Decongestion therapy for lymphatic drainage

DEAR DR. ROACH: I have lymphedema in my right leg. From the knee to the bottom of my foot, my leg is swollen and red, and always in pain. I’ve had it for over two years.

I’ve seen several different doctors, with no help. They say that if they knew what is causing it, maybe they could do something. Help.

ANSWER: Lymphedema is a condition of inadequate lymphatic drainage, usually to a particular area, such as a limb. It can be caused by several conditions, including cancer. For this reason, cancer doctors often are more knowledgeable about this condition. It can affect people for no known reason.

The treatment goals and methods usually are the same whether the cause is known or unknown.

The treatment of choice is lymphatic decongestion therapy. This is performed by a therapist (occupational or physical) specially trained in the technique, or by a device.

Most people also use prescribed pressure garments, which help prevent the fluid from coming back after the treatments.

Insurance doesn’t always pay for these treatments, and relatively few therapists are trained in it; these can be significant barriers to proper treatment, as is physician ignorance of this condition and its treatment.

The redness you describe can be related specifically to the swelling; however, infection is common in people with severe lymphedema, and this may need to be treated before lymphatic decongestion therapy can begin.

This is particularly important in people with skin breakdown and weeping of fluid through the skin.

DEAR DR. ROACH: I have a non-cancerous fibromatosis nodule above my collarbone. It is painful.

I also have a history of Dupuytren’s contracture. Could this be on a nerve, causing the pain?

ANSWER: “Fibromatosis” is a nonspecific term for a tumor of connective tissue. Dupuytren’s contracture also is caused by fibrous tissue, in this specific instance in the hand, so it’s possible your tumor above the collarbone could be related.

Indeed, any kind of tumor can press against nerves and cause pain. The pain from nerve damage usually is described as “burning,” “pins-and-needles” or “sharp,” so the quality of pain can give a clue to its underlying source.

Some tumors, such as desmoid tumors, are not cancerous, but can invade locally, damaging nerve cells; fortunately, the pathology report you sent shows that this type of tumor is unlikely.

Treatment options include medicine, surgery and possibly radiation. Most people get partial relief from medication: Pain from a neuropathy (this term just means any damage to a nerve) usually can be reduced by half or more with medication, often medicines used for seizures (like gabapentin) or depression (like amitriptyline), even though the person has no seizures or depression.

Surgery or radiation may be appropriate to consider for people with large tumors, especially if they are clearly pressing on a nerve.

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