What is Lymphedema?

When blood is pumped to the body by the pumping power of the heart, it is distributed throughout the body through arteries. While coming back to the heart, the light fluid part comes to the heart with the veins and the heavy part comes with the lymph vessels. If there is a problem in the veins, varicose occurs, if there is a problem in the lymphs, lymphedema occurs.

Lymphedema: It can be defined as the accumulation of protein-rich fluid as a result of the disruption of the lymphatic circulation, sometimes congenital, sometimes after infection and surgeries.

What Causes Lymphedema?

Lymphedema can sometimes be congenital and is known as elephant disease. Lymphedema is common after breast surgery, after abdominal and pelvic organ surgeries, after joint prostheses, after radiotherapy and infections. The higher the number of lymph nodes removed, the larger the area of radiotherapy, the greater the risk.

When Does It Develop?

Congenital lymph edema can occur at any time in life. Post-surgical ones develop slowly after surgery or 1-2 years later.

What are the Symptoms?

Feeling of tightness or fullness in the arm, pain, heaviness, tingling, swelling and redness, difficulty in movement in the arm, hand and wrist, tightening of the watch, ring or bracelet, feeling of tightness in the skin, related distress and discomfort.

When slowly swelling, the patient may not be noticed by the patient’s relatives or the doctor unless the measurement is made. When noticed, the diameter difference may have reached the level that needs to be treated.

If the swelling increases too much, discharge may occur in the area with lymphedema and this is called tears of the skin. These are areas open to infection.

How Can I Be Protected?

It is not possible to predict the development of lymphedema. However, it would be useful to inform the patient before the operations with lymphedema risk.

•     Do not neglect any swelling, contact your physical therapy doctor immediately.
•     Keep your arm clean, do skin care.
•     Apply moisturizer to the skin after bathing and during the day. Moisturizer should not contain alcohol, perfume, mineral oil, talc, lanolin.
•     Avoid repetitive movements such as scrubbing, pulling, pushing with the risky arm.
•     If the skin is scratched, insect bitten, wash it with soap, keep it clean and protect it. Use anti-bacterial cream. Clean and close any open wounds. In mild burns, wash and protect with soap and water
• In terms of infection, be alert to symptoms such as redness, swelling, increased temperature, sensitivity and fever, call your doctor immediately.
•     Use an electric shaver (not a depilatory cream, wax or razor) when removing underarm and leg hair.
•     Protect your arm from sunburn. Use sunscreen creams and avoid prolonged exposure to the sun.
•     Make sure that the creams you use are not cosmetic. Inappropriate ingredients may cause allergies and scarring.
•     Be careful where there is a risk of bugs, bee bites or cat scratches. If the bite occurs, clean the skin, raise the arm, apply a cold and consult your doctor.
•     Avoid anything that will irritate the skin.
•     Always use protective gloves when handling pots and pans that come out of the oven. Be careful with the steam of boiling water and food coming out of the microwave oven.
•     Before entering the bath, always check the temperature of the flowing water with your other arm, do not use too hot water.
•     Avoid excessively hot environments such as saunas, hot springs, or going out in extreme heat in summer.
•     Try to stay away from all kinds of heat!!
•     Use gloves when doing house and garden work.
•     Wear a protective ring on your fingers while sewing.
•     Do not get vaccinated from the risky arm, do not have blood pressure measured, do not have blood drawn.
•     Avoid wearing tight clothing, gloves, and jewelry.
•     Avoid carrying bags and files with the risky handle.
•     Do not hold your arm in a certain position for a long time.
•     Use a pressure cuff when you go on a journey.

What Should I Do If It Swells?

Contact your doctor immediately, even if you have had this experience before, it will be appropriate for you to be evaluated by your physical therapy doctor.

How to understand lymphedema: When a patient who is thought to have developed lymphedema is encountered, the first thing to do is try to understand the cause of lymphedema and determine its type and stage as much as possible. If it started after a surgery, infection or radiotherapy, measuring the difference in diameter between the two arms or legs is sufficient for the diagnosis. If the cause is not clear, advanced diagnostic methods are used. Doppler ultrasonography, lymphoscintigraphy and MR can be used for diagnosis.

Is There a Treatment?

Yes, Lymphedema has a treatment. If it is swollen recently, the treatment will be shorter, if your arm is swollen for a long time, the treatment will take longer. Therefore, starting treatment as soon as possible will increase the success of the treatment.

How is it treated?

The aim of the treatment is to reduce the swelling and try to prevent it from occurring again. This process is a long process that the patient and the doctor should follow in harmony. But the results are positive for the patient.

•     Correct skin care (moisturizer suitable for the arm should be applied from the bottom up in one direction, the skin should not be dry) (2 times / day)
•     The most effective treatment is manual lymph massage. Before the treatment, which extremity (arm or leg) is swollen, its lymph map is taken and how to pass the obstructed area is determined. Afterwards, starting from the closest point to the heart, the lymph vessels are emptied towards the heart and goes down to the lowest part of the swelling. Afterwards, the swollen extremity of the patient is bandaged with a short stretch bandage to allow lymph drainage for 24 hours.
•     In the next phase of the treatment, the patient or his / her relatives can be taught a simple form of self-massage and manual lymph drainage (it should be applied by experienced people who have been trained in this subject). Please do not have it done by inexperienced people, your swelling may increase!)
•     If the diameter difference is large (2- 2.5 cm between the two arms), manual lymph massage and bandage treatment is started. The bandage treatment and the material used are specific. A multi-layer application is made with a short stretch bandage. It should be performed by an experienced physical therapy and rehabilitation physician. When the diameter decreases to different desired limits, pressure armrest is switched.
•     Pressure pumps (pneumatic compression applications)
•     Exercises: The most important stimulator of lymph circulation is the muscle pump and with the right exercise, lymph circulation is accelerated and swelling can be prevented.

How Does Lymphedema Affect Us?

In the case of lymphedema, infection or clot may develop in the arm or leg. Movement of the swollen arm or leg becomes difficult, there is limitation and pain over time.

Is There A Treatment With Medicine?

In studies conducted all over the world, no positive results have been found showing that the drug is effective in the treatment of lymphedema. Therefore, the use of drugs is not recommended in treatment guidelines.

Is There a Lymphedema Diet?

Gaining weight increases the risk of lymphedema. Therefore, in order to prevent water retention and not to gain weight, foods with fiber should be consumed by staying away from sugary and salty foods.