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Lymphedema patients to benefit from expanded treatment program

BY: CYNTHIA MANLEY

reporter_4.24.98_2.jpg (16k)

4/24/1998 - Lymphedema patient Patricia Robey (left) recently got some treatment assistance from her five-year-old granddaughter Briana Smith as well as physical therapist Heather Hunt. (Photo by Donna Jones Bailey).

Vanderbilt Stallworth Rehabilitation Hospital has expanded its outpatient program to help patients suffering from lymphedema, a frustrating and potentially debilitating swelling often resulting from surgical or radiation damage to the lymphatic system.

Earlier this spring, additional staff underwent intensive training in techniques to treat lymphedema and prevent or lessen the recurrence of swelling. The Vanderbilt Stallworth Lymphedema Program now includes two physical therapists, two occupational therapists and a massage therapist.

"It¹s very gratifying to be able to help these patients, many of whom feel that they¹ve been everywhere with no success," said Mary Kay Moses, a master¹s degree-trained physical therapist.

"We want people to know that this service is available. We hope to expand our services to provide pre- and post-operative consultation to physicians and patients."

The system of lymphatic vessels and lymph glands (nodes) serves to return protein and water from the tissues to the bloodstream. Lymphedema is the accumulation of lymph fluid in the tissues, commonly the arms or legs and sometimes the trunk.

Lymphedema often results when the lymphatic system is interrupted or damaged by surgery or radiation. It also may occur after infection.

Common examples of lymphedema include swelling in the arm in breast cancer survivors after a mastectomy or radiation therapy, or swelling in a leg after orthopaedic surgery or after a leg vein has been removed for a coronary artery bypass graft.

Swelling can range from slight to severe, Moses said.

"Usually it¹s not painful, but it can be a terrible nuisance," she said. "It can lead to other problems, such as back pain in a patient who has had to alter his or her gait because of swelling in the leg. Patients with leg swelling, for example, may also be more prone to falls, especially elderly patients."

Vanderbilt Stallworth therapists take a multi-pronged approach in treating patients with lymphedema:

o A special technique called Manual Lymphatic Drainage (MLD).

"MLD is a light manual technique that stimulates the superficial collecting lymphatics and promotes flow of lymph fluid through the body to the kidneys for excretion," Moses said.

o Use of compression bandages to prevent accumulation of fluid in the involved limb.

"We teach them to bandage themselves and require them to wear the bandages around the clock, except when they are in the shower," she said. "After a few weeks, they can be fitted with compression garments, which are available from several different medical suppliers."

o Education about long-term self-care and proper skin care.

"Anyone with lymphatic disruption is more prone to infection or allergic reactions, so we want to educate them about taking care of their skin and avoiding cuts," Moses said. "We want to inform them about things they should watch for and things that are likely to exacerbate symptoms. For example, someone who has never had symptoms may suddenly experience swelling after a plane ride because of the change in air pressure. This can be avoided by wearing a compression garment."

o Use of specific exercises to enhance the effects of treatment and prevent recurrence of symptoms.

Patients typically undergo treatment sessions for up to six weeks, beginning with daily therapy and gradually reducing the frequency depending on the patient¹s response, Moses said

"We¹d like to catch patients early in the development of their lymphedema because the response is much quicker," Moses said. "Patients who undergo surgery or radiation should watch for an abnormal increase in swelling, which is the primary symptom."

Lymphedema is a life-long disease, and treatment such as that provided at Vanderbilt Stallworth is not a cure, but it can improve the patient¹s quality of life. With treatment and proper care afterward, many patients can avoid future exacerbation of symptoms, Moses said.

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