Lymphedema is an excessive accumulation of lymph — a fluid that originates in the spaces between body cells. It shows itself as a visable and palpable swelling of a body part — usually an arm or leg — and occurs when blocked, damaged, or missing lymphatic vessels fail to adequately move fluid and protein resulting in an accumulation of fluids in the affected area.

Even though lymphedema is more often seen in an arm or leg, it can affect any part of the body.

There are two forms of lymphedema, the symptoms and treatments of both being similar:

• Secondary lymphedema, the most common form, is an acquired condition that is most often the result of surgery, radiation, lymph node dissection, severe trauma or infection.
• 
  Primary lymphedema, a congenital or familial condition, occurs when lymph vessels are
  underdeveloped or malformed.

Signs and Symptoms of Lymphedema

Lymphedema can develop in any part of the body. When Lymphedema begins
to develop, the signs to watch out for are:

1. Prickly, burning, or itchy sensations in the area.
2. A heavy or achey feeling; skin feeling tight and full
3. A ring, watch, or bracelet tightness at wrist
4. Clothes not fitting in a certain area
5. Increased swelling in an area that sometimes recedes at night but returns as the body is vertical for         a long period of time.
6. Persistent swelling
7. Decreased flexibility, especially in the knee, elbow, ankle, or wrist.

Stages of Lymphedema

LATENT: Showing no symptoms, though factors may be present.
Stage 1: (MILD), "pitting" edema, when tissue is pressed there is
a finger impression in the skin that stays. Usually in the morning
upon rising the affected area is about normal size and the edema has receded.
Stage 2: (MODERATE), "non pitting", tissue is spongy; the tissue
bounces back when pressed without indentation.
Stage 3: (SEVERE), swelling is irreversible and the limb or area
becomes very large. The tissue is hard (fibroti).

If lymphedema is left untreated, the limb or area will continue to swell with
areas of stagnated lymph that isn't moving. This stagnation leads to fibrosis
(an accumulation of stagnated lymph that doesn't move and becomes hardened).
Because this fluid is protein-rich, it is a perfect medium for growth of bacteria.
The area or limb becomes highly susceptible to infection (cellulitis). Furthermore, severe
swelling and: fibrosis leads to loss of mobility, other chronic infections and
sometimes irreversible complications.

Any break in the skin can open the way for bacteria to enter. It is very important
to maintain good healthy skin by: keeping it clean, soft and supple, and safeguarding
against any cuts, bites, etc.

--------------------------------------------------------------------------------

Problems from Untreated Lymphedema

When lymphedema is untreated, this protein-rich fluid stagnates in the tissues of the affected
part resulting in an overload of the lymph drainage system in that area. Serious problems can arise:

Infection requiring treatment with antibiotics and possible hospitalization for repeated occurrences.
Hardening of tissue that further interrupts lymphatic flow and causes discomfort, pain, and fibrosis.
Impaired movement or inability to walk; difficulty with activities of daily living.
Cosmetic deformity and an altered lifestyle.

--------------------------------------------------------------------------------

Treatment - Hands-On-Therapy

Treatment depends upon the stage and severity of the lymphedema. The key is
to begin treatment as early as possible, by focusing on reducing swelling and
re-channeling lymph into functioning lymphatic vessels. The GOAL is to decongest,
reduce, and in some instances, re-contour the affected area.

Treatment includes:

• Treatment of underlying infections
• Intensive skin care
• Manual Lymph Draining (MLD) Therapy
• Gradient sequential pump — used only in conjunction with MLD therapy
• Circumferential measurements of affected limb/limbs
• Compression bandaging to prevent re-accumulation of lymph fluid.
• Therapeutic exercises
• Compression garments
• Patient education for independent, long-term management
• Wound care - Dressing and gradient bandaging

--------------------------------------------------------------------------------

How Does Therapy Work?

MLD is a gentle, specific MASSAGE technique performed by certified MLD therapists to
increase the flow of lymph fluid from the affected region and open new channels in nearby
healthy tissue into which the lymph can flow. Compression bandages or garments are
then applied to prevent re-accumulation of fluids.

In conjunction with therapy, the patient receives instructions in a long-term, home management program.

Since lymphedema is a chronic condition, it requires proper treatment and maintenance to
control swelling and increase quality of life.

--------------------------------------------------------------------------------

Patient Precautions

LYMPHEDEMA can occur immediately post-operatively, within a few months, a couple of
years, or 20 or more years after cancer therapy.

With proper education and care, LYMPHEDEMA can be avoided or, if it develops, kept under control.

FOLLOW THESE INSTRUCTIONS:

• Don't ignore any slight swelling. Consult your physician immediately.
• Never allow injections, IV's, blood pressure, or other invasive therapy in the affected arm or area.
• Keep the area "at risk" clean and healthy by applying good skin care including lotions.
• Avoid vigorous, repetitive movements against resistance with the affected limb, eg. scrubbing, pushing, pulling.
• Avoid heavy lifting or wearing shoulder bags over the affected area.
• Don't wear tight jewelry or bands around affected areas. Including rings, bracelets, belts, and in the case of breast surgery, check the bra straps and band for pressure points.
• Avoid extreme temperature changes - hot and cold.
• Avoid any type of trauma, eg. bruises, cuts, animal scratches, bites, sunburn or burns. Wear gloves when doing house and/or garden work to avoid any trauma to the skin or dirt/bacteria invading the tissue.
• Keep nails trimmed but avoid cutting the cuticles unless done by a professional.
• Exercise is important, but don't overtire an affected area. EVERYTHING IS DONE IN MODERATION. Recommended exercises: walking, swimming, light aerobics, cycling, and specially designed ballet or yoga. DON'T LIFT OVER 12 POUNDS.
• When travelling by air, wear a compression garment and in most instances, reinforce it with compression bandages and/or a higher class compression garment. This is the time to increase fluid intake especially water.
• Wear a well-fitted bra, and if a breast form is being worn, make sure it is light weight.
• When removing hair from the body, use an electric razor instead of a blade.
• Wear a well-fitted compression garment during waking hours. At least every 4-6 months check with a lymphedema therapist to see if it is compatible with your lymphedema.
• WARNING - If a rash, blistering, redness, fever, or increase in temperature in the affected area occurs, consult your physician immediately. These are signs of an impending infection and could mean a worsening of lymphedema.

** To avoid infection, practice meticulous skin care and guard against any breaks in the skin.

--------------------------------------------------------------------------------

Services for Lymphedema, Cancer and Wound Care

• Consultation and Evaluation of Lymphedema
• Combined Decongestive Therapy (CDT) - Treatment for Lymphedema
• Measure and fitting of gradient compression garments for Lymphedema and venous insufficiency.
• Designing specialty compression systems for problematic lymphedemas and venous conditions.
• Skin and Wound care to treat the effects of chemotherapy, surgery and radiation.
• Fitting post-mastectomy bras and prostheses.
• Teaching patient self-care and planning home care regimens for maintenance.
• Wig Fitting.
• Instruction in care and use of Gradient Sequential Pneumatic Pumping Systems.
• Fitting Orthopedic and Sports Injury Equipment

--------------------------------------------------------------------------------

Medical Supplies and Medical Equipment

• Complete supply of bandages, compression systems, skin care and wound care needs.
• Sports Injury and Orthopedic Durable Medical Equipment and Supplies.
• Full line of Mastectomy supplies.
• Fashion Wigs
• Gradient Sequential pneumatic pumping systems and supplies
• Skin and Wound care supplies
• Directional Flow Garments and Accessories

--------------------------------------------------------------------------------

Lymphedema Therapy Cost Schedule

The following link is available Lymphedema Therapy Cost Schedule. To view or print PDF files, you need Adobe Acrobat Reader Browser Plug-in installed on your computer.

Note: Prices are subject to change without prior notice. Please call 408-782-1028
to talk with a Ginger K Center representative to verify prices.

--------------------------------------------------------------------------------

Insurance Information

Insurance carriers may offer full or partial coverage for therapy. Consult a Case
Manager within your insurance company to determine the benefits available to you.

Our staff will assist you with any questions or concerns you may have.

--------------------------------------------------------------------------------

Non-Profit LISG

Lymphedema Information & Support Group (LISG)
Donations and Contributions are greatly accepted by calling 408-782-1028. All proceeds help patients to cannot afford Lymphedema and Cancer Care supplies.