The G Sleeve

There is a newer product for those of us with arm lymphedema.  It is called the G-Sleeve

Patient Safety Gear, Inc. 400 NW 67th St., Suite 106 • Boca Raton, FL 33487
Phone: (866) 9-SLEEVE (753383) • Fax: (561) 997-6852
info@g-sleeve.com

It has a 1st Place Winner for Patient & Ataf Safety from the Surgical Products magazine, many many nurses and medical staffers.   With this on, you can more relax about some medical personnel putting needles into that lymphedema arm.

You can read about it more at the below homepage.

G Sleeve home page

Lymphedema Reliever

There is yet another so called miracle device being now
sold that promises that quick fix, cure and help with lymphedema.  It is called the Lymphedema Reliever and is basically a piece of plastic that will only cost you $50US.

What ever you do folks, do NOT be taken in by this - and

all they want from you is $50 from a piece of plastic that 

has absolutely nothing to do with helping LE. 

Pat

Lymphedema Complications

Lymphedema Complications

Nov 2012

Thought it would be good for us to have a review of lymphedema complications.  All to often newly diagnosed lymphedema patients try to push this out of their mind by thinking, "if I ignore this, it will not get worse."

The reality though, is that it does get worse and it comes along with a horrible list of potential life threatening complications.

When I first started Lymphedema People just 3 ½ years ago, there was basically a short list of complications associated with lymphedema. As time has continued and studies have bee completed and as there has been better follow up on lymphedema patients, the list of complications has expanded.

Furthermore, there has been more thorough documentation of the complications face by those of us with long term lymphedema. Usually, these complications are a result of our LE not being treated properly or infact treated at all.

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immunodeficient and the proein rich fluid provides an excellent nurturing invironment for bacteria. See our page Infections Associated with Lymphedema for further information on infections.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids. See Lymphedema and Pain Management.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections. See also Thrombophlebitis

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as dry skin, splitting, plaques and nodules, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

12. Pain ranging from mild in early lymphedema to severe in late stage lymphedema.

13. Lymphatic cancers which can include angiosarcoma, lymphoma; Kaposi's Sarcoma; lymphangiosarcoma (Stewart_treves Syndrome);

Cutaneous T-Cell lymphoma; Cutaneous B-Cell lymphoma; Pseudolymphomatous Cutaneous Angiosarcoma.

See also: Primary Lymphedema and Cancer for a discussion and Lymphatic Cancers Secondary to Lymphedema.

Note: These cancers are rare and are usually associated with long term, untreated or improperly treated lymphedema. Typically occuring in stage three or four; quite rare in stage two.

14. Skin complications possible in stages 3 and 4 include papillomatosis; placques including “cobblestone” appearing placque; dermatofibroma;Skin Tags; Warts and Verrucas; Mycetoma skin fungus; dermatitis and many lymphedema patients report increased problems withpsoriasis; eczema and shingles. I would suspect this may be due to again, the immunocompromised condition of the arm or leg afflicted with lymphedema.

15. Documented but rare complications in late stage also can include Lymphomatoid Papulosis; Cutis Marmorata; Acroangiodermatitis;Dermatolymphangioadenitis (DLA); Papillomatosis cutis carcinoides

16. Debilitating joint problems. This is caused by a combination of the excess fluid weight and the constant inflammatory process that accompanies lymphedema. As we have gotten older, many lymphedema patients are having total knee replacement, total hip replacement, ortotal shoulder replacement while others are experiencing carpal tunnel syndrome and are having carpal tunnel surgery or experiencing shoulder problems associated with lymphedema and must haverotator cuff surgery

LONG TERM EFFECTS

There are numerous side effects and long term affects you may experience with lymphedema. Some of these include fatigue, weight gain, pain (sometimes to the extreme), depression, continued swelling of the limbs or abdomen. Some have experienced cardio cavity and pleural edema. Lymphedema can also cause fibrosis. This is where the limb becomes very hard and can become nonresponsive to available treatment options. With extensive fibrosis also comes heightened risks of blood clots in the affected areas.

Lymphedema also cause localized immunodeficiency problems. It also may be suspect in long term immunity problems, especially in very long term primary lymphedema patients. This may be a controversial statement, but I have known of primary lymphedema patients who's immune system seems to have collapsed from unknown reasons. In my personal situation, mine did just that with the result I acquired two different lymphomas. Hopefully, research will be done in this area.

Lymphangiosarcoma is another possible complication of lymphedema. While many LE'ers worry about contracting this, it is extremely rare. Risk factors are extreme fibrosis, radiation on fibrotic areas and continued infections.

Read More:

Complications of Lymphedema

Possible Genetic Predisposition to Lymphedema after Breast Cancer

Possible Genetic Predisposition to Lymphedema after Breast Cancer

Lymphat Res Biol. 2012

Beth Newman, Ph.D.,¹ Felicity Lose, Ph.D.,² Mary-Anne Kedda, Ph.D.,¹ Mathias Francois, Ph.D.,³ Kaltin Ferguson,² Monika Janda, Ph.D.,¹ Patsy Yates, Ph.D.,⁴ Amanda B. Spurdle, Ph.D.,^2,* and Sandra C. Hayes, PhD^1,*

^Abstract

Background

Known risk factors for secondary lymphedema only partially explain who develops lymphedema following cancer, suggesting that inherited genetic susceptibility may influence risk. Moreover, identification of molecular signatures could facilitate lymphedema risk prediction prior to surgery or lead to effective drug therapies for prevention or treatment. Recent advances in the molecular biology underlying development of the lymphatic system and related congenital disorders implicate a number of potential candidate genes to explore in relation to secondary lymphedema.

Methods and Results

We undertook a nested case-control study, with participants who had developed lymphedema after surgical intervention within the first 18 months of their breast cancer diagnosis serving as cases (n=22) and those without lymphedema serving as controls (n=98), identified from a prospective, population-based, cohort study in Queensland, Australia. TagSNPs that covered all known genetic variation in the genes SOX18, VEGFC, VEGFD,VEGFR2, VEGFR3, RORC, FOXC2, LYVE1, ADM, and PROX1 were selected for genotyping. Multiple SNPs within three receptor genes, VEGFR2, VEGFR3, and RORC, were associated with lymphedema defined by statistical significance statistical significance  or extreme risk estimates

Conclusions

These provocative, albeit preliminary, findings regarding possible genetic predisposition to secondary lymphedema following breast cancer treatment warrant further attention for potential replication using larger datasets.

NIH

Genital elephantiasis due to donovanosis: forgotten but not gone yet ...

Nov 2012

Narang T, Kanwar AJ.

Source

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Sciences and Research Chandigarh, Chandigarh, India.

Abstract

Genital elephantiasis is a disease that is characterized by massive enlargement of the genitalia. Early aetiological diagnosis is of paramount importance so that development of genital elephantiasis can be prevented; otherwise it is not completely reversible with medical therapy and often requires surgical intervention. Chronic mental distress and disability can result as it interferes with daily/routine activities of the affected individual. Over time, the infectious causes of genital elephantiasis have evolved, from syphilis in the pre-penicillin era to donovanosis, lymphogranuloma venereum and recently filariasis, tuberculosis, leishmaniasis, HIV and chromoblastomycosis. With a declining prevalence globally, donovanosis is at risk of being forgotten as a cause of genital swelling; however, it is known to persist for years without treatment and can lead to complications such as lymphoedema and genital mutilation. We herein present a case of genital elephantiasis that was eventually diagnosed as being due to donovanosis.

PubMed

see also: 

Donovanosis (granuloma inguinale)

Granuloma inguinale

Microvascular filtration is increased in the forearms of patients with breast cancer-related lymphoedema.

Nov 2012

Radmer Jensen M, Simonsen L, Karlsmark T, Bülow J.

Source

1Bispebjerg University Hospital.

Abstract

Breast cancer related lymphedema (BCRL) is a frequent and debilitating complication to breast cancer treatment. The pathophysiology is complex and remains poorly understood; however, data suggest that changes in the peripheral circulation may contribute to edema formation. In 13 volunteers with unilateral BCRL the following aspects of upper extremity peripheral circulation were examined: Muscle relative microvascular volume, capillary filtration coefficient, central- and local sympathetic vascular reflexes, skin blood flow and forearm blood flow. This was studied by: Real-time contrast enhanced ultrasound, venous occlusion strain gauge plethysmography, lower body negative pressure, non-invasive blood pressure measurements and skin (99m)Tc-pertechnetate clearance technique. 

Measurements were performed bilaterally and simultaneously in the forearms enabling the use of the non-edematous forearm as a control. Capillary filtration coefficients were additionally measured in healthy age-matched controls. The Capillary filtration coefficient was 7.98±2.52 μL100mL(-1)mmHg(-1)min(-1) (mean±SD) in the edematous forearms and 6.09±1.83 in the non-edematous forearms in the patient group. The Capillary filtration coefficient was 3.32±1.17 μL100mL(-1)mmHg(-1)min(-1) in the forearms of healthy controls, significantly less than the both the edematous- and non-edematous forearms of the patient group. 

No significant differences were found in muscle relative microvascular volume, forearm blood flow , central- or local sympathetic vascular reflexes. Forearm microvascular filtration is increased in patients with BCRL, and more so in the edematous arm.

The vascular sympathetic control mechanisms seem to be preserved.

We propose that the increased capillary permeability may be due to low-grade inflammation promoted by reduced clearance of inflammatory mediators.

Journal of Applied Physiology

Elephantiasis nostras verrucosa in a patient with major depressive disorder

Nov 2012

[Article in Spanish]

Simón Llanes J, Coll Vilar I, Tamarit Francés C, Niubó de Castro I.

Source

Unidad Hospitalaria de Rehabilitación, Hospital Psiquiátrico Universitario Institut Pere Mata, Reus, España. Electronic address: simonj@peremata.com.

Abstract

Elephantiasis nostras verrucosa is a rare condition characterised by papules, verrucous lesions, fibrosis and deformity of the affected area. It is caused by chronic lymphedema that could be congenital or produced by a non-associated infection (such as tuberculosis, mycotic infection, syphilis), surgery, radiotherapy, trauma, neoplastic obstruction, obesity, portal hypertension, or congestive heart failure. There is no standard treatment for this rare skin disorder. Depending on the cause and the severity, the treatment can be medical or surgical. We report the case of a man seen in our hospital with a major depression and elephantiasis nostras verrucosa skin lesions on both legs, who was successfully treated with surgical debridement and conservative measures.

PubMed

A newly designed SIPC device for management of lymphoedema.

WARNING TO ALL LYMPHEDEMA PATIENTS

This abstract is a prime example of just how bad information can be that is presented even through PubMed.

Lymphology 101 clearly shows that high pressure pneumatic devices can cause serious damage to the good lymphatics, making lymphedema even worse.

Read this for education, but please, please, please, what ever you do never ever ever set the compression level on high if you use a pneumatic device.

A newly designed SIPC device for management of lymphoedema.

PubMed

Pat

Experimental Lymphedema: Can Cellular Therapies Augment the Therapeutic Potential for Lymphangiogenesis?

1. Stanley G. Rockson

1. Correspondence to:
   Stanley G. Rockson, MD, Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California 94305. E-mail: rockson@stanford.edu

The lymphatic system, the subject of centuries of paradoxical relative neglect, is finally and deservedly coming into focus. This integral component of the mammalian vasculature plays a central role in immunocompetence and fluid homeostasis and, therefore, is often an active participant in the progression of disease.
The biology of regional lymphatic vascular insufficiency is complex. When regional lymphatic flow is insufficient to maintain tissue fluid homeostasis, interstitial fluid accumulates and swelling ensues. Furthermore, in addition to this readily observed role in the maintenance of tissue fluid homeostasis, functioning lymphatics are crucial to the traffic of immunocompetent cells from the tissue periphery to the lymph node, where antigenic processing can occur.
Lymphedema is the all-too-frequent clinical consequence of impaired lymphatic function. The condition does not typically threaten survival, yet the advent of lymphedema can significantly undermine productivity and quality of life for affected individuals. The sequelae of lymphedema include loss of function, restriction of movement, risk of infection, and profound alterations in psychosocial adjustment that include fear, affective disorders, and loss of self-esteem and body image. Lymphedema is a chronic debilitating disease for which there continues to be a great deal of clinical confusion and treatment delay.
See complete article: 
Journal of the American Heart Association

Lymphedema Patients Require Individualized Care

Lymphedema Patients Require Individualized Care

Main Category:Lymphology/Lymphedema
Also Included In: Cancer / Oncology
Article Date: 14 Aug 2012 - 0:00 PDT

Millions of American cancer survivors experience chronic discomfort as a result of lymphedema, a common side effect of surgery and radiation therapy in which affected areas swell due to protein-rich fluid buildup. After reviewing published literature on lymphedema treatments, a University of Missouri researcher says emphasizing patients' quality of life rather than focusing solely on reducing swelling is critical to effectively managing the condition. 

Jane Armer, professor in the MU Sinclair School of Nursing and director of nursing research at Ellis Fischel Cancer Center, said many insurance providers and health care professionals assess whether lymphedema patients need treatment based solely on how swollen their limbs are. However, several studies have shown that the volume of fluid doesn't necessarily correspond with patients' discomfort. 

"Practitioners need to treat the swelling while considering patients' distress. We don't want to burden them with unnecessary or ineffective treatments," Armer said. "Health care providers should focus on managing symptoms and choose carefully among various treatments to provide individualized care plans that comfort patients, which may require modifying existing protocols." 

In their literature review, Armer and her colleagues found that Complete Decongestive Therapy (CDT), a comprehensive approach for treating lymphedema involving skin care, exercise, manual lymphatic drainage and compression of the swollen limbs, may be the best form of specialized lymphedema management. 

"Patients have different medical needs and come from culturally diverse backgrounds. They have different goals, support systems, pain levels and treatment tolerances. All these factors influence patients' responses to care, which affects their well-being," said Marcia Beck, a review co-author and an MU graduate who now works at Truman Medical Centers in Kansas City, Mo. 

"Caring for lymphedema patients should be flexible and adjusted to maintain patients' quality of life," said Ausanee Wanchai, another co-author who received her doctorate at MU and now teaches at Boromarajonani College of Nursing in Buddhachinnaraj, Thailand. 

In a separate literature review, the researchers found that Intermittent Pneumatic Compression (IPC) therapy, in which sequential inflatable devices surrounding swollen limbs are used to increase lymphatic circulation, is beneficial as an adjunct therapy for chronic lymphedema patients who have limited or no access to medical care; patients can use the compression devices in their homes. 

Armer said further research is needed to demonstrate the usefulness of various lymphedema treatments, such as CDT and IPC. The literature reviews were the third and fourth in a series of 12 to be published in conjunction with the American Lymphedema Framework Project (ALFP). As director of the ALFP, Armer works alongside clinical experts and investigators to increase awareness of lymphedema and related disorders. The ALFP was founded in 2008 and is headquartered at the MU Center for Lymphedema Research, Practice and Health Policy. Its steering committee and staff currently are partnering with the International Lymphedema Framework (ILF) in producing an updated edition of the ILF Best Practice Document from 2006. 

Medical News Today

π-Shaped lymphaticovenular anastomosis for head and neck lymphoedema: A preliminary study.

Oct 2012

Ayestaray B, Bekara F, Andreoletti JB.

Source

Department of Plastic and Reconstructive Surgery, Nimes University Hospital, pl Pr Robert Debré, 30000 Nimes, France; Department of Plastic and Reconstructive Surgery, Breast Institute, 15, av Jean Jaurès, 90000 Belfort, France. Electronic address: bayestaray@yahoo.fr.

Abstract

BACKGROUND:

Head and neck lymphoedema secondary to jugular lymphadenectomy is a severe issue, without efficient solution. Successful treatment of lymphoedema of the upper and lower limbs has become possible with supermicrosurgical lymphaticovenular anastomosis. The technique based on two end-to-side anastomosis is named π-shaped lymphaticovenular anastomosis. We have evaluated this method for chronic head and neck lymphoedema.

METHODS:

From November 2010 to April 2011, four patients with a chronic head and neck lymphoedema were treated by π-shaped lymphaticovenular anastomosis. Three patients had a unilateral lymphoedema, and one patient had a bilaterallymphoedema. The mean age of the patients was 63.2 years (range, 46-77 years). The mean duration of the lymphoedemawas 2.6 years (range, 1-5). Every patient was operated under local anaesthesia through a face-lift skin incision. One π-shaped lymphaticovenular anastomosis was performed at each operative site.

RESULTS:

The average operative time to perform one π-shaped lymphaticovenular anastomosis was 1.9 h (range, 1.8-2.5). The calibre of lymphatic vessels used for lymphaticovenular anastomosis ranged from 0.3 to 0.7 mm (average, 0.5). A venous back-flow was found in seven lymphaticovenular anastomosis (70%). Three patients (75%) had a qualitative improvement of skin tissue and a significant circumferential reduction after surgery. The average circumferential differential reduction rate was 3.7% (range, 0.6-7.8) (p = 0.006). The average cross-sectional area differential reduction rate was 7.2% (range, 1.2-15.1) (p = 0.007). The average volume differential reduction rate was 6.9% (range, 2-14.8) (p = 0.05).

CONCLUSIONS:

The authors present a new option to treat head and neck lymphoedema. π-Shaped lymphaticovenular anastomosis is an effective method to reduce the severity of skin tissue fibrosis and lymphoedema volume. Further studies with larger groups of patients are required to confirm the outcome of this preliminary study. EBM Level = level 4.

Elsevier

see also:

Lymphatic-venous anastomosis

A 24-year-old Ethiopian Farmer with Burning Feet.

Oct 2012

Visser BJ, Korevaar DA, van der Zee J.

Source

Academic Medical Centre - University of Amsterdam, Amsterdam, The Netherlands; Dutch Expert Center for Lymphovascular Medicine, Nij Smellinghe Hospital, Drachten, The Netherlands.

Abstract

Podoconiosis is a non-infectious tropical disease caused by exposure of bare feet to irritant alkalic clay soils. This causes an asymmetrical swelling of the feet and lower limbs due to lymphoedema. This swelling is called "elephantiasis" and may lead to severe disability of the patient. It is found in areas of tropical Africa, Central and South America and north-west India, where such soils coexist with high altitude, high seasonal rainfall and low income. Social stigmatization of people with the disease is widespread and economic losses are enormous. Podoconiosis is unique in being an entirely preventable non-communicable tropical disease. However, so far it has received little attention from health care policy makers.

Full text: Tropical Medicine and Hygiene

see also: 

Podoconiosis Lymphedema From Exposure to Clay Soil