http://www.lymphnotes.com/article.php/id/149/ Truncal Lymphedema Introduction Truncal lymphedema, which affects the chest region, frequently develops following breast or lung cancer treatment and can be present with or without significant involvement of the adjacent arm. Some studies suggest that up to 80% of women may develop truncal lymphedema after certain breast cancer diagnosis and treatment procedures, yet the condition often remains undiagnosed or treated. Symptoms Pain is a significant symptom of truncal lymphedema and it usually affects the shoulder and chest wall. The pain accompanying truncal lymphedema is usually more severe than pain associated with lymphedema of the arm. Anterior chest wall swelling is most commonly located in the affected breast or on chest wall, over the collarbone (area of the neck), in the axillary cavity (the area under the arm), on the inner surface of the upper portion of the adjacent arm, and along the scar lines. Swelling of the back usually appears as extra rolls of fat along the side of the trunk, fullness over the shoulder blades or upper back, and (if the right side is affected) fullness across the waistline on the right side of the trunk. Swelling of the arm may, or may not, be present. Differential diagnosis of truncal lymphedema can be difficult if the patient does not also present with lymphedema of the upper extremities. Reconstruction complaints include that the reconstructed breast is too large, misshapen, and uncomfortable during the activities of daily living. Treatment Modalities Manual lymph drainage is very important in removing excess fluid, softening fibrotic tissues, and easing pain in the area. Patients with truncal lymphedema may require frequent visits for MLD treatment. Photo Courtesy of Bellisse. Compression is difficult to obtain; however, the specialized Compressure Comfort Bra is designed to meet the compression needs in this area. It is also designed to provide comfort in the underarm area where swelling may remain. Because this bra has a pocket to hold a prosthesis, insurance will often pay for this garment under the terms of the Women’s Health and Cancer Rights Act. Specialized quilted compression pads are available to be worn under a bra. These aids encourage lymph drainage and help to soften fibrotic tissue. These are available from several manufacturers and are often custom made to fit the areas of greatest need. Bandaging is of limited value on the chest for two reasons: First, bandages are designed to work with the pumping action of muscles and this kind of muscle action is not present in the chest. Second, because of the constant changes in chest size while breathing, it is difficult to bandage effectively and to keep these bandages in place. Exercise is particularly important in managing truncal lymphedema. The movements of muscles and the flexing of joints stimulate the flow of lymph and stimulate natural drainage. Exercises in chest deep water is particularly important because the pressure of the water provides compression over the entire affected area. See Aquatic Therapy. Self-Massage is extremely important in managing truncal lymphedema because it helps to compensate for the difficulty in obtaining compression. Self-massage should be performed regularly as recommended by your lymphedema therapist. Avoiding a Tourniquet Effect The term "tourniquet effect" is used to describe any garment that blocks or slows lymph drainage. You can take steps to avoid such damaging areas of blockage. Courtesy of Bosom Buddy. Avoid a heavy prosthesis. A heavy prosthesis places pressure against the chest wall, but not where you want compression. It also drags on the bra straps. Wearing a light-weight prosthesis can ease this problem. Avoid narrow bra straps. Bra straps that dig into the shoulders block the flow of lymph at the terminus. Wearing a bra with wide padded straps, such as those on the Compressure Bra shown above, eases this problem. Avoid an underwire bra. This type of bra is not recommended for anyone who has had breast cancer treatment and is at risk of developing lymphedema Avoid constriction around the chest. If the lower band of a bra band is too tight, and without elasticity, it blocks the flow of lymph. Therefore the bra band should be wide and flexible. Avoid constriction around the waist. This includes tight waistbands on clothing and long-line bras. They have a girdle-like effect around the waist that blocks the flow of lymph. References For more photographs and information about truncal information read the Bellisse article “What Does Truncal Lymphedema Look Like?” Living Well with Lymphedema by A. Ehrlich, A, Vinjé-Harrewijn PT, CLT, and E. McMahon PhD. Lymph Notes. 2005, pages 41-42. Truncal Lymphedema by E. Muscari-Lin, RN, MSN. APRN, BC, AOCN. Lymph Link, Vol 16, No 1, January-March 2004. © LymphNotes.com 2006.This information does not replace the advice of a qualified health care professional. ================================= ======================================================= http://www.lymphnotes.com/article.php/id/189/ Malignant Lymphedema Introduction Malignant lymphedema is a form of lymphedema caused by the mechanically impaired lymph flow in the lymphatics and/or lymph nodes due to the growth of a malignant tumor. Despite its name it is the tumor, not the lymphedema, that is cancerous!. The swelling is a form of secondary lymphedema caused by impaired lymph flow due to the pressure from the growth of a malignant tumor within another body system. How Malignant Lymphedema Develops As the tumor grows it causes pressure on lymph vessels and/or nodes. This pressure, which develops very quickly, blocks the flow of lymph and causes the swelling. The differences between malignant lymphedema and secondary lymphedema are shown in the table below. Malignant Lymphedema Secondary Lymphedema develops quickly in days or weeks. frequently develops slowly over months or years. is very painful because of rapid swelling. is mostly painless unless the swelling is uncontrolled. has skin color that is normal, but shiny due to rapid swelling. It may become cyanotic (blue) due to impaired circulation. has normal skin color during the early stages. The exception is when an infection is present. begins with firm tissue consistency. begins with soft tissue consistency. How Malignant Lymphedema is Treated The primary concern is to find, and treat, the tumor that is causing the pressure. Removing the tumor relieves the pressure that was causing the swelling; however, the patient is now at risk for developing secondary lymphedema due to the cancer treatment. ======================================== ============================================================ http://www.lymphnotes.com/article.php/id/250/ Lymphatic Malformations Introduction Lymphatic malformations are rare conditions in which there is abnormal prenatal development of the lymphatic system that can affect any body part. These conditions, which often can be detected on prenatal ultrasounds, cannot be cured. What are Lymphatic Malformations? A lymphatic malformation is a rare condition in which abnormal prenatal development of the lymphatic system results in tumor-like formations that can occur in the skin and in just about any portion of the body. The most common locations are in the face, neck, torso, groin and the extremities. They can also occur in the intestines, abdominal cavity and even in bones. Lymphatic malformations are commonly disfiguring and often associated with other medical problems. The children and their families face medical problems, emotional difficulties and the isolation that comes with having such a rare condition. C.A.L.M., an acronym for “Children Anguished with Lymphatic Malformations,” is a support group that was founded in 1993 to help families afflicted with this rare and misunderstood disfiguring disorder. To learn more about this condition and the activities of the Stay Calm organization visit the Stay Calm web site. Intestinal Lymphangiectasia Intestinal lymphangiectasia, which is also known as lymphangiectasis, is a fairly rare condition that affects the digestive system and causes difficulties including constipation, diarrhea, and abdominal pain. According to medical dictionaries lymphangiectasia means, “the dilation (expansion) of lymphatic vessels” or “a malformation of lymphatic vessels.” To the families of children with intestinal lymphangiectasia, this means multiple hospital trips, special diets, and surgeries to control this potentially life threatening condition. One side effect of intestinal lymphangiectasia is the development of lymphedema in various parts of the body. For example, we heard from the mother of an eight year old son. He suffers from lymphangiectasia and now has developed lymphedema in both legs, the right arm, abdomen, scrotum, and penis. To learn more about this condition, and how the families affected by it manage, also visit these web sites. http://littleleakers.com/ http://www2.caringbridge.org/ca/ironkidmike/ Lymphedema-Distichiasis Lymphedema-Distichiasis is an autosomal dominant disorder that classically presents as lower-limb lymphedema and distichiasis which is a double row of eyelashes. Irritation of the cornea, with corneal ulceration in some cases, brings the patients to the attention of ophthalmologists. Other complications may include cardiac defects, cleft palate, spinal extradural cysts, and photophobia. This condition, which occurs primarily in males, is transmitted by an autosomal dominant chromosome, which means that it can be transmitted when only one parent who has this condition. =============================================== ================================================================== http://www.lymphnotes.com/article.php/id/349/ Lumpy Jaw is Not Part of Lymphedema A dental abscess can cause of "lumpy jaw" to develop. Introduction Yes, there really is a disease known as lumpy jaw and it is not related to lymphedema! However information about this condition may answer some of the questions we have received from visitors who are worried about swellings in the head and neck area. The medical name for this condition is actinomycosis and it is caused by the bacteria actinomyces. These bacteria are normally present in a healthy mouth without causing any problems. An infection does not occur unless these bacteria are introduced into the tissues of the mouth due to an injury, a dental abscess, or oral surgery.[1] Important These lumps are not swollen glands; however, because infection is present in the area nearby lymph nodes under the jaw or along the neck can become swollen. Signs and Symptoms Once in the tissues these bacteria form an abscess. This is usually a chronic condition and there may be several abscesses present that produce hard, red-to-reddish-purple lumps either on exterior of the jaw bone or on the lower portion of the face. This is why the condition is known as lumpy jaw. [2] With the passage of time an abscess can form a fistula. Eventually this breaks through the surface of the skin and allows pus to drain out of the abscess. Unfortunately just because it is draining does not mean that it has healed. Treatment Usually this condition is chronic before it is diagnosed and then it often requires treatment for several weeks with IV antibiotics and this is followed by months of oral antibiotics. To speed healing, sometimes surgery is performed to open and drain the abscess. ========================================= ============================================================== http://www.lymphnotes.com/article.php/id/188/ Swollen Lymph Nodes Introduction The term swollen glands, also known as lymphadenitis or swollen lymph nodes, refers to an abnormal enlargement of one or more lymph nodes. Swollen glands are most commonly caused by an infection. [1] Swollen Glands and Lymphedema Swollen glands are not a symptom of lymphedema; however if you have lymphedema, and you develop swollen glands, this is most commonly a symptom of an infection. A lymphedema related infection requires prompt treatment including a diagnosis of the cause of the swollen glands. Additional Causes of Swollen Glands In addition to infection, other conditions that are associated with swollen lymph nodes include: an abscessed or impacted tooth chronic fatigue syndrome ear infection gingivitis HIV or AIDS Hodgkin's disease infectious mononucleosis leukemia mumps non-Hodgkin's lymphoma rheumatoid arthritis rubella sexually transmitted diseases tonsillitis tuberculosis Shotty Lymph Nodes Shotty lymph nodes are clusters of small swollen lymph nodes that may occur when the immune system is reacting to an infection. These nodes are so named because they feel like buckshot under the skin. Who Treats Swollen Glands? When swollen glands occur, a primary care provider is consulted first. Then, based on the patient’s condition, a referral may be made to the appropriate specialist. =============================== ============================================================ http://www.lymphnotes.com/article.php/id/316/ When Lymphedema Affects Your Hand Introduction Lymphedema that affects the arm often also affects the hand. For some patients this is only a minor inconvenience. For others it is a major problem that interferes with the activities of daily living and even the ability to continue working. What Happens According to Christine Thomas LPT, CLT-LANA, a member of the Lymph Notes Editorial Advisory Board, “Most patients with arm edema will also have some hand edema (NOT everyone, but most). The reason for this is that gravity is constantly acting on the swelling, pulling it to the lowest possible point. The basic principle of bandaging or wearing a compression sleeve is that it must provide more compression at the bottom than it does at the top (to help counteract gravity, and boost the fluid up and out). “When you wear just a compression sleeve, the hand is left with no compression. Any fluid that is in the hand will not be able to move up and out because it will be blocked by the compression that the sleeve provides at the wrist. Wearing just a sleeve without a glove will often make any hand swelling worse. “The natural solution is to add compression to the hand. When bandaging, this begins at the fingers and continues upward to the shoulder. When wearing a compression sleeve, the best solution is to wear a compression glove. "There are companies that carry ready-made or standard size gloves; however, the best fit and compression are usually gained with a custom made glove." Compression Garments for the Hands Courtesy of Lymflo Therapies Inc. Some manufacturers make a sleeve and glove combination; however, except in the lightest weights, these are very more difficult to put on and take off. For this reason the sleeve and glove are usually worn as separate garments. The most effective garment of hand compression is a glove with "finger stubs" that hold the glove in place and provide the more effective compression over most of the hand. Wearing a Gauntlet Courtesy of Juzo USA. Another option, is wearing a gauntlet such as the one shown here. This leaves the fingers completely exposed with only a "thumb stub" to hold the glove in place. This is more convenient because the fingers are free; however, the compression is not as effective because the fingers are not covered. This means that any fluid trapped in the fingers will stay there. Courtesy of JoVi Pak. Compression Aids for the Hands Compression garments are only worn during the day when you are active. At night your therapist usually recommends either bandaging or a compression aid. These cover the hand. Shown here are bandages being placed over a compression aid. Notice that this covers the hand and fingers. Helpful Tips Wearing a compression glove throughout the day can get messy—particularly if your dominant hand is involved; however, there are steps that you can take to minimize the inconvenience. Have two gloves. This allows one to be worn while the other is being laundered. (You don’t want to take changes with infection due to dirty gloves.) Teach yourself to do more tasks with your non-affected hand. This reduces the chance of getting the glove dirty. Keep inexpensive plastic food handler gloves, in a large size, conveniently located where you can readily put on a glove before performing messy tasks such as preparing food or cleaning up in the kitchen.