Mas­sage can al­le­vi­ate lym­phedema is­sues

The Hazleton Standard-Speaker - - HEALTH - Robert Ash­ley, M.D.

DEAR DOC­TOR: I have Stage 1 lym­phedema in my left leg, which causes pain and swelling. I do self-mas­sages ev­ery mor ning, but it’s not enough. Can any­thing re­verse this? I’ve heard that lymph node re­place­ment hasn’t been very suc­cess­ful.

DEAR READER: First, let me ac­knowl­edge the frus­tra­tion you must feel, not to men­tion the pain. This can be a dif­fi­cult con­di­tion to treat.

Here’s what hap­pens: The lym­phatic sys­tem is part of the cir­cu­la­tory sys­tem of the body — only in­stead of circu- lat­ing blood, it cir­cu­lates lymph, a clear fluid that con­tains waste prod­ucts from pro­teins; cells, in­clud­ing white blood cells; and some­times bac­te­ria. Lymph nodes fil­ter the lymph of in­fec­tion and pos­si­ble cancer cells. The ly mph even­tu­ally drains up­ward to­ward the hear t, where it re­turns into the blood­stream. When the lym­phatic sys­tem is dis­rupted, it leads to lym­phedema, the swelling of an ar­mor leg caused by stag­nant fluid within the limb.

Such dis­rup­tions can oc­cur due to in­fec­tion or cancer in the lymph nodes; ra­di­a­tion ther­apy or node re­moval as part of cancer treat­ment; or some­times, due to none of th­ese causes. The lat­ter is termed pri­mary lym­phedema. The con­di­tion is of­ten in­her­ited; is more likely to oc­cur in the legs; and is more com­mon in women.

Stage 1 lym­phedema, with which you have been diag- nosed, is char­ac­ter­ized by swelling that can sub­side if the limb is kept el­e­vated for up to 24 hours. If not treated prop­erly, Stage 1 lym­phedema can de­velop into Stage 2 or Stage 3, caus­ing in­flam­ma­tion, in­fec­tions and scar­ring of the der­mis, the thick layer of skin be­low its sur­face. In Stages 2 and 3, lymph can’t re­turn to the heart, even with el­e­va­tion of the legs.

My first sug­ges­tion is to keep your le gs el­e­vated as much as pos­si­ble and to avoid po­si­tions that put more pres­sure on the lym­phatic sys­tem, such as pro­longed stand­ing, sit­ting or rest­ing cross-legged. Sec­ond, keep your weight down, be­cause obe­sity can worsen lym­phedema. Third, watch for signs of in­fec­tion and help pre­vent in­fec­tion by keep­ing skin moist to pre­vent small breaks in it.

The type of mas­sage that you do, called lym­phatic drainage, helps move lym­phatic fluid up­ward. Phys­i­cal ther­a­pists trained in man­ual lym­phatic drainage can ac­cen­tu­ate this up­ward move­ment, as can the day­time use of com­pres­sion stock­ings.

The node-re­place­ment pro­ce­dure you ref­er­ence is called va scu­lari zed lymph node trans­fer (VLNT), in which a lymph node is trans­fer red from one part of the body to an­other to help lym­phatic drainage. It’s some­times used for breast cancer pa­tients who de­velop lym­phedema in the arm af­ter hav­ing lymph nodes re­moved from the armpit. In those cases, a lymph node is trans­ferred from the groin and con­nected to the lym­phatic sys­tem in the armpit.

In sum­mary, use com­pres­sion stock­ings, keep do­ing the mas­sage tech­niques and seek out a phys­i­cal ther­a­pist for lym­phatic drainage. But most im­por­tant, don’t give up. You don’t want the lym­phedema to progress fur­ther.

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