About Lymphedema Management

If you had lymphedema, you would want to know about the current and best treatment options. 

As a lymphedema physical therapist therapist with 30 years of experience I can tell you this: There are recent changes in how lymphedema is understood, and how it should be managed. And you should take note. 

Without getting too technical, you should know that Starling’s Law, a dogma that has existed for over 100 years, was recently refuted and is no longer the commanding scientific view on how the body handles the return of interstitial lymphatic fluid into the circulatory system. Before the updated knowledge was revealed to the scientific community, there had been indication that something was brewing about our knowledge of the lymphatic system. The lymphedema community was actually not too sure how to categorize this phenomenon. It wasn’t really understood and it wasn’t spoken of. The certification courses described lymphatic edema as “other” swelling. It was not the same kind of swelling as traumatic edema we were told. It was not the same kind of swelling that might occur after you sprain an ankle. The term secondary lymphedema was coined to describe the particular swelling that occurs after cancer-related surgical procedures and treatments that include chemo and radiation therapies. As a result of these treatments, it was not uncommon that the lymphatic system would be permanently altered by the surgical removal of lymph nodes and the surgical dissection of large patches of the lymphatic network. The lymphatic system is the network that handles the movement of all fluids except blood through the body. A simple way to think about it, is as your body’s plumbing, and sewage removal system. Pretty important system, isn’t it? 

What has now changed as a result of updated scientific knowledge (I will describe this in greater detail in a later blog), is that we regard all swelling on the same continuum. This means that all swelling occurs by the same principle and resolves by the same principle. No more “other” swelling. 

In 2017 I co-authored a study in which we evaluated the benefit of therapeutic cooling of the skin in the presence of cancer-related lymphedema. Our conclusion was that cooling softened the skin, and reduces cancer-related secondary lymphedema. It also potentially reduces the formation of fibrosis, which occurs in the presence of stasis, or pooling, of lymphatic fluid. Because of the underlying surgical procedures and disruption of the lymphatic system, secondary lymphedema may still be a symptom a cancer patient must learn to manage, but early cooling therapy, as is currently already utilized in the post-op management of all major surgical procedures, has the potential to significantly reduce inflammation, the formation of scar tissue, expedite healing and the return of functional movement, and generally decrease the symptoms we have come to accept as normal in the presentation of progressive lymphedema. 

By delivering a new lymphedema paradigm, the scientific community, has opened the eyes of the certified lymphedema specialists, the wound care specialists, and the general rehabilitation and healthcare community to the realization that we must always consider lymphatic circulation, and any overload on the high microvascular filtration that results in lymphatic pooling and possible chronic swelling. Treatments commonly utilized for lymphedema management have overlapping relevance in managing any chronic swelling of the human body. And traditional methods used to manage swelling such as skin cooling, already reflected in my study of 2017, have relevance in treating secondary lymphedema. A note of warning, when cooling over delicate body parts, extra care is needed. In my study I presented a modified skin cooling technique that is effective on sensitive body parts such as the 

breasts. If you would like to try skin cooling over lymphedema, please purchase my book and read about the technique first. 

The lesson here? We must stay open at the top, and always question outcomes, and always be ready to debunk myths. It’s fun to advance knowledge, isn’t it?

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