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

Low-invasive lymphatic surgery and lymphatic imaging for completely healed intractable pudendal lymphorrhea after gynecologic cancer treatment.

Sept 2012

Mihara M, Hara H, Narushima M, Mitsui K, Murai N, Koshima I.

Source

Department of Plastic Surgery and Reconstructive Surgery, University of Tokyo, Tokyo, Japan.

Abstract

Lower limb lymphedema and an accompanying lymphatic fistula (lymphorrhea) occur as complications after gynecologic surgery to treat cancer. Herein, we report the case of a 68-year-old woman who underwent resection and radiotherapy because of uterine cervical cancer (stage 2a) 20 years previously. Left lower limb and pudendal lymphedema and continuous lymphorrhea developed soon after surgery. Conservative treatment was administered; however, the edema increased, and a pudendal lymphatic fistula and cellulitis developed repeatedly. Lymphovascular anastomosis (LVA) and lymph vessel ligation were performed after preoperative evaluation via lymphoscintigraphy and indocyanine green (ICG) lymphography. A radioisotope injected into the first interdigit pedal region flowed into the pudendal region via the inguinal lymph nodes at preoperative lymphoscintigraphy. Linear patterns were observed up to the half level of the crus, and stardust patterns occurred over the lower abdominal and pudendal regions at ICG lymphography. During surgery, ICG lymphography was also used to identify the site of the fistula. With the patient under local anesthesia, LVA was applied in the half crus and left inguinal regions, followed by ligation and division of lymph vessels flowing into the fistula. The region around the fistula was excised as a 1 × 3-cm tissue block. As of 5 months after surgery, no recurrence of lymphatic fistula or exacerbation of lymphedema has occurred. This case shows the effectiveness of preoperative ICG lymphography and lymphoscintigraphy followed by treatment via lymph vessel ligation and LVA for curative resolution of a lymphatic fistula.

PubMed

For further information on Lymphoscintigraphy

Infectious Disease Doctor for Lymphedema

Infectious Disease Doctor

I am a firm believer in the concept of a “team” approach to the management and treatment of lymphedema and its associated complications.

What is a Team Approach?

The team approach is a group of medical providers working together for the well being and health of the lymphedema patient.

In my situation, my team consists of

Primary Care Doctor
Oncologist
Pulmonary Doctor
Infectious Diease Doctor

Why Do I Need an Infectious Disease Doctor?

Until I acquired lymphoma, the most pressing complication that I experienced with my leg lymphedema was recurrent and severe cellulitiis. It was apparent long ago that we desperately needed a way to control it (try to prevent) and if it did occur to promptly and successfully treat the infection.

The result is that I have been under the care of an ID doctor now for over twenty years.
Because of our susceptibility to infections and because our lymphedema arm or leg is immunocompromised, it is essential that any lymphedema patient with recurrent infections enlist the aide of an “ID” doctor. They are specially trained in infections and are far more qualified to treat them then any other type of doctor.

My ID doc, Dr. Elliott Raizes has been a life saver and a God send in my own battle with lymphedema. Not only does he has that “old fashioned” and rapidly disappearing concern for his patients, but his knowledge of bacterial infections is unbelievable.

How Do I Find an Infectious Disease Doctor?

The easiest way is to simply ask or if need be insist on a referral to one in your area from your PCP. They may already know of a good doctor within your community.

You can also find participating ID doctors in your insurance plan through their “Find a Doctor” service or you can locate one through the internet.

Pat

What is an ID Specialist?

Infectious Disease Specialists are like medical detectives. They examine difficult cases, looking for clues to identify the culprit and solve the problem.

Your ID Physician Has 9-10 Years of Specialized Education & Training

4 years of medical school
3 years training as a doctor of internal medicine
2-3 years specialized training in infectious diseases

Most ID specialists who treat patients also are board certified. They have passed a difficult certification examination by the American Board of Internal Medicine in both internal medicine and infectious diseases.

Reducing Risk of Infectious Disease

One of the best strategies for preventing infectious diseases is immunization. Make sure you and your children receive all recommended vaccinations.

Ask your doctor for advice about other things you and your family can do to prevent infectious diseases.

When You Need an ID Specialist

Many common infections can be treated by your personal physician. Your doctor might refer you to an ID specialist in cases where an infection is difficult to diagnose, is accompanied by a high fever, or does not respond to treatment. ID specialists also see healthy people who plan to travel to foreign countries or locations where infection risk is higher. In these cases, ID specialists can help determine whether special immunizations or other preventive measures are necessary to protect travelers from disease.

Typical Procedures

ID specialists review your medical data, including X-rays and laboratory reports such as blood work and culture data. They also may perform a physical exam to help determine the cause of the problem.

Tests

ID specialists often order laboratory tests to examine samples of blood or other body f luids or cultures from wounds. A blood serum analysis can help the ID specialist detect antibodies that indicate what type of infection you have. These advanced tests can further explain the results of earlier tests, helping to pinpoint the problem.

Treatments

Treatments consist of medicines—usually antibiotics—to help battle the infection and prevent it from returning. These medicines may be given to you orally (in the form of pills or liquids) or administered directly into your veins, via an IV tube. Many ID specialists have IV antibiotic therapy available in their offices, which decreases the likelihood that you will need to be hospitalized.

What Information Should You Give Your ID Specialist?

All medical records related to your condition

X-rays, laboratory reports and immunization records. Often your personal physician will forward this information to the specialist before your scheduled appointment.
A list of all medications you take

This list should include over-the-counter and prescription medications

A list of any allergies you have.

Let the ID specialist know if you are taking birth control pills.

Some antibiotics may interfere with the effectiveness of oral contraceptives.

How Does My ID Specialist Work With Other Medical Professionals?

The ID specialist works with your personal physician to determine which diagnostic tests are appropriate. If treatment is necessary, your doctor and the ID specialist will work together to develop a treatment plan best suited to your needs. Often you will be asked to return to the ID specialist for a follow-up visit. This allows the specialist to check on your progress, confirm that the infection is gone and help prevent it from coming back. If you acquire an infection while in the hospital, the ID specialist will work with other hospital physicians to help direct your care.

The specialist also might provide follow-up care after you go home.

If your ID specialist is also your personal physician, he or she will coordinate your care, referring you to other specialists when necessary.

ID Specialists Are Experts in the Diagnosis and Treatment of Illnesses Caused by Microorganisms.

ID specialists see patients to determine whether their symptoms are due to an infection.

Patients often see ID specialists due to a fever.

Some ID specialists serve as primary care physicians, for example, for people with HIV/AIDS, treating most illnesses and coordinating their patients’ overall care.

In all of these cases, the specialized training and diagnostic tools of the ID specialist can help determine the cause of your infection and the best approach to treatment.

Where Can I Get More Information About the Prevention and Treatment of Infectious Diseases?

Your doctor is your best source of information. In addition, the Infectious Diseases Society of America (IDSA), a professional organization of nearly 8,000 ID physicians, scientists, and other infectious diseases experts, can help point you in the direction of resources and additional information.

Visit IDSA’s website

Infectious Disease

Infectious Disease Internal Medicine Subspecialty

An infectious disease (ID) specialist is a doctor of internal medicine (or, in some cases, pediatrics) who is qualified as an expert in the diagnosis and treatment of infectious diseases. After seven or more years of medical school and postgraduate training, ID specialists complete two to three years of additional training in infectious diseases.

ID specialists have expertise in infections of the sinuses, heart, brain, lungs, urinary tract, bowel, bones and pelvic organs. Their extensive training focuses on all kinds of infections, including those caused by bacteria, viruses, fungi and parasites. Many ID physicians specialize in treating patients with infections due to human immunodeficiency virus (HIV), the cause of AIDS.
Along with their specialized knowledge comes a particular insight into the use of antibiotics and their potential adverse effects. ID specialists also have additional training in immunology (how the body fights infection), epidemiology (how infections spread) and infection control.

What an infectious disease specialist does

The role of an infectious disease specialist is to review a patient's medical data, including records, X-rays and laboratory reports. They may perform a physical examination, depending on the type of problem. They also counsel healthy people who plan to travel to countries where there is an increased risk of infection.

Laboratory studies are often necessary and may include blood studies and cultures of wounds or body fluids. They may order blood serum studies for antibodies indicating the presence of unusual or uncommon diseases. These studies may help explain the results of studies that a general internist may already have done.

Work in the infectious disease specialty is limited to diagnosis and medical treatment. Infectious diseases specialists do not perform surgery.

When you need an infectious disease specialist

Not everyone who has an infectious disease needs an infectious disease specialist. Your general internist can take care of most infections, but sometimes specialized expertise is needed to either diagnose or manage specific infectious diseases.

When a fever raises the suspicion that you may have an infection, when an infection is potentially serious, or when problems occur with treatment, it may be necessary to consult an infectious diseases specialist. ID specialists can provide special insight into tests that will be helpful in diagnosing and understanding the infection and preventing recurrent infections. They can often help determine what treatment you need, if any, and whether you should receive antibiotics. You may not require any treatment, but if you do, they may confer with your personal physician about which diagnostic testing and forms of treatment are best suited to your needs. If you are hospitalized for an infection or acquire an infection while hospitalized, ID specialists will follow and help direct your hospital care. In some cases, they may continue to see you after you go home from the hospital.

How infectious disease specialists work with other physicians

Although infectious diseases specialists sometimes serve as primary care physicians, in most cases you will still need your regular doctor. Usually you will be asked to return to the ID specialist for a follow-up visit to review test results and to be sure that your infection has been eliminated. ID specialists may wish to follow up with you until we feel confident that the infection will not recur. You will resume care with your regular physician when your condition has stabilized or is cured.

Doctors for Adults

See also: Infectious Disease Doctor

Secondary Lymphedema From Infections

Lymphedema Caused by Infections Cellulitis and Erysipelas

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Persistent Periorbital and Facial Lymphedema Associated With Group A beta-Hemolytic Streptococcal Infection (Erysipelas).

Ophthal Plast Reconstr Surg. 2007 March/April Buckland GT 3rd, Carlson JA, Meyer DR. *Department of Ophthalmology; and daggerPathology, Division of Dermatology and Dermatopathology, Albany Medical College, Albany, New York, U.S.A.

Chronic lymphedema is both a risk factor for and consequence of erysipelas (cellulitis). We report a case of a 62-year-old woman with rheumatoid arthritis treated with etanercept and prednisone, who developed chronic periorbital lymphedema 2 months after Group A beta- hemolytic streptococcus infection of the face. She had significant ptosis OS and thickened, hyperpigmented periorbital skin. Biopsies were consistent with chronic lymphedema. Of note, on 6 months follow- up, the patient's appearance was improved though she still had residual ptosis. A period of extended observation may be warranted in these cases. PMID: 17413641

[PubMed - as supplied by publisher]

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Edema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg

Date: 4/9/07 9:36 AM EST

2006 Nov CLINICAL AND LABORATORY INVESTIGATIONS Cox NH. Dermatology Department, Cumberland Infirmary, Carlisle CA2 7HY, UK. neil.cox@ncumbria-acute.nhs.uk

BACKGROUND: Cellulitis of the lower leg is a common problem with considerable morbidity. Risk factors are well identified but the relationship between consequences of cellulitis and further episodes is less well understood.

OBJECTIVES: To review risk factors, treatment and complications in patients with lower leg cellulitis, to determine the frequency of long-term complications and of further episodes, and any relationship between them, and to consider the likely impact of preventive strategies based on these results.

METHODS: Patients with ascending, presumed streptococcal, cellulitis of the lower leg were identified retrospectively from hospital coding. Hospital records, together with questionnaires to both general practitioners and patients, were used to record subsequent complications and identifiable risk factors for further episodes.

RESULTS: Of 171 patients, 81 (47%) had recurrent episodes and 79 (46%) had chronic oedema. The concurrence of these two factors was strongly correlated.

CONCLUSIONS: This study demonstrates that the true frequency of postcellulitic oedema, as well as that of further episodes, is probably underestimated. Furthermore, there is a strong association between these factors, each of which is both a risk factor for, and a consequence of, each other, and for which intervention (reduction of oedema or more prolonged antibiotic therapy) may reduce the risk of recurrent infection. By contrast, self-reporting of toeweb maceration is low, so attempts to reduce the risk of recurrent cellulitis by treatment of tinea pedis or bacterial intertrigo may fail.

Blackwell Synergy

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Persistent Periorbital and Facial Lymphedema Associated With Group A beta-Hemolytic Streptococcal Infection (Erysipelas).

Ophthal Plast Reconstr Surg. 2007 March/April
Buckland GT 3rd, Carlson JA, Meyer DR. *Department of Ophthalmology; and daggerPathology, Division of Dermatology and Dermatopathology, Albany Medical College, Albany, New York, U.S.A.

Chronic lymphedema is both a risk factor for and consequence of erysipelas (cellulitis). We report a case of a 62-year-old woman with rheumatoid arthritis treated with etanercept and prednisone, who developed chronic periorbital lymphedema 2 months after Group A beta- hemolytic streptococcus infection of the face. She had significant ptosis OS and thickened, hyperpigmented periorbital skin. Biopsies were consistent with chronic lymphedema. Of note, on 6 months follow- up, the patient's appearance was improved though she still had residual ptosis. A period of extended observation may be warranted in these cases.

PMID: 17413641 [PubMed - as supplied by publisher]