Lymphoedema Management

All patients with chronic swelling or lymphoedema should be treated by a qualified lymphoedema therapist with a medical background. We provide expert assessment and treatment for any swelling, helping you manage the oedema and improve your quality of life.

What is Lymphoedema?

Primary Lymphoedema: This is a condition where swelling occurs—usually in the legs or feet—because the lymphatic system doesn't function properly. It is caused by an abnormality present from birth or that develops later in life, making it harder for the body to drain fluid effectively.

Secondary Lymphoedema: This is a chronic condition caused by damage to the lymphatic system, often resulting from surgery, cancer treatment, infection or trauma. It leads to swelling—typically in the arms or legs, but it can occur anywhere in the body, including around the chest or breast tissue following breast cancer surgery.

Stages of Lymphoedema

  • Stage 1: Abnormal flow in the lymphatic system, even though there are no visible clinical signs or symptoms. For example, after lymph nodes are removed for cancer treatment, the body adjusts by forming new pathways called accessory pathways. Sometimes these are sufficient to manage the fluid in the affected limb, but this can change at any stage. Therefore, proper education about the possibility of lymphoedema is necessary even at stage 1. Early lymphatic screening after surgery with a fluoroscopy camera could reduce the risk of developing oedema in the future.
  • Stage 2: There is an accumulation of fluid with clinical swelling. Swelling resolves with elevation, often during the night. Pressing on the area may leave a dent (pitting oedema). This stage can be managed very effectively with Manual Lymph Drainage (MLD), and sometimes compression garments will assist, depending on the severity of the swelling.
  • Stage 3: Permanent swelling that does not resolve with elevation or during the night. Pressing on the area no longer leaves a dent, because the inflammation in the limb has now caused abnormal tissue changes. There might be changes in the skin texture with scarring and thickening. Pitting oedema might still be present in some areas.
  • Stage 4: Elephantiasis (large, deformed limb) with skin thickening and sometimes "wart-like" growth and extensive scarring. This stage is still manageable with MLD and compression. It might take longer, but it is still worth doing treatment at this stage to prevent disease progression.

How We Treat Lymphoedema

During treatment, you will be evaluated, and all aspects of your condition will be considered to treat you effectively. Fluoroscopy-Guided Manual Lymph Drainage (FG-MLD) is a gentle massage technique used to assist your body in effectively absorbing the fluid back into the lymphatic system. It does not involve needles of any sort and should not be painful.

Complete Decongestive Therapy (CDT) is performed in the initial stage of lymphoedema and may include the following components:

  • Fluoroscopy-guided manual lymph drainage to move fluid through the lymphatic system
  • Mobilising affected joints to allow excess lymphatic fluid to drain into lymph nodes
  • Exercise as a vital part of both acute therapy and long-term maintenance
  • Bandaging when necessary to reduce oedema in the beginning stages. In most cases, with new protocols, bandaging should not be required for longer than a week. Only in absolutely extreme cases is more than a week of bandaging necessary.
  • Laser treatment to help with fibrosis or acute inflammation
  • Compression pumps depending on your individual situation
  • Long-term compression sleeves or stockings to maintain results, especially in later stages

We use specialised orthotists to measure for stockings to ensure proper fitting of garments.

Fluoroscopy Guided Lymphoedema Mapping

Lymphatic Mapping is one of the latest developments in diagnostics and treatment of lymphoedema, using Near Infrared Imaging (NIR). It allows us to identify and visualise, in real time, the superficial lymphatic pathways. This enables us to map your lymphatic system, gaining valuable knowledge to find the best drainage pathways for more effective treatment.

Using fluoroscopy-guided mapping, we can observe your functional lymphatics in real time and perform the best MLD techniques that are individual to you, enhancing and improving your overall results. This technique, called "Fill and Flush" (FG-MLD), was developed by Professor J.P. Belgrado.

How It Works:

The mapping is performed using a Photodynamic Eye as a Near Infrared Imaging (NIR) Camera with Verdye – ICG (Indocyanine Green), which is used at a fraction of the dose used in other medical procedures. This allows the lymphatics to be observed in real time.

Benefits of Fluoroscopy Mapping:

  • Improves treatment outcomes by identifying precise drainage pathways
  • Allows for more effective, personalised treatment plans
  • Empowers you with knowledge of your pathways and teaches precise self-help drainage techniques
  • Makes you more independent and speeds up treatment time
  • Allows for early detection in cancer patients, often before you feel changes in the affected area
  • Prevents long-term and more serious effects of lymphoedema through early intervention

Lymphatic Screening for Early Detection

Early identification of lymphoedema is crucial in the advanced treatment of swelling. Research has found that radiation, chemotherapy, and surgery can result in the development of swelling in affected areas. Screening can detect changes even before swelling becomes visible to you or your doctor, helping to avoid the formation of lymphoedema.

A screening programme in cancer patients can recognise the presence of lymphoedema and result in early intervention and prevention. Initial screening is done directly before and after treatment, which can include surgery or radiation. These screenings can be repeated every 6 months for a period of 24 months.

Lymphoedema is a chronic condition, and early recognition ensures that symptoms are managed early, often before visual changes have occurred. If early lymphatic changes are identified, efficient management will greatly reduce the possible deterioration of the condition. With lymphatic mapping, the best and most efficient pathways will be identified, which will greatly enhance your treatment programme.

Exercise and Lymphoedema

Exercise is a vital part of controlling lymphoedema. An individual exercise programme should be designed to ensure that it is something you can do most days of the week. Whether you want to exercise for health reasons or compete in marathons, lymphoedema should not stop you from achieving your fitness goals. We will gladly assist you in reaching your dreams in terms of fitness.

Living with Lymphoedema: Do's and Don'ts

In the past there was a lot of information on what you should NOT do when you are diagnosed with lymphoedema, and some of these elements can be backed up by evidence. However, at Lymph Therapy we believe that these should be taken into consideration, but they should not overwhelm your life.

What to Do:

  • Take care of the affected area just a little bit more than you would the rest of your body – be careful of sunburn, scratches, injury, or anything that can create inflammation
  • Exercise and use your arm or legs as much as you can or would have previously
  • Maintain a healthy weight. The superficial lymphatics go through the fatty layer of your skin, and excess adipose tissue makes drainage more difficult
  • Follow a healthy diet and drink enough water. The more water you drink, the less you will swell. Generally, 2-3 litres of water is a healthy amount to take in 24 hours, unless you have another medical condition
  • See your lymphoedema therapist for treatment or advice whenever you are unsure of anything related to your lymphoedema
  • If you must wear long-term compression sleeves or stockings, make sure that you wear them every day
  • Moisturise your skin to keep it supple and healthy. Use a cream that does not contain unnecessary toxins or perfume

What to Avoid:

  • Do not let anyone draw blood from the affected arm or leg. The tourniquet used to stop blood flow can damage the superficial lymphatic vessels. If proper protocol is followed to protect the lymphatics, the risk is minimal.
  • Try not to carry a heavy bag on the affected side shoulder, as this might compromise lymphatic flow if pathways go to the collar bone.
  • Be careful of cuts and scrapes in the affected area. The increased protein in the lymphatic system creates a higher risk of skin infection (cellulitis). If the skin becomes red and the area spreads within 24 hours, you need an antibiotic urgently.

Lipoedema Management

Lipoedema is a very different condition to lymphoedema. Even though there are some similarities, it is managed differently.

Lipoedema is part of a group of disorders called fat disorders. It is also a connective tissue disease, and this effects the skin, the lymphatic system and the vascular system.  Inflammation and hormone fluctuation plays a crucial role in lipoedema progression.

There are different types and stages of lipoedema. These are classified differently in some journals, but proper diagnosis is key for maintaining lipoedema. As in most parts of the world, it is very much an under-diagnosed condition.

Treatment Approach:

Once diagnosis is made, a treatment plan can be developed for your specific needs.

  • Manual lymph drainage (MLD) and Self Lymphatic Drainage (SLD)
  • Exercise specific to what you can tolerate
  • Compression stockings or sleeves depending on the amount of swelling present
  • Surgery – liposuction is normally the only surgical option