Lymphoedema is a progressive condition if left untreated. The earlier we can start treatment, the better the treatment outcome for suffers of Lymphoedema, by reducing the progression of symptoms. Treatment strategy is to minimise the amount of Lymph fluid left in the tissues. Over time this fluid becomes more sticky and causes a scar like formation under the skin (fibrosis). When the fluid become thicker it becomes more difficult for both the therapist and the patient to manage swelling. Eventually the skin becomes affected and starts to break down, due to too much pressure being put on it by the oedema.
Exercise and weight management is very important in keeping Lymphoedema under control, but care has to be taken not to overdo it, as this will increase the pressure on the Lymphatic system and increase swelling.
There is a grading system used to help identify the severity and appropriately treat Lymphoedema.
Stage 0 / Latency Stage
This first stage is often difficult to classify as there are only minor signs and symptoms at this point. The ultimate goal is to keep patients in stage 0. In the case of Primary Lymphoedema family history may be an indicator in drawing attention to the possibility of the condition in this phase. With Secondary Lymphoedema, medical advice will hopefully have been given to patients to alert to what to look out for.
· There will be no visible swelling.
· Sensory dysfunction, referred to as paresthesia is often felt. Tingling and numbness in affected limb.
· Connective tissue changes at microscopic level.
Manual Lymph Drainage, exercise therapy and compression garments are recommended at this stage to avoid progression.
· Visible swelling appearing in one limb when compared to other side.
· Swelling reduces completely when the affected limb is elevated.
· The skin can be deeply depressed by ones finger, leaving a temporary indentation (known as pitting)
· No hardening or visible skin changes.
More Intensive treatment plan required at this stage to reduce systems and keep Lymphatic system from being further comprised.
· An area of scarring and hardening under the skin, known as Fibrosis develops.
· The swelling does not completely reduce when the limb is elevated.
· It becomes harder to leave an indentation on the skin.
· There may be pronounced superficial skin changes such as excessive tissue and hardening.
Treatment strategy is difficult to generalise at this point due to the nature of complications associated with stage 2 Lymphoedema.
· At this point, the patient will find mobility very difficult due to extreme swelling.
· The skinís surface will have changed considerably with pain and compression damage.
· The amount of fatty tissue will have increased.
· There is a risk of skin infections.