Related Terms: Manual Lymphatic Drainage MLD Comprehensive Decongestive Therapy CDT Pneumatic Compression Pump Therapy, Lymphedema Surgical Treatment, Liposuction, Laser Treatment, Wholistic Treatment, Benozpyrones and Flavonoids, Diuretics, Acupuncture, Complimentary Medicine, Alternative Medicine, Naturopathy
Patients continue to express a tremendous amount of frustration in obtaining insurance coverage for both lymphedema treatment and for garments, sleeves and supplies. When you seek a referral to a certified lymphedema therapist, you should first understand insurance companies and their policy towards lymphedema treatment, especially in terms of your own coverage. You may also, need to have a letter of medical necessity, you may need to know how to appeal insurance denials, you may also at times need to know how to file a complaint against your insurance company and how_to_file_a_health_insurance_appeal.
Another problem we face with lymphedema is how to choose a primary care doctor that understands and or even knows about lymphedema.
Click here for lymphedema in children
If you are considering an inpatient treatment program, you will want to read our Tips on Inpatient Lymphedema Treatment Centers page.
TWO BASIC TYPES OF THERAPY FOR LYMPHEDEMA
Manual Lymphatic Drainage (MLD): is a unique, therapeutic method of stimulating the movement of fluids in the tissues. The gentle, rhythmic, pumping, massage movements follow the direction of lymph flow and produce rapid results. It assists the cutaneous lymphatics in picking up and removing not just fluids, but all the waste products, protein particles and debris from our system. It also is successful in breaking fibrosis and fibrotic areas of a lymphodemous limb.
This treatment was created and developed Danish therapists Dr. Emil Vodder and his wife, Estrid, in the 1930's and was introduced in Paris in 1936. They are also credit with creating a specialty of medicine called Lymphology.
First brought to North America in 1982, the school is located in Victoria, British Columbia, Canada. Before it was introduced the standard treatment course in North American was either a surgery called debulking or the use of compression machines wherein the limb was literally squeezed by pneumatic air pressure.
Comprehensive Decongestive Therapy (CDT) is used primarily in the treatment of lymphedema and venous insufficiency edema. It is a combination of MLD, bandaging, exercises and skin care. CDT may also involve breathing exercises, compressive garments and dietary measures. A frequent indication for CDT is lymphedema caused by irradiation or surgery due to cancer. It can relieve edema, fibrosis and the accompanying pain and discomfort.
Also known as Complete Decongestive Physiotherapy (CDP), this treatment therapy was pioneered in the United States by Dr. Robert Lerner.
Compression Pump Therapy - Pneumatic Compression Therapy
In decades past there was very little that could be done about lymphedema. The most commonly used therapy in the 1960's was the compression machine. A boot or arm sleeve was placed over the affected limb and it was “squeezed” by use of air pressure. A patient was then fitted with a type of heavy strength hose or stocking. That treatment has largely gone out of favor for two reasons. First, it wasn't that effective secondly more serious damage was done to good lymphatics by the continual pressure. Thirdly, many patients experiencedgenital lymphedema as a result of the compression of the legs.
Another “treatment” was surgical. Debulking surgeries were performed and the fluid filled tissue was removed. Another surgery tried in the 1970s was called the Thompson's Procedure. After debulking, a flap of skin was sewn into the muscle supposedly to act as a “wick” to draw fluids into the deeper lymphatics. I had three of these 9 hours surgeries and they were not successful. So these surgeries have also gone by the wayside.
Earlier versions of debulking surgeries used in the treatment of lymphedema include the Charles Procedure and the Kondolean Procedure. These two were first used in/around 1912.
Later versions of surgeries including the sewing in of a flap of skin (similar to the Thompson). These dermal flap surgeries were the Sistrunk procedure (1918), the Homans Miller procedure (1936) and finally the Thompson Procedure.
Today experiments in microsurgery are being tried throughout the world. These surgeries include placements of shunts in hope of creating new pathways for lymphatic flow.
A new and still somewhat controversial treatment for lymphedema has emerged from Sweden. Head of the lymphedema unit in the department of plastic and reconstructive surgery at Malmo University Hospital, Dr. Hakan Brorson reports that in the 70 lymphedema patients he treated with this method said that his patients had complete reduction of swelling with no recurrence.
Despite that he does recommend to patients that they continue therapy which includes wearing controlled compression bandages.
Candidates for the procedure are person with severe lymphedema with no pitting and who have been non responsive to other therapies.
Its controversial because of the fact he makes 15 to 20 small incisions on the arm. Of course this type of invasive procedure opens the arm up to be at high risk for an infectious complication. He also has reported that there have been no such occurrences.
Another new frontier in the treatment of lymphedema involves using the laser. From various trials lasers appear to help liquid viscosity (helping lymph flow), shown to be effective improvement of wound healing, has helped remove port stains in the Klippel-Trenaunay syndrome (a lymphatic development disorder), and it has been used effectively in treating edema from venous thrombosis.
Holistic Medicine is defined as a system of total patient care that involves the physical, emotional, social, economic, and spiritual needs of the patient.
It also considers the patient's response to illness and disease and its impact on the patient's ability to meet self-care needs.
In terms of treating lymphedema, the treatment involves the use of enzymes, vitamins, herbs and homeopathic compounds in conjunction with standard recognized decongestive therapies. Other goals of this approach include body detoxification, prevention of cellulitis and prevention of fibrosis.
It is rare that in this website I offer my own personal opinion on a treatment option. Usually I give the information for my readers to draw their own conclusions based on the evidence provided.
However, there is one treatment that is beginning to be used for lymphedema that I feel so strongly about, I must comment.
Dangers with Acupuncture and Lymphedema
1. The many holes put into your leg offers a wide open gate to potentially life threatening infection. Bacteria will have many access points to inside your lymphedema limb.
2. The lymphorrea (fluid) that is drained by this action has disastrous effects on your skin. The fluid is very caustic and can cause severe deterioration of the dermal layers. Skin breakdown from this fluid is a very real danger.
3. This is only a crude stop-gap treatment method. Without proper wrapping and garment use, the fluid will simply re-collect. You must have treatment that will prevent the accumulation of fluid.
Please before you even begin to try this treatment, consider well the consequences.
To understand why these agents are not recommended for the treatment of lymphedema we must first start with a basic definition of edema and lymphedema.
Edema: Abnormal pooling or build up of fluid in tissues. Generally caused by underlying medical conditions such as hypertension, varicose veins, thrombophlebitis, congestive heart failure, kidney failure steroid therapy, inflammatory reactions, or injury or trauma.
Diuretics are used to assist in the correction of the base problem causing the edema.
Lymphedema: A disorder in which “lymph” collects usually in a limb as a result of a congenital, hereditary malformation of the lymphatic system, or is a result secondary conditions such as node removal for biopsies, damage to the lymphatics from radiation, injury or trauma or by parasitic infection. Diuretics cannot help the underlying condition of lymphedema.
Why not use diuretics for lymphedema?
Perhaps the single most important consideration is in the composition of the lymph fluid caused by lymphedema. The fluid is a protein-rich substance that provides a breeding and nourishment center for bacteria. This has to be removed to lesson the risks of cellulitis and lymphangitis.
This fluid also has to be removed so as to prevent the formation and progression of fibrosis as lymphedema advances through the various stages.
Diuretics remove none of this waste fluid.
Benzopyrones in the Treatment of Lymphedema
It has been proposed that benzopyrones would be beneficial for lymphedema patients because of their ability to breakdown the proteins in the excess lymph fluid and stimulate lymphatic activity. These drugs bind to accumulated interstitial proteins, inducing macrophage phagocytosis and proteolysis. As a result The resulting protein fragments pass more readily into the venous capillaries and are removed by the vascular system.
Also, as an antioxidant it would help the body cleanse itself of toxins.
The best research available has been due to one individual, J.R. Casley-Smith. He described the benzopyrones, coumarin and troxerutin, for this purpose in 1974. What he has reported is that the process of resolving or having noticible results from benzopyrones generally takes several months. He also points out that benzopyrones do not remove the cause of protein-rich edemas. Clearly then, they can only be used as an adjunct to decongestive therapy and correct garment usage.
Coumarin which is the most widely used benzopyrone has also been implicated in liver toxicity.
Drugs or herbal substances commonly used in Alternative Medicine, falls under the broader class of drugs called flavonoids. Some forms have been found useful in assisting in the treatment of cancers because of their ability to act as inhibitors and suppressants of tumor growths. Other types have been shown to help in the treatment of lymphatic developmental disorders. While these agents have been used for lymphedema in Europe and India there continues to be much debate of their effectiveness. In the United States the FDA has yet to approve their use.
Broad spectrum of herbal, substances used in Alternative and Complimentary medicine. Flavonoids which are water soluble (versus oil soluble as the carotenes are) have demonstrated antioxidant properties and as such may assist the body in eliminating radical free agents.
These substances were first discovered by Albert Szent-Gyorgi, Ph.D., a Nobel laureate who also discovered vitamin C.
Other treatment modalities that are being experimented with and used include such therapies as Kinesiology Technique, Reflexology therapy, Endermologie treatments. For information regarding these techniques, please refer to the links below index of articles.
Current Treatment Options for Lymphedema February 26, 2010
Lymphedema Treatment Act
Inclusion of these pages does not consitute an acceptance of the treatment modality. The pages are for patient information and education. In situations where I feel the treatments are either ineffective, dangerous or just plain bogus I have added my personal commentary.