such as sleeves, gauntlets, stockings, pantyhose, vests, etc. They can be ordered in a large selection of standard sizes and different compression classes, which are determined either by the physician or the lymphedema therapist. Adjustable strapping systems for upper and lower extremities are also available in a variety of  styles and sizes and while most patients’ measurements will fit within the parameters of the manufacturer’s standard sizes, some compression garments and strapping systems have to be ordered custom made. The correct size of the garment needs to be determined by the lymphedema therapist, or a certified fitter.

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!

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Chronic venous insufficiency (CVI) is an advanced stage of venous disease that occurs when the inner lining of the veins and/or the valves located within the larger veins are not working sufficiently, causing venous blood to collect or “pool” in the veins (venous stasis).

The blood pressure inside the thin-walled veins is considerably . . . → Read More: Chronic Venous Insufficiency and the Effects on the Lymphatic System]]>  

Chronic venous insufficiency (CVI) is an advanced stage of venous disease that occurs when the inner lining of the veins and/or the valves located within the larger veins are not working sufficiently, causing venous blood to collect or “pool” in the veins (venous stasis).

The blood pressure inside the thin-walled veins is considerably lower than the pressure in the arteries. A system of valves inside the larger veins prevents pooling of venous blood in the lower extremities and helps ensure that the venous blood is transported back to the heart efficiently. A sufficient return of venous blood to the heart would not be possible without the help of the muscle and joint pumps, diaphragmatic breathing and the suction effect of the heart during its relaxation phase (diastole). Together with a functioning valvular system in the veins, these supporting mechanisms propel the venous blood back to the heart.

Chronic venous insufficiency develops most commonly as a result of blot clots in the deeper veins of the legs. This condition, known as deep venous thrombosis (DVT), results in changes in the fluid dynamics in the veins and causes the pressure in the veins to increase and the system of valves to become insufficient. If the venous blood pressure stays elevated over long periods of time, chronic venous insufficiency develops. Chronic venous insufficiency resulting from DVT is also known as post-thrombotic syndrome; as many as one of every three individuals affected by DVT will develop this problem within five years after diagnosis (1).

Symptoms and signs of CVI

The problems associated with CVI do not disappear without treatment and the complexity of treatment increases as the disease progresses. Untreated CVI can lead to serious complications, to include lymphedema, and early diagnosis and treatment is of utmost importance. A specialized physician should be consulted as soon as the following symptoms are present:

• Swelling in the lower legs and ankles, especially after extended periods of standing. This is often the first sign and caused by the pooling of venous blood
• Heavy, tired, aching or restless legs
• New varicose veins
• Leathery-looking skin on the legs
• Flaking or itching skin on the legs or feet
• Stasis ulcers (or venous stasis ulcers) generally around the ankles, that won’t heal

These symptoms are caused by a condition known as ambulatory venous hypertension, which is itself a result of obstruction inside veins, retrograde (“backward”) venous flow (reflux), or a combination of these. The deficient valves in the veins in CVI fail to prevent the retrograde flow of venous blood during muscle pump activity, specifically the activity of the calf musculature during walking (ambulatory). Muscle activity in the legs applies outside pressure to the veins and a functioning system of valves forces the venous blood upward and towards the heart while walking and prevents backflow. In CVI the blood is not only forced upward towards the heart during muscle activity, but also “backwards” causing the pressure in the veins of the lower leg to increase even more (ambulatory venous hypertension).

This pathological increase in pressure subsequently has an effect on the blood capillaries, and more fluid is filtered from the blood into the tissues. It is the lymphatic system’s responsibility to compensate for the increased amount of tissue fluid by increasing its activity; this is also known as the lymphatic safety function. If the lymphatic system, despite working to its maximum capacity, is not able to cope with the additional fluid, edema develops in the leg.

In the initial stages this swelling may recede with elevation and rest, but over time and without adequate treatment (compression, elevation, exercise), the constant strain on the lymphatic system may lead to damage to the lymphatic vessels, leading to reduction of its transport capacity. This condition, described as combined venous and lymphatic insufficiency, has serious consequences, and without treatment the symptoms associated with CVI and ambulatory venous hypertension will gradually worsen, and the condition will progress through the following stages.

Stage 0 – subclinical stage

As long as the lymphatic system is able to compensate for the increase in tissue fluid resulting from venous hypertension, affected individuals remain free of edema, but may experience other symptoms typically associated with CVI (see above).

Stage 1 – phlebo-lympho-dynamic insufficiency (Edema)

The lymphatic system works to its maximum capacity, but is unable to drain the elevated fluid resulting from the ambulatory venous hypertension. The lymphatic system is still healthy, but experiences overload, which is also known as dynamic insufficiency of the lymphatic system. Edema develops over the course of the day.
In the early stages the lymphatic system is able to “catch up” with the excess fluid in the tissues during rest at night and the edema tends to decrease or completely recede during night time rest. At night the gravitational forces are inactive and the pressure in the venous system returns to normal values in the supine position.

Proper treatment approaches in this stage include elevation, exercises and compression.

Stage 2 – phlebo-lympho-static insufficiency (Lymphedema)

Blood capillaries with elevated pressure values and lymph vessels working on their maximum capacity that remain without appropriate intervention and treatment for extended periods of time will eventually suffer damage. Red blood cells (erythrocytes) leave the blood capillaries through their stretched walls, causing the skin to become reddish-brown due to deposits of tissue storage iron (hemosiderin). Subsequent to high pressure inside the lymphatics, the walls of lymph vessels becomes fibrotic and the valves inside larger vessels become inefficient, which causes impairment of the lymphatic system to a point so severe that it is unable to perform its basic functions. This results in an accumulation of not only fluid, but also protein in the tissues.

Lymphedema will develop as a result of the venous pathology, and its symptoms are exacerbated by the symptoms associated with CVI. The lymphedema appears initially smooth and is pitting. Without treatment it progresses into a more fibrotic stage (see stages of lymphedema).

Early diagnosis and treatment is of utmost importance to prevent further complications. Complete Decongestive Therapy is indicated treatment approach in this stage.

Stage 3

Severe changes in the skin and subcutaneous tissues are typical in this stage. Ulcerations may develop as a consequence of reduced oxygenation and nutrition of the tissues. In addition to lymphedema and leg ulcers, symptoms of lipodermatosclerosis are present, which include:

• Pain
• Hardening of the skin
• Localized thickening
• Moderate redness
• Increased pigmentation
• Small white scarred areas
• Varicose veins

In addition to Complete Decongestive Therapy, other treatment approaches, such as wound care, may become necessary.

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)http://dermatology.cdlib.org/143/case_presentations/postthrombotic_syndrome/vereecken.html