Swelling that persists can be difficult to diagnose. However, lymphoedema is often not considered and the diagnosis of primary lymphoedema usually presenting in the foot is often delayed for years. For patients presenting after cancer surgery and lymph node excision, the diagnosis may be relatively easy, yet early referral for treatment remains crucial. Reversal of limb volume increase and maintenance is only possible before the permanent lymphoedema-induced tissue changes of fibrosis and fat accumulation have occured. There have been recent changes in the risk and management recommendation for lymphoedema in recent times, as anaecdotal (often quite reasonable) advice has been challenged by research.
The taking of blood pressure recordings or blood from the lymphoedema arm has not been proven to exacerbate lymphoedema. However, the use of the non-affected limb is preferred. Maintaining normal use of the affected limb, exercise including repetitive or isometric (weights) and permission to undertake activities in the heat (except saunas) or the cold are now key self-management strategy recommendations. One in six patients with lymphoedema will experience cellulitis in the affected limb usually due to Streplococcus Pyogenes, which remains sensitive to penicillin. Rapid diagnosis, early treatment and continuing a second course of antibiotics are imperative in avoiding hospitalisation.
Complex lymphoedema therapy of skin care, decongestive massage, multilayer bandaging, exercise and ultimately compression garmenting remain the mainstay of lymphoedma management. However, providing this care in the current health environment remains a difficult task.
Surgeries, such as liposuction, lymph node transfers and lympho-venous anastomoses are (re)emerging as complementary therapy for selected patients. The Macquarie Advanced Assessment Clinic is the only multidisciplinary Clinic available in Australia to select and provide these services embedded in a research environment.
To find out more on the Advanced Lymphoedema Assessment Clinic please click here
Dr Helen Mackie, Lymphoedema and Rehabilitation Specialist, 66 Rosamond Street, Hornsby, NSW 2077. Phone 02 9847 5085.
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