Mas­sage tech­niques can help al­le­vi­ate swelling from lym­phedema

The Progress-Index - - SPORTS DESK - DR. ROBERT ASH­LEY —Robert Ash­ley, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine at the Univer­sity of Cal­i­for­nia, Los An­ge­les.

Dear Doc­tor: I have Stage 1 lym­phedema in my left leg, which causes pain and swelling. I do self-mas­sages ev­ery morn­ing, but it’s not enough. Can any­thing re­verse this? I’ve heard that lymph node re­place- ment 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 cir­cu­lat­ing 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 lymph even­tu­ally drains up­ward to­ward the heart, where it re­turns into the blood­stream. When the lym­phatic sys­tem is dis­rupted, it leads to lym­phedema, the swelling of an arm or 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 di­ag­nosed, 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 legs 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 vas­cu­lar­ized lymph node trans­fer (VLNT), in which a lymph node is trans­ferred 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.

A 2016 study of 305 VLNT pa­tients found a noted re­duc­tion in limb swelling and a de­creased rate of in­fec­tion of the af­fected limb. How­ever, this pro­ce­dure was pre­dom­i­nantly done on pa­tients with­out pri­mary lym­phedema, so it may not be ap­pli­ca­ble to you.

The T-cell in­hibitor tacrolimus has shown an abil­ity to pre­vent in­flam­ma­tion and scar­ring of the der­mis in an­i­mal stud­ies of lym­phedema, but hu­man re­search is needed.

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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