Lymphedema/Lipedema/Complete Decongestive Therapy

Lymphedema is a swelling of one or more body parts. It often happens in the legs and arms but it can also happen to the neck, face or genitals. The condition of lymphedema is a result of abnormal accumulation of protein-rich edematous fluid in the affected area. This condition affects millions of people worldwide and can be primary lymphedema: meaning the cause is unknown/person was born with it, or secondary lymphedema, meaning the cause leading to the lymphedema is known.

Several conditions classified as a type of lymphedema respond well to manual lymphatic drainage and decongestive therapy. Complete Decongestive Therapy is a multi-phase approach that treats various forms of lymphedema, lipedema, venous insufficiencies, and edema. Some conditions that can benefit from complete decongestive therapy include:

  • Post cancer treatment edema

  • venous-related edema (chronic venous insufficiency, venous edema)

  • Post-injury edema

  • Edema due to hereditary conditions

  • congenital lymphatic malformations

  • chronic edema from kidney disease or heart disease

  • lipedema

  • lymphedema-distichiasis syndrome

  • radiation-induced lymphedema

  • obesity-informed lymphedema

Complete Decongestive Therapy can help a wide range of conditions and it can help many regain their quality of life. When you come into see us, we work with you to create a personalized treatment plan that works for you.

Lymphedema ranges from Stage 0 through Stage III.

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Stage 0 Lymphedema: this is the latency stage and can involve various sensation changes, stasis leading to discomfort, heaviness or achiness. Symptoms can return to normal after activity or triggers are controlled but often return when the area is taxed. This could happen in one or more areas. We encourage those experiencing Stage 0 lymphedema to seek treatment right away to avoid progression.

Stage I Lymphedema: lymphedema starts to become more apparent at this stage. Swelling is present in the affected area. Swelling usually responds to elevation or light compression however, lymphedema at this stage typically progresses to stage II in weeks or months because the lymphatic vessels are laboring to maintain capacity. Early intervention at this stage helps counteract lymph accumulation and reduces the progression of lymphedema if there are no further complications or injuries to the lymph vessels.

Stage II Lymphedema: the continued imbalance between the lymphatic load and the lymphatic transport capacity has worsened and while swelling my fluctuate, it is persistent. There could also be lymphostatic fibrosis (connective tissue (collagen) deposition and other inflammatory elements). Stage II lymphedema is the most common form of lymphedema due to inadequate early identification and or delayed or inappropriate intervention.

Stage III Lymphedema: when lymphedema is neglected, it often progresses to stage III. There is usually extreme dermal hardening, distortions, connective tissue proliferation, further damage/impairment to the superficial lymphatic structures, infections risks, and other issues that continue to exacerbate damage to the lymphatic structures and worsen the lymphedema. Lymphedema at this stage requires more time in Phase I CDT.

MORE ABOUT COMPLETE DECONGESTIVE THERAPY

Complete Decongestive Therapy is a multi-modal, multi-phase approach consisting of intensive in-clinic treatment followed by ongoing self management at home and sometimes in conjunction with other treatments/therapies that further quality of life and relief from the edematous conditions.

In Phase I of CDT, we’ll conduct an initial appointment to assess your condition and conduct some tests. We’ll also discuss the treatment plan with you based on your presenting symptoms. The intensive phase can require visits for 3 or more weeks, depending on the severity of your condition, and as many as 3 times a week up to 7 days a week during the first week of treatment. Phase I therapies include manual lymphatic drainage, skincare, wound care (as needed), compression bandaging and exercise.

  • Manual lymphatic drainage: this therapy is a sequence of specific techniques that redirect fluid from congested and swollen areas to functioning lymphatic regions in the body.

  • Wound care: this therapy aids quicker closure of wounds, sores and promotes healing.

  • Compression bandaging/garments: this therapy utilizes specific multi-layered bandaging, padding and garments to promote the flow of fluid in swollen areas.

  • Skincare: we teach you tips to reduce the risk of infections, improve skin health, nail care and health and reduce sores/wounds.

  • Exercise: we take you through some range of motion exercises, stretches and aerobics exercises that help strengthen the lymphatic system and contribute to volume loss.

Phase II of CDT is maintenance of the progress made during the in-clinic phase. Maintenance can include getting fit for compression garments, self-bandaging, exercise plan, diet plan, skincare, nail care, self lymphatic drainage techniques and daytime/night time donning and doffing procedures that aid continued recovery from lymphedema/lipedema. We offer additional services in our phase II that are technology driven and we discuss that with you as pertaining to your particular needs. We also offer maintenance lymphatic drainage therapy, continued fibrosis reduction and fat reduction for those whose conditions necessitate that type of care.

Lymphedema and lipedema are chronic conditions. As a result, it can be sometimes necessary to return to Phase I again when conditions worsen. Continued care at home and intermittent clinical visits help to manage the condition and reduce Phase I intensive care needs.

LIPEDEMA

Lipedema is a disorder of the subcutaneous loose connective tissue. The connective tissue separates skin from muscle, adipose (fat) tissue, extracellular matrix and other components. The fat cells in lipedema can be painful. While lipedema is also treated with CDT, the two conditions are not the same. Lipedema is symmetrical enlargement of the limbs, mainly of subcutaneous fat tissue but it can also have lymphedema components. Lipedema fat is difficult to lose through dieting, exercise or bariatric surgery.

Lipedema causes body disproportion and the enlarged fat on the thighs, inner knees and calves can limit mobility. Lipedema can affect other extremities, not just the legs and it is described by stages and types.