Lymphedema refers to swelling that generally occurs in the arms or legs caused by a blockage in the lymphatic system. Despite recent Medical advancements that addresses Lymphedema, knowledge about this condition is still lacking among the general population. World Lymphedema Day is a patient driven initiative to make the cure for lymphedema of global health priority. At Medicircle we present to you Lymphedema awareness series where we are featuring eminent vascular surgeons, physiotherapists and plastic surgeons, treating lymphedema and raise awareness for all of the people to help them find knowledge and innovations.

Dr.Raja Tiwari is a Consultant Plastic Surgeon at all India Institute of Medical Sciences, New Delhi. He is an experienced plastic surgeon and has been associated with eminent organizations like Artemis Hospitals, Gurgaon, Yamaguchi Hospitals, Japan and the Royal Melbourne Hospital Australia etc. He is the first Indian to be awarded the prestigious international Aesthetic Surgery fellowship by the American Society of Aesthetic Plastic Surgery,USA.

Lymphedema and its Variants

Dr. Raja says, “Lymphedema is a collective term. Primary cause of lymphedema developing in a person is due to blockage in the lymphatic channels. Lymphatic channels are very thin walled veins. These channels push lymphatic fluid out of the body. These are very fine and small channels. Lymphedema can be due to primary or secondary reasons. 

Primary lymphedema cases are hereditary in nature. So, they are transmitted through genes from your parents or grandparents to the child. In these type of cases, lymphatic channels have a developmental problem. Either they are not developed, or they have developed poorly. In these cases, the child will eventually develop some kind of lymphedema either during birth, after birth, even when he or she is at puberty or even later on in life.  Secondary lymphedema develops mostly due to Filaria and can also be due to cancer treatment, radiation surgery or any kind of accidents. In all these conditions, the lymphatic channels are secondarily affected. Hence, they are damaged,” talks Dr. Raja.

Dr. Raja adds, “In our Country, Primary Lymphedema cases are not in majority. They are less than 10-15% of total no. of cases. Most common type of cases are post filarial lymphedema cases and then post cancer treatment cases which develop lymphedema.”

Therapies Useful in Lymphedema

Dr. Raja emphasises, “When lymphedema occurs, because of the increased size and weight of the limb, the person has a tendency to move less and less. Over a period of time, even the joints will become stiff which will further deteriorate the functionality of the limb. List of some useful therapies-

Physiotherapy - Physiotherapy has an important role, not only to maintain the normal functionality of the limb which is affected but also in general to improve the circulation of the body.

Manual Lymphatic Drainage - It is a special kind of Physiotherapy. There are specialists who do this Manual Lymphatic Drainage, in which they do a light massage. It is different from the regular massage that you do for the muscles. With this therapy, you can actually move the limb from the skin to the more proximal part of the body towards the heart where it enters into the main bloodstream. With this therapy again the size can be reduced. If followed over a period of time both these things can help.

Compression Therapy - You might have heard about compression stockings and compression bandage. Once we are doing physiotherapy and following this manual lymphatic drainage, after this we have to use the compression stockings to keep the lymphedema in control rather than allowing it to increase the size of the limb.”

Factors Responsible for Lymphedema

Dr. Raja points out, “When we are targeting weight loss, we are applying two things. One is exercise and the second is diet.

Exercises - When you are doing regular exercise, you are burning calories, and a large part of the lymphomatous tissue which are also fatty tissue. So, when you are burning calories, all that fat is also reduced. Muscles act as a pump for the lymphatic movement.  Thus, when you are moving muscles, they get activated and all that lymphatic tissue will therefore reduce the size. This results in general improvement in the toxin level of the body. Although it does not have a direct relationship with a lymphedema, but indirectly contributes to a lot of things, which can ultimately reduce the lymphedema.

Diets - If you are taking a high fat diets, that fat will be converted into Kyle and ultimately to lymphatic fluid, which will gets collected in the oedematous limb. Hence by reducing the amount of fat in the body, size of the limbs reduces. Similarly, it stands for Sugar. Thus, by keeping the fat and the sugar in control, you can indirectly help in reducing the size of the limb. Salt itself accumulates water. So, whenever you are taking a high salt diet, it accumulates more water and all that water will ultimately lead to more lymphedema. So, limit the amount of salt consumption in your diet.”

Lymphedema Can be Cured

Dr. Raja suggests, “There are microsurgeries available now, where we transfer lymph nodes from other healthy parts of the body to the part which is affected. Now, if we are transferring some lymph nodes from other parts to the effected part, you can assume that there will be substantial improvement in the condition of that limb. Apart from this, conditions such as filaria, in which not only the lymph channels, but also the subcutaneous tissue, undergoes fibrosis and the entire part gets filled with fibrotic tissue. These conditions cannot be treated by transferring any lymph nodes or any lymphatic vasculature or even bypassing the lymphatic channels. So, Primary Lymphedema, or the post cancer cases, are good candidates for surgery and can be cured by doing operations on them. The second type which is the post filarial cannot be cured, we can only reduce the amount of tissue which has increased over a period of time.”

Whom To Consult

Dr. Raja Mentions, “If it is a Hereditary Lymphedema, Plastic Surgeons have to be consulted first. They will conduct certain examination to tell about Aetiology. He will diagnose the condition. But if it requires any kind of surgery, especially a lymphatic surgery, then the Plastic Surgeon or specifically a micro surgeon is the one to be approached for.

Sometimes lymphedema can be confused with a vascular oedema. One has to be sure which oedema it is. And in such cases, it would be better to consult a vascular surgeon for varicose vein therapy.”

(Edited by Renu Gupta)