Manual Lymphatic Drainage with Pumps

2008-10-20T14:37:00.001-04:00

Manual lymphatic drainage, also known as "complex decongestive physiotherapy," is a very gentle technique that consists mainly of stimulating the skin and the underlying lymphatic vessels by hand. It's different from more traditional massage, which concentrates on muscles and deeper tissues and can be quite vigorous. That kind of massage might worsen lymphedema rather than making it better.

In manual lymphatic drainage, a physical, occupational, or massage therapist gently stimulates the affected arm by delicately moving his or her hand and fingers on the surface of your skin. The therapist moves the skin slowly, with circular or pumping motions that are generally directed toward the shoulder. The technique requires specific training and certification. Ask potential therapists whether they have taken a special course and how many hours of lymphedema training they have received.

At the end of every session, the therapist applies customized bandages. The goal is to minimize the re-accumulation of fluid and reshape the arm to look more like the unaffected arm. The therapist will prescribe exercises for you to do with the bandages in place.

Lymphedema therapy is often once per day, three to five days per week, for a number of weeks, depending on the extent of your swelling. Each session usually lasts 1 to 1½ hours. The procedure is also expensive and may not be covered by medical insurance plans.

The success of manual lymphatic drainage is closely tied to the skill and dedication of the therapist, as well as your own bandaging skill and dedication to your treatment program. The structure and physiology of your lymphatic system may also affect the success of treatment.

Pneumatic (air-driven) pumps

Pneumatic pumps are the foundation of traditional edema therapy. Your arm is placed into a full-length plastic sleeve that fills with air, compressing your tissues, moving stagnant fluids up and out of the swollen arm. After using the pump you will usually apply compression bandages or a sleeve to maintain the reduction you achieved.

An effective lymphedema pump has two features:

Gradient pressure: This means that the pump puts stronger pressure on the hand area than it does on the upper arm, pushing fluid in the proper, upward direction. Less useful lymphedema pumps put equal pressure on the whole arm.
Sequential pressure: This means that the pump exerts pressure that moves from the hand up the arm with a sort of "milking" technique.

This treatment requires up to a two-hour commitment each day to get temporary relief. You can do the therapy in your home while you are reading or watching TV. The settings of the machine and your overall plan must be determined by a qualified professional. Over time, a therapist should also check to see how the treatment is working. Good lymphedema pumps are expensive (about $5,000 to $6,000), but you can rent them from a surgical supply store. Most medical insurance plans cover part or all of the cost.

Be cautious about medical practices and independent companies promoting the pump. Some of these companies don't have trained physical or occupational therapists to supervise your care. Buy or rent a lymphedema pump only from a rehabilitation center or through the recommendation of your physical or occupational therapist.

Breast Cancer and Lymphedema

2007-06-15T09:18:00.000-04:00

Over 2 million women in the United States are breast cancer survivors. The American Cancer Society estimates that 10-15% of these women (200,000-400,000), although others have proposed an even higher estimate of 30-40% (600,000 to 800,000) women will develop lymphedema over their lifetime. A 1998 review article of 7 large reports published since 1990 report an incidence of lymphedema in 6-30% of breast cancer survivors treated in 5 Western countries. Approximately 5% of breast cancer survivors noted lymphedema after their first year of treatment. A study that questioned 263 women 20 years after their treatment showed that 49% had experienced at least mild lymphedema, and that 11% experienced severe cases. Seventy seven percent of the women who had lymphedema reported early onset swelling (within 3 years of diagnosis) and the other had late onset of symptoms at a rate of 1% per year. This late onset lymphedema correlated with two epidemiologic factors: a history of infection or injury, and weight gain since treatment. (This will be further discussed later)

In part because lymphedema may develop weeks, months or years following treatment for breast cancer, it is difficult to accurately determine the exact causes of lymphedema. Long-term studies of women with differing life styles, treatments and backgrounds have not shown a relationship between age, obstructive drainage, number of lymph nodes to which cancer had spread, or weight at diagnosis. They have, however, identified relationships between the following and the onset of lymphedema:

Radiation therapy: This may cause damage or scarring to lymph nodes or lymph vessels leading to lymphedema in approximately 30% of women who have undergone radiation therapy. Several studies also noted a significant increase in lymphedema for women who have undergone radiation therapy to either the axilla, or from radiation scatter to the breast or chest wall.
Surgery: Axillary dissection (the surgical removal of lymph nodes under the arm) or the destruction of lymph nodes. A large (1278 patient) study showed that 15.9% of women undergoing axillary dissection and radiation therapy developed lymphedema and that the risk correlated with number of lymph nodes removed. Other studies noted that there was no difference in the rate of lymphedema between women who had undergone modified radical versus radical mastectomy, and breast conserving surgeries such as lumpectomy, axillary dissection and radiation therapy.
Tumor growth: A tumor may surround a lymphatic vessel and thereby obstruct lymph flow.

The foremost reasons why women developed late-onset lymphedma (3 or more years following therapy) are weight gain following cancer treatment, infection and injury. It is therefore advisable for women who have undergone treatment for breast cancer to be aware of the following:

Weight gain following cancer therapy should be avoided as much as possible as it has been shown to increase susceptibility to lymphedema. Although patients who were overweight at the time of their diagnosis had a higher incidence of lymphedema than women of optimal weight, weight gain in post-treatment years were shown to be a stronger predictor of lymphedema development. A nutritionist may be consulted to encourage a balanced low fat, high fiber diet along with some form of exercise to help maintain an ideal weight.
Infection (cellulitis: bacterial infection of the skin or lymphangitis: infection of the lymphatic vessels or system) can lead to an increase in blood flow, and thus an increase in lymph build-up in the affected area. Lymphangitis may also cause obstruction of lymphatic vessels and consequent lymphedema due to lymph back-up. Oral antibiotics may be prescribed by a physician if an infection does occur.
Airplane flights: even for people without lymphedema the low pressure may cause swelling. This swelling is accentuated in women susceptible for lymphedema or with a mild case.
Injury: It is important to avoid wounds in the arm on the same side of a mastectomy or lymph node dissection. Even minor scrapes or sterile needle pricks should be avoided as they may trigger the onset of lymphedema. Any wounds should be cleaned properly with antibiotic soap. Prophylactic (to avoid the onset of) oral antibiotics may be prescribed by a physician to reduce the chance of infection.
Other incidences that cause blood to rush to the area, such as overuse of the affected limb, sudden changes in temperature (hot tub, sauna), trauma and vigorous massages are also implicated in initiating or aggravating existing lymphedema.

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Manual Lymphatic Drainage with Pumps

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