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LYMPHEDEMA AND SWELLING OF THE LEGS

Patients with varicose veins often complain of swelling in their legs.  At Vein & Skin, we frequently do see swelling related to varicose veins (venous disease).  However, many times the   swelling is a result of a totally different problem called lymphedema.  Because there are multiple causes for swelling, it is important to receive a proper diagnosis.  The treatment and approach is different for venous disease and lymphodema.  Ignoring swelling and delaying treatment could create a bigger  problem if the swelling  is in fact caused by lymphedema.

lymphedema 1

Patients can have both venous edema and lymphedema at the same time.  Vein & Skin can diagnose the differences between the two, using history, physical exam and ultra sound studies.  It is very important to make the diagnosis of lymphedema for proper treatment. The patient needs to know the consequences of not treating the condition properly because it is a lifelong issue that worsens if not properly cared for.

The good news is that there is a way to control the swelling of lymphedema.   Diagnosis, patient education and proper treatment are all crucial in the control of lymphedema.    The importance of education cannot be over-emphasized because the treatment requires long-term management after the initial diagnosis. 

What is lymphedema?

Lymphedema is the collection of proteinaceous fluid in the body’s tissues because of dysfunction in the lymphatic drainage system.  The condition is not entirely correctable, but can be managed.  This first requires the proper diagnosis and then patient education and finally proper treatment.

Is treatment easily established?

Frequently the patient seeks medical advice but is not properly diagnosed. They usually have had symptoms for years.    Most lymphedema patients complain of swelling of the legs that is typically asymmetric.  They feel  that their legs are heavy and uncomfortable.   Since swelling and “heavy and uncomfortable” legs are also a symptom of varicose veins, they may have been advised to seek varicose vein treatment, which will not help the problem.  The patients may have been put on diuretics to get rid of fluid, but this is not effective with lymphedema.

Side effects or complications related to the disease.

Lymphedma patients frequently complain of having repeated infections in their legs.  This is often a red flag for the diagnosis.  A diagnostic physical finding called stemmers sign is frequently present in these patients.  Stemmers sign  is a swelling in the toes in which the skin cannot be pinched to create a skin fold because of skin fibrosis (skin thickening).  The skin in lymphedema   patients becomes thickened and hard in the affected areas.  There is also a size difference in the legs and nodular thickening of the skin.  In the early stages of lymphedema, there is also pitting edema of the tissues (swelling that leaves an indentation when pressed upon by a finger).

What is involved in treatment?

Education of the patient is a critical step in the treatment.    The patient needs to know that there are treatment options and that it will be a lifelong commitment to the proper control of the swelling.  This will require frequent visits for treatment and follow-up care with qualified care providers, and/or certified lymphatic therapists, which is usually covered by insurance policies.

What are the goals of treatment?

The main goals of treatment are #1 education,  #2 skin and nail care,  #3 supervised exercise routine,  #4 manual lymphatic drainage (massage), and #5 compression hose or bandaging.

#1 Education:  motivates the patient to do proper care and prevent further progression of the disease

#2  Skin and Nail Care:  skin care prevents infections which can cause further destruction of the lymphatic system, causing the problem to get progressively worse.  Frequently a combination of topical steroids and creams are needed to prevent infection.

#3 Supervised Exercise Routine:  allows the patient to keep the legs functional and mobile

#4   Manual  Lymphatic Drainage:  massage is needed to keep the fluid collection controlled; otherwise the condition will progress and worsen

#5  Compression bandaging:  sometimes needed to control swelling.  Then the patient is instructed on self care management, with includes leg elevation and compression stockings or other compression devices.

 

Vein & Skin has experts trained in properly diagnosing lymphedema and directing  proper steps for treatment.  You can be confident that you will receive the best care available from our board certified physicians.  Call today for your appointment at 404-508-4320.