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BACKGROUND | DIAGNOSIS | TREATMENT | SURGERY |
GLOSSARY OF TERMS
Lymphatic System (referred to as the body’s second circulatory system) collects and filters the interstitial fluid of the body. The Lymphatic System maintains the body's fluid balance and fights infections.
Deep Vein Thrombosis (DVT) is a condition marked by the formation of a blood clot (thrombus) within a deep vein (as of the leg or pelvis) that remains attached to its place of origin on the vessel wall.
DVT may be asymptomatic or be accompanied by symptoms (as swelling and pain) and that is potentially life threatening if dislodgment of the thrombus results in Pulmonary Embolism.
Pulmonary Embolism (PE) is a sudden obstruction of a pulmonary artery or one of its branches by an embolus, an abnormal particle (as a piece of cholesterol, calcium or blood clot, or air bubble) circulating in the blood that hinders blood flow. The embolus is most often a blood clot originating in a vein of the leg or pelvis.
PE is marked by labored breathing, chest pain, fainting, rapid heart rate, cyanosis, shock, and sometimes death
Cellulitis: subcutaneous (under the skin) inflammation of connective tissue--adipose tissue, tendons, ligaments, muscles, cartilage and bone
Lymphatic Filariasis is a parasitic disease caused by microscopic, thread-like worms, transmitted in larval form by mosquitoes. Discovered in 1877 by British Dr. Joseph Bancroft, the adult worms live in lymph vessels and lymphoid tissues periodically shedding larvae into the peripheral bloodstream, often causing Lymphoedema by blocking lymphatic drainage.
Lymphatic Filariasis affects over 120 million people in 80 countries throughout the tropics and sub-tropics of Asia, Africa, the Western Pacific, and parts of the Caribbean and South America. The disease spreads from person to person by mosquito bites. Repeated mosquito bites over several months to years are needed to contract Lymphatic Filariasis. Short-term tourists have a very low risk. People living for a long time in tropical or sub-tropical areas where the disease is common are at the greatest risk for infection. An infection will show up on a blood test.
Homocysteine is an amino acid found in the plasma of the blood, high levels are associated with vascular disease.
Erythrocytosis is a dramatic increase in the number of circulating red blood cells.
Thrombocytosis is an abnormal increase in the number of blood platelets.
BACKGROUND
MECHANISM
Lymphoedema is characterized by severe swelling in the arms and legs due to the accumulation of lymph fluid in the surrounding tissues. People with Lymphoedema have a compromised lymphatic system.
Lymph vessels are a third type of blood vessel that carries fluid from the tissues and organs of the body back to the veins. The lymph vessels are long, thin-walled tubes that form an intricate network in the arms and the legs. In the case of people with Lymphoedema, it is has been observed that the lymph vessels are either absent or damaged and lymph fluid accumulates in the surrounding tissue resulting in massively swollen arms and legs.
Severe cases of Deep Vein Thrombosis (DVT) have also been linked to Lymphoedema.
The greatest danger with Lymphoedema is the constant risk of developing infection in the affected limbs that can become gangrenous.
CAUSE
Lymphoedema may be inherited or caused by injury to the lymph vessels. Many things can cause damage to the lymph vessels including cancer and treatment for cancer, such as surgery or radiation therapy, most notably for breast cancer.
Lymphoedema may also be caused by certain infections that may inhibit the lymphatic system from functioning properly, such as cellulitis commonly associated with diabetes.
World wide, the most common cause of Lymphoedema is a type of infection known as Lymphatic Filariasis.
PATIENT PROFILE
In cases for which Lymphoedema is inherited, the condition may be present at birth or develop during the early years of life.
Cancer patients are at increased risk of developing Lymphoedema as the result of damage to the lymph vessels by surgery or radiation therapy.
Diabetic patients are also at increased risk of developing Lymphoedema as the result of infection from cellulitis.
People living for a long time in tropical or sub-tropical areas where Lymphatic Filariasis is common are at risk for developing Lymphoedema by infection from repeated mosquito bites over several months to years.
SYMPTOMS
The swelling produced by Lymphoedema is usually not painful, but it may cause a heavy, aching discomfort that limits a person’s ability to use his or her arms or legs.
Lymphoedema can cause significant emotional distress due to the disfigurement of severe swelling and difficulty in wearing clothes or shoes.
In many cancer patients these symptoms do not develop until months or even years after their therapy has concluded.
DIAGNOSIS
BLOOD ANALYSIS
Blood tests are performed to look at general health and to assess risk factors that affect the progression of the disease, including fasting blood cholesterol levels, blood sugar, kidney and liver function, and homocysteine levels.
DOPPLER/DUPLEX ULTRASOUND EXAMINATION
A measurement of blood flow and the identification of sites of vessel blockage is accomplished with the use of a hand-held Doppler probe. This allows the examiner to listen to the blood flow. The most accurate and detailed test, is a Duplex Ultrasound exam. This provides an ultrasound image of the vessel to determine whether there is any blockage or structural damage and is also able to record quality of blood flow as well as localised blood pressure.
TREATMENT
SMOKING CESSATION
Immediate and complete tobacco use cessation is absolutely essential. We require this not only of patients with Lymphoedema, but of all patients with circulatory disorders. Individuals who smoke not only put themselves at risk for developing vascular disease but also undermine attempts at treatment.
Cigarette smoking in particular is known to cause erythrocytosis, plasma volume contraction, and thrombocytosis. These are all conditions which lead to dramatically increased risk of venous and arterial thrombosis.
We understand the difficulty many smokers face in quitting and we work with our patients to overcome this personal challenge. We offer several strategic methods to help them end their addiction and improve their vascular health.
MOST TREATMENTS TODAY
The primary goals of most treatments of circulatory disorders today are to attempt to relieve symptoms and prevent further complications. At present, the majority of treatments act superficially in treating a patient’s symptoms and avoid dealing with the root of the problem.
Standard therapies typically include exercise programmes to try to increase blood supply to the affected tissues and the use of antibiotics to help in treating non-healing ulcers. Treatment of Lymphoedema is also directed at reducing and managing leg swelling and improving the flow of lymph fluid. Such therapies alone do not deal with the underlying cause of a patient’s illness. This is the reason the vast majority of treatments do not succeed.
ACHIEVING NEW HEIGHTS IN VASCULAR CARE
At Vascular General, we have developed innovative therapeutic procedures for the treatment of all circulatory disorders of the lower extremities that have consistently produced dramatically successfully results.
Due to the long duration and frequent reoccurrence of open sores or ulcers in the lower extremities, the microorganisms involved in the infection expand exponentially in number and develop into colonies that have a type of protective shield or layer of armor which is resistant to antibiotics. This is why all too often ulcers appear to be non-healing and do not respond to antibiotic medication.
The finding that low dose electric current can disrupt the protective layer shielding microbial colonies is well documented in the scientific literature. Our application of low dose electrotherapy in combination with antibiotic medication has time and again yielded the knockout punch to the life-threatening microbial colonies infecting chronic wounds.
SAVING LIFE AND LIMB
Within a few weeks of our treatments, persistent open wounds that never seem to close and were for so long a constant danger to life and limb, are cleaned from infection, closed, and allowed to heal.
Our innovative use of low dose electrotherapy is not only a vital weapon in the battle against the spread of open wound infection but also a tool for the repair of such damages to the vascular system as inflammation of the vessel wall, ischemia, atherosclerosis, and thrombosis. The most common treatments for Lymphoedema are a combination of Complete Decongestive Therapy (CDT), Compression garments or bandaging, and Vasopneumatic Compression Therapy.
COMPLETE DECONGESTIVE THERAPY (CDT)
CDT consists of manual manipulation of the lymphatic ducts—gentle, rhythmic massaging of the skin to stimulate the flow of lymph fluid to return to the blood. In the blood’s passage through the kidneys, the excess fluid is filtered out and eliminated from the body through urination.
COMPRESSION BANDAGING & STOCKINGS
The most common treatment of Lymphoedema involves wearing compression stockings (special stockings that apply steady pressure to the arm and leg), to increase circulation. Compression stockings can prevent much of the swelling caused by the disorder.
VASOPNEUMATIC COMPRESSION THERAPY
In addition to standard compression stockings which can only provide static compression, Vasopneumatic Compression Therapy provides intermittent compression. It more closely mimics the muscle contractions that the body uses to force tissue debris and excess fluid out of the affected area and into the lymphatic system for proper drainage. The therapy is designed to compress portions of the leg to enhance blood flow to the extremity. Therapeutic effects from this treatment regimen include the decrease in venous pressure, interstitial fluid pressure, vasoconstriction, and blood viscosity.
SURGERY
In rare cases, surgical treatment may be recommended for patients with advanced Lymphoedema that have not responded to complete decongestive physiotherapy and compression therapy. It is very unusual for Lymphoedema to require surgical treatment.
