Physiotherapist Candice Kuschke sheds light on the challenges of living with lymphoedema – a condition marked by persistent and sometimes painful swelling that can significantly affect daily life. She provides a deeper understanding of the causes, varied treatments, and lifestyle changes necessary for effective management. With early diagnosis and a dedicated, multidisciplinary approach, this condition can be managed to improve patients’ quality of life.
What is lymphoedema?
Lymphoedema is a chronic condition where the lymphatic system is unable to cope with the fluid demands in certain areas of the body. This dysfunction can result from a failure of the lymphatic system itself, fluid overload due to a faulty venous system, or inflammatory conditions. It is also often associated with cancer and cancer treatments, as these can disrupt the flow of lymph fluid, causing lymphoedema.
The lymphatic system plays a critical role in maintaining tissue fluid balance and supporting immune function. It relies on bodily movement to operate effectively. Despite its importance, the lymphatic system has only recently gained broader recognition in medical research, which continues to uncover fascinating insights into its functions.
Types of lymphoedema
Lymphoedema is classified into two types:
- Primary lymphoedema: This occurs due to malformed or faulty lymphatics, typically present from birth (congenital).
- Secondary lymphoedema: This results from localised damage to the lymphatic system, such as trauma, surgery, cancer treatments (e.g. lymph node removal, chemotherapy, or radiation), or tissue damage.
Why early diagnosis is essential
Lymphoedema progresses in stages, and early diagnosis makes management significantly easier. Without timely intervention, the condition can lead to increased swelling and permanent changes in connective tissue, such as thickening and fibrosis, which are difficult to reverse. Severe cases may require surgical intervention.
Lymphoedema can affect various parts of the body, including one or both limbs, the head, neck, breast, or genitals. Leaving it untreated increases the risk of cellulitis, as well as the affected area to grow larger over time, the skin to thicken, and mobility to diminish.
Who can diagnose or treat lymphoedema, and where can you get help in South Africa?
If swelling persists for more than two weeks, it should not be ignored. General practitioners or physiotherapists with knowledge of lymphoedema are often the first point of contact.
A lymphoedema therapist is the next point of referral, and your nearest therapist can be found on the LAOSA (Lymphoedema Association of South Africa) website.
A referral to a lymphoedema therapist is essential for further assessment and management. Certified lymphoedema practitioners – such as physiotherapists, nurses, and occupational therapists with advanced training – are best equipped to assist.
Only certified professionals should manage lymphoedema to ensure appropriate care. Diagnosing lymphoedema involves a thorough assessment of medical history, symptom patterns, and any past injuries or surgeries that could be contributing factors.
Treatment and management
After identifying the cause of lymphoedema, a tailored treatment plan can be created, considering the patient’s lifestyle and financial circumstances. Lymphatic mapping is now available in South Africa. This provides a detailed visual of superficial lymphatic pathways unique to each person. This enables customised manual lymph drainage techniques for optimal results.
Complete decongestive therapy (CDT) is the cornerstone of lymphoedema management. It comprises four main components:
- Manual lymph drainage
- Compression therapy (e.g. multilayer bandaging)
- Skincare
- Exercise and nutrition
Treatment is divided into two phases:
- Intensive phase: Aimed at reducing limb volume.
- Maintenance phase: Focused on sustaining the reduced volume.
Lifestyle adjustments are crucial for effective management. Without these, initiating intensive treatment may be futile. Patients must commit to healthier living practices to achieve long-term success.
Your practitioner may also recommend lymphoscintigraphy, also known as lymph node mapping. It is a non-invasive nuclear medicine imaging test that enables doctors to see the lymphatic system, diagnose issues, and help create a more customised treatment plan. More information about this is also available on the LAOSA website.
The role of compression garments
Compression garments are vital for helping the lymphatics transport fluid back into the bloodstream. However, compliance can be challenging due to discomfort, tightness, and heat – especially during summer when swelling tends to worsen.
Orthotists play an essential role in finding suitable and comfortable garments, and improvements in design are continually being made. Your lymphoedema therapist will usually refer you to a qualified orthotist for garment fittings.
Advances in surgical techniques
Micro-surgical techniques such as lymph node transplants and lymphovenous anastomosis (LVA) are becoming more refined. Patients considering surgical interventions should consult plastic or vascular surgeons specialising in lymphatic treatments or adipose tissue (liposuction).
The importance of exercise and nutrition
Exercise and nutrition are key to managing lymphoedema. Reducing systemic and localised inflammation, improving muscle mass, and lowering body fat percentage have shown positive results in reducing limb volume. A multimodal approach is necessary, as no single treatment can address all aspects of the condition.
Lymphoedema vs lipoedema: Key differences
A case of mistaken identity
Lymphoedema is often mistaken for lipoedema, as both conditions cause swelling and heaviness in the legs. However, they are distinct:
- Lipoedema is a fat metabolism disorder.
- Lymphoedema involves fluid drainage issues in the lymphatic system.
In some cases, both conditions can occur together (lipo-lymphoedema), further complicating diagnosis and treatment.
To learn more about lipoedema and how it differs from lymphoedema, Aesthetic Appointment’s article Understanding Lipedema: Causes, Symptoms, and Treatment Options provides a guide to this condition.
Final thoughts
The physical and emotional demands of lymphoedema are significant, and managing it requires a team of skilled medical professionals and the support of family and friends, as patients may require physical assistance with compression garments, bandaging, and emotional encouragement. However, with the correct care, it is manageable and considering how far we have come in the past 10 years, I can’t wait to see how far treatment will evolve in the next 10.
If you’re seeking a practitioner who specialises in the above-mentioned treatments and can help you find the right medical-grade compression garments, we recommend visiting the Lymphedema Association of South Africa’s website at www.laosa.co.za.
BSc Physiotherapy, WITS 2004, Orthopaedic Manipulative Therapist OMT1 2007, Leduc and LTA certified Lymphoedema Therapist 2010, PINC Certified Physiotherapist (PINC and Steel 2017), UK NQF Level IV Cancer Rehabilitation Exercise Specialist-Wright Foundation 2013
Candice is a Physiotherapist based in Johannesburg with a special interest in Oncology Rehabilitation and Lymphoedema. Having completed her Lymphoedema certification in the UK in 2010, she worked as the Lead Oncology Physiotherapist at the Cromwell Hospital in London. She went on to become a trainer for the Lymphoedema Training Academy when she returned to South Africa while establishing her private practice. An active member of the Lymphoedema Association of South Africa (LAOSA) exco for 9 years, she continues to pursue better ways to diagnose and manage lymphoedema and engage with medical schemes to improve reimbursement for complications related to oncology treatment.