Lymphoedema

The lymphatic system collects the lymph that naturally accumulates in our bodies. If it does not work properly due to a congenital or acquired cause (e.g. injury, accident, cancer or most commonly surgery), the lymph builds up and causes swelling. Leg swelling can occur in one or both limbs. This swelling is called lymphoedema.

Diseases with symptoms similar to lymphoedema

Swelling similar to lymphoedema can be caused by several things. The treatment for most of these is different from lymphoedema, so they should be ruled out.

• Spontaneous swelling can occur after standing or sitting all day, even in a healthy individual
• in the case of heart failure, the heart is unable to circulate blood properly in the body, so fluid slowly builds up in the legs. Treatment to increase the strength of the heart muscle is needed.
• back pain and chronic venous insufficiency usually develop slowly as a result of standing and sitting and little exercise. Initially marked by a feeling of "heavy legs", the veins slowly dilate, thicken and become tortuous.
• Swelling is one of the first symptoms of deep vein thrombosis and varicose veins. Seek medical attention immediately if you notice painful swelling on your legs, with warm, reddened or bluish skin.
• in kidney disease, the kidneys cannot eliminate water and waste products and fluid accumulates. The general condition can be very bad.
• Swollen feet can be an unwanted side effect of some prescription drugs. Most commonly, it can be caused by certain heart medications called calcium channel blockers, non-steroidal anti-inflammatory drugs, diabetes drugs, as well as contraceptives and antidepressants.
• in the last trimester of pregnancy, a growing baby can squeeze the blood vessels from the leg to the heart. This obstructs the blood flow and mild swelling appears in the legs.
• arthritis, arthrosis, rheumatoid arthritis, gout, bursitis and other arthritis
• injuries - strains, sprains, torn ligaments, broken bones
• infections (e.g.

Once all of the above have been ruled out - it doesn't take a skilled doctor long to do this - all that is left is lymphoedema.

Symptoms of lymphoedema

The most obvious symptom, depending on which limbs are affected, is swelling or thickening of the back of the hand or foot. The swelling gradually spreads upwards, i.e. it also appears on the shin or forearm.

Initially it feels like "pasta". When pressed, the fingertip remains there for a long time and the skin only slowly smooths out.

In severe cases, this symptom is barely noticeable or not noticeable at all.

The swelling may appear or disappear from time to time. It is usually worse during the day, as sitting or standing makes it difficult for fluids to be absorbed from the limbs.

Symptoms are typically much worse in hot weather than in cool weather.

Treatment of lymphoedema

Unfortunately, there is no cure for lymphoedema. However, this does not mean that the symptoms should be tolerated. With proper and regular treatment, they can be reduced to a minimum and the negative impact on quality of life can be minimised. If you "manage" lymphoedema properly, you can live a full, trouble-free life.

Lymphoedema does not usually go away once it appears, meaning that symptoms are likely to stay with you for the rest of your life and you and your family will need to adjust to daily management.It is worth learning what to do - and how to do it - and doing it regularly.

In most cases, lymphoedema symptoms can be effectively treated using a combination of the following methods. It is important for the patient to master these methods so that they can manage themselves self-care.

The aim of lymphoedema treatment is to move the accumulated fluid to an area of the body where the lymphatic circulation is still intact and able to absorb and remove the lymph. Since lymph is located in the space between cells, it is relatively easy to "divert" by gentle mechanical pressure and massage.

According to current medical recommendations, the treatment consists of:

Tying
The aim is to protect wounds, especially to prevent chapping between the hairline and fingers.

Elastic bandage (bandage) and compression stockings 
Some doctors recommend wearing a bandage or elastic stocking at all times.
Other opinions suggest that if the person is otherwise inactive (e.g.

Resting
This is why it is a good idea to take several rests a day, and to elevate the leg higher than the hip in a lying or semi-lying position. In the case of the arm, the shoulder should be lower than the arm.

Manual lymphatic massage
Manual lymphatic massage has a very important role to play in increasing the lymphatic drainage capacity and thus reducing the rate of lymphatic overgrowth.
Most patients need manual massage from time to time.

Machine lymphatic massage
Machine lymphatic massage is recommended when manual massage is not available. The device inflates air through special cuffs and the resulting pressure triggers the flow of interstitial fluid.

Muscle stimulation (EMS)
Muscle stimulators are less effective than mechanical massage. It is recommended for people who cannot afford the more expensive lymphatic massage machine and for some reason cannot move or can hardly move at all (e.g. walking is not possible).

Other things to know in case of lymphedema

• Like to pay close attention to skin protection and careful nail care. It is very important to keep tight skin and nails clean and protect them from damage. Skin dryness should be avoided. Wearing protective gloves is recommended for housework and other work involving a risk of skin injury.
• Sunbathing, saunas and overly hot baths should be avoided.
• Blood should not be drawn from an arm with lymphedema and blood pressure should not be taken from the affected arm.
• Deodorants containing aluminium salts make lymphatic circulation difficult, so additive-free organic deodorants are recommended instead - they do not overload the lymphatic system with toxins.
• Keeping an ideal body weight is important, with two important pillars being a moderate diet and constant physical activity.

Expectations of modern lymphatic massage machines

A lymphatic massage machine is a very precisely controlled air pump. The air compartments of a pair of boots, gloves or belt-like cuffs connected to it inflate the air compartments in the set sequence and at the set pressure. The inflated air compartment exerts pressure on the skin and underlying tissues. This pressure triggers the flow of fluid (lymph) in the blood vessels and between the tissues.

Control how and where the fluid flows by adjusting the inflation-release.

Choose a device that meets the following criteria!

• Choose the right size cuff! If the cuff is too big, the effect may be less than desired (similarly, if you wear a size 45 shoe on a size 38 foot, you may have a hard time walking to the store)
• To choose your size, measure your girth 
  leg: ankle, calf, knee and thigh (both legs)
  arm: wrist-left-arm-elbow-hip
  trunk: waist-hip
• If you have arm oedema, an arm cuff is enough
• If you have leg oedema, you should buy a torso cuff as well as a leg cuff to move the lymph further away from the thighs
• The more air spaces in a cuff, the more finely you can control the fluid distribution.
• For domestic, maintenance treatment, 4 air chambers are usually sufficient, but for more severe conditions and in the office environment, devices with 6-12 or more air chambers are recommended.
• Devices with multiple air chambers but no adjustable pressure per air chamber are less effective in treating lymphoedema. They are appropriate for mild oedema, varicose veins and massage.

Accurate pressure control

• The device should provide calibrated, accurate pressure delivery.
• The pressure should be adjustable separately for each air compartment.
• The pressure hold time and the length of the pause between inflation cycles should be adjustable.