DEFINE LYMPHEDEMA AND LEARN THE SYMPTOMS AND STAGES

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2 LECTURE OBJECTIVES DEFINE LYMPHEDEMA AND LEARN THE SYMPTOMS AND STAGES OBTAIN A BETTER UNDERSTANDING OF CHRONIC VENOUS INSUFFICIENCY AS IT RELATES TO LYMPHEDEMA

3 LECTURE OBJECTIVES IDENTIFY THE TREATMENT METHODS AND ROLE OF COMPLETE DECONGESTIVE THERAPY DISTINGUISH DIFFERENCE BETWEEN SHORT STRETCH AND LONG STRETCH BANDAGES

4 WHAT IS LYMPHEDEMA LYMPHEDEMA IS AN ACCUMULATION OF PROTEIN RICH FLUIDS IN THE SOFT TISSUES CAUSING SWELLING IN VARIOUS BODY PARTS

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6 CLASSIFICATION OF LYMPHEDEMA PRIMARY LYMPHEDEMA CAUSED BY MALFORMATION OF THE LYMPHATIC SYSTEM. CAN BE PRESENT AT BIRTH OR DEVELOP AROUND THE AGE OF PUBERTY OR AFTER THE AGE OF 35.

7 CLASSIFICATION OF LYMPHEDEMA SECONDARY LYMPHEDEMA MAY BE CAUSED BY SURGERY, TRAUMA, INFECTION, COPD,CHF RADIATION TREATMENTS, DIABETES, VENOUS OR ARTERIAL INSUFFICIENCIES

8 ANATOMY/PHYSIOLOGY OF LYMPHATIC SYSTEM LYMPH CAPILLARIES INITIAL LYMPHATIC SYSTEM PRECOLLECTORS, COLLECTORS LYMPH NODES LYMPH ORGANS

9 LYMPHATIC SYSTEM DRAINAGE

10 FILTRATION AND REABSORPTION OF THE LYMPHATIC SYSTEM PROCESS IS DEPENDENT ON A PRESSURE GRADIENT FLUID MOVES FROM HIGH TO LOWER PRESSURE

11 FILTRATION FILTRATION IS A TRANSPORT OF FLUID THROUGH A MEMBRANE PROVIDING THAT MEMBRANE IS PERMEABLE TO THE FLUID.

12 RESABSORPTION REABSORPTION OCCURS AS A RESULT OF OSMOSIS 80-90% OF THE FLUID IS REABSORPED BACK INTO THE VENOUS SYSTEM 10-20% REENTERS THE LYMPHATIC SYSTEM.

13 STAGES OF LYMPHEDEMA STAGE ONE ACCUMULATION OF PROTEIN RICH FLUID REVERSIBLE

14 STAGES OF LYMPHEDEMA STAGE TWO SPONTANEOUSLY IRREVERSIBLE LYMPHEDEMA PROTEIN-RICH EDEMA FLUID CONNECTIVE & SCAR TISSUE

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16 STAGES OF LYMPHEDEMA STAGE THREE LYMPHOSTATIC ELEPHANTITIS PROTEIN-RICH EDEMA FLUID CONNECTIVE AND SCAR TISSUE FIBROSIS OF DERMAL TISSUES SKIN PAPILLOMAS

17 STAGE 3

18 SKIN CHANGES AND PAPILLOMAS

19 CLINICAL PRESENTATION OF LYMPHEDEMA SYMPTOMS RANGE FROM MILD TO SEVERE DECREASED FLEXIBILITY AND MOBILITY FEELING OF HEAVINESS IN THE LIMB

20 CLINICAL PRESENTATION OF LYMPHEDEMA EXCESSIVE AND PROGRESSIVE SWELLING ANY WHERE IN THE BODY ASYMMETRICAL - ONE LIMB LARGER COSMETIC DISFIGUREMENT

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24 ELEPHANTITIS

25 STEPS OF COMPLETE DECONGESTIVE THERAPY (CDT) MANUAL LYMPHATIC DRAINAGE (MLD) COMPRESSION BANDAGING GARMENT FITTING

26 STEPS OF COMPLETE DECONGESTIVE THERAPY (CDT) REMEDIAL EXERCISES DIAPHRAMATIC BREATHING LIMB ELEVATION NUTRITION METICULOUS SKIN AND NAIL CARE FOLLOW UP AND SELF CARE

27 ACE BANDAGES VS THREE LAYER WRAPS ACE BANDAGES : CREATE A HIGH RESTING PRESSURE THAT IS DIFFICULT TO TOLERATE ACE BANDAGE PRESSURE CONTINUES TO INCREASE

28 ACE BANDAGES VS 3 LAYER WRAPS 3 LAYER COMPRESSION WRAPS: FORM A STRONG SUPPORT HIGH WORKING PRESSURE BANDAGES CAN BE WORN AT REST AND DURING ACTIVITIES. TOLERATED FOR LONG-TERM USE

29 COMPRESSION GARMENTS MEASURED IN MILLIMETERS OF MERCURY CUSTOM OR NON- CUSTOM OPEN OR CLOSED TOE

30 COMPRESSION GARMENTS VELCRO CLOSURE STYLE (I.E. CIRCAID, READY WRAP) KNEE HIGH, THIGH HIGH, OR CHAPS STYLE

31 CUSTOM ELVAREX GARMENTS

32 GARMENTS USED IN LYMPHEDEMA

33 COMPRESSION GRADES 8-15 mmhg : NON-MEDICAL GRADE OVER THE COUNTER FOR USE WITH ACHY AND FATIGUED LEGS (I.E PREGNANCY OR FREQUENT STANDING)

34 COMPRESSION GRADES mmhg: NON-MEDICAL GRADE CIRCULATORY CONDITIONS LEG FATIGUE AND SWELLING FOR SPIDER VEINS, VARICOSE VEINS, PREGNANCY

35 COMPRESSION GRADES mmhg: MODERATE HEAVINESS OR SWELLING MILD-MOD VARICOSITIES POST VEIN SURGERY POST ORTHOPAEDIC SURGERY

36 COMPRESSION GRADES mmhg: PATIENTS PRONE TO CLOTS LYMPHEDEMA OBESITY PHLEBITIS

37 COMPRESSION GRADES 50-60mmHg: SEVERE LYMPHEDEMA SEVERE POST-THROMBOTIC POST SURGERY

38 LYMPHEDEMA TIPS SKIN CARE: AVOID SCRAPES, SCRATCHES, CUTS MOISTURIZE DAILY TO PREVENT DRY SKIN AND IRRITATION AVOID INFECTION KEEP NAILS SHORT AND DO NOT CUT CUTICLES

39 LYMPHEDEMA TIPS SLOWLY BUILD UP THE LENGTH AND INTENSITY OF ANY ACTIVITY DRINK WATER CHECK LEGS FOR ANY CHANGES IN SIZE, SHAPE, TEXTURE MAINTAIN A GOOD WEIGHT

40 LYMPHEDEMA TIPS AVOID NICKS AND SKIN IRRITATION WHEN USING RAZORS USE SUNSCREEN AND INSECT REPELLENT TO PROTECT SKIN WASH SCRATCHES OR OPEN WOUNDS WITH SOAP AND WATER AND APPLY ANTIBIOTIC CREAM

41 CHRONIC VENOUS INSUFFICIENCY RESULT OF POOR BLOOD RETURN FROM THE LOWER EXTREMITIES TO THE HEART

42 CHRONIC VENOUS INSUFFICIENCY ONE OR MORE VEINS DO NOT RETURN BLOOD FROM THE LOWER EXTREMITIES BACK TO THE HEART REASON FOR THE DIFFICULTY IS DUE TO DAMAGED VENOUS VALVES AND BLOOD REFLUXES

43 CVI VS LYMPHEDEMA CVI DULL ACHY PAIN PAIN IS WORSE WITH STANDING PAIN IS BETTER WITH LEGS ELEVATED LYMPHEDEMA HEAVINESS OR CRAMPING IN THE LEGS. ITCHING AND TINGLING

44 SYMPTOMS OF CVI VENOUS LEG ULCERS INFECTIONS FROM VENOUS ULCERATIONS HEMATOLOGIC FLUID ACCUMULATION SKIN CHANGES AND HEMOSIDERIN STAINING

45 CAUSES/RISK FACTORS OF CVI DVTs FEMALE TALL AGE OBESITY PREGNACY PROLONED SITTING OR STANDING GENETIC

46 VENOUS INSUFFICIENCY AND LYMPHEDEMA

47 CHRONIC VENOUS INSUFFICIENCY CVI: SWELLING LOCALIZED TO FEET AND ANKLES SKIN COLOR CHANGES- BLUE HEMOSIDERIN STAINING CHRONIC WOUNDS AND POOR HEALING DUE TO POOR CIRCULATION

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49 VENOUS ULCER: CHRONIC VENOUS INSUFFICIENCY HAS RESULTED IN SWELLING, DARK DISCOLORATION, AND LARGE AREA OF SKIN BREAKDOWN.

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52 CHRONIC VENOUS INSUFFICIENCY ULCERATIONS

53 LYMPHEDEMA LYMPHEDEMA: SWELLING OF ENTIRE LIMB AND FOOT. ONE LIMB LARGER REDDENED SKIN- SUSCPTIBLE TO FUNGAL INFECTIONS AND TISSUE FIBROSIS

54 LYMPHEDEMA INCREASING ACCUMULATION OF PROTEIN RICH FLUID CAUSES WEEPING OF LIMB, WOUNDS, AND CELLULITIS

55 LYMPHEDEMA SENSATION OF TIGHTNESS AND HEAVINESS IN LIMB- RARELY PAIN HIGH PROTEIN ACCUMULATION

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60 CONTRAINDICATIONS TO TREATMENT ARTERIAL DISEASE (light compression ) DEEP VEIN THROMBOSIS (DVT) ACUTE INFECTION (cellulitis, erysipelas) CARDIAC EDEMA MALIGNANT LYMPHEDEMA (precaution)

61 SIGNS AND SYMPTOMS OF INFECTION INCREASED REDNESS IN THE SKIN AROUND A WOUND PAIN IN AND AROUND THE WOUND FEVER HIGHER THAN 102 INCREASE IN THE AMOUNT OF DRAINAGE A BAD ODOR FROM THE DRAINAGE OR WOUND

62 WHEN TO REFER TO LYMPHEDEMA THERAPIST WHEN EDEMA DOES NOT RESOLVE OR INCREASES AFTER TWO WEEKS OF THE INJURY OR SURGERY INCREASED EDEMA IN EXTREMITY FOLLOWING CELLULITIS OR OPEN WOUND. CHRONIC HEAVINESS OR ACHING OF THE LOWER EXTREMITIES.

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65 GOALS OF LYMPHEDEMA THERAPY REDUCTION IN CIRCUMFERENTIAL (CM) MEASUREMENTS FOR TRANSITION TO COMPRESSION GARMENTS INCREASE IN RANGE OF MOVEMENT AND FLEXIBILITY INSTRUCTION IN SELF MANAGEMENT AND CAREGIVER TRAINING

66 EFFECTS OF CDT c Courtesy photo from Klose Lymphedema Care

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68 Teenage patient with primary lymphedema before and after complete decongestive therapy. Courtesy photo from Klose Lymphedema Care Teenage patient with primary lymphedema before and after complete decongestive therapy. Courtesy photo from Klose Lymphedema Care

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75 PREVENTATIVE GUIDELINES

76 Take precautions to avoid insect bites. A simple mosquito bite can cause cellulitis (erysipelas) and further increase the size of your leg. Wear an insect repellent when outdoors. Take extra precautions when caring for your feet. Do not use a razor or any sharp instrument to cut corns or callouses. Use a nail file carefully when filing toenails and a pumice stone to loosen dead skin. Inform all health care personnel that you have lymphedema. Avoid injections or any acupuncture treatments of your affected leg. Use caution when doing exercises or participating in sporting activities. Avoid movements that overstrain or put extra weight on the muscles.

77 THANK- YOU

78 REFERENCES 1. FOLDI, MICHAEL, FOLDI,ETHEL. FOLDI S TEXTBOOK OF LYMPHOLOGY. (12/2006) PHYSIOTHERAPY FOR CHRONIC VENOUS LYMPHATIC INSUFFICIENCY WEISSLEDER, H AND SCHUCHARDT C ET.AL LYMPHEDEMA DIAGNOSIS AND THERAPY.(2008) THERAPY CONCEPTS KLOSE, GUENTER. KLOSE TRAINING & CONSULTING, LLC (2009) 4. ACADEMY OF LYMPHATIC STUDIES. (2005) PHYSIOLOGY AND PATHOPYSIOLOGY OF THE LYMPATIC SYSTEM