Lymphedema – Persistent Swelling in Arms or Legs: Dr. Silke Grummt on Symptoms, Causes, Treatment

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00:00:27: Expertly scrutinized clearly explained.

00:00:35: With lymphedema, fluid accumulates and swelling occurs in one or even several different areas of the body.

00:00:42: Most frequently the legs or arms are affected.

00:00:45: I'm speaking with Dr.

00:00:47: Silke Grump today about the causes symptoms And also the treatment of Lymphedema.

00:00:53: She is a specialist in dermatology and The medical director at the Whitlinger Therapy Center In Valxy Austria.

00:01:01: Doctor Grump where exactly can lymphedima actually develop?

00:01:05: Indeed, a lymphedema will always form whenever there is some form of damage to the lymphatic system.

00:01:12: And given that the lymphetic system extends throughout the entire body it is theoretically possible for a lymphodema to develop at any location in the body depending on the nature of the damage.

00:01:24: What we see most frequently or what we really see everyday life are injuries primarily in area of arms and legs In neck area & face.

00:01:34: We still see a certain frequency there, but the extremities are by far most commonly affected.

00:01:40: Now lymphedema and lipidema very often lump together So what exactly is difference between them?

00:01:48: Yes that's good question For which to provide an exact answer.

00:01:53: I could really go into detail.

00:01:55: Essentially they're two fundamentally different conditions That happen share the name edema.

00:02:00: But thats where similarity ends.

00:02:03: As I said, a lymphedema is specifically damaged to the lymphatic vessels or lymph nodes meaning it affects differs massively from lymphedema and is fundamentally very easy to distinguish.

00:02:37: It's also important to note that there are overlaps, yes so ultimately it's often not quite that simple because they're our patients who have lipidema And at the same time Lymphedema can often be diagnosed in those very same patients.

00:02:51: But let's stay with lymphedima for a moment.

00:02:54: How exactly does it develop then?

00:02:56: So is it something that's congenital or do people acquire it later in life?

00:03:02: There are, in fact both types of variants.

00:03:05: We distinguish between what is known as a primary and secondary lymphedema.

00:03:09: In Primary Lymphedema there are structural disorders in the lymphatic system which are genetically determined from birth.

00:03:18: so these patients who have some anatomical disorder This doesn't always have to manifest itself at birth.

00:03:28: this might only become apparent over the course of one's life, but anatomically I Have a disorder that is genetically determined Located somewhere within my lymphatic system with A secondary lymphedema.

00:03:41: it's like this These are patients for whom?

00:03:44: At some point in their life.

00:03:46: Their lymphatic System was absolutely perfect.

00:03:49: i Always say just as The creator originally intended It And then something happened, where a disruption or damage entered this system.

00:03:59: The cause for that again can be very different – the most common cause is surgical procedures meaning that lymphedema develops after a surgical intervention but also infections, inflammations and other such factors can lead to so-called secondary lymphedima.

00:04:21: How do the swellings behave with this particular condition?

00:04:25: Do they tend to come and go, or are they consistently

00:04:28: present?".

00:04:30: Well in mild early stages it's still a matter of coming-and going.

00:04:34: So...the patient can indeed perceive that under certain circumstances The affected extremity increases in volume And that the swelling intensifies.

00:04:44: But when the patient finally calms down Can elevate their legs Or next morning after truly restful night the swellings are often still present.

00:04:53: if I only have a very slight issue.

00:04:55: The more advanced or the more damage i have in the system, the less the body can deal with it on its own to the point where the body no longer eliminate fluid that is in tissue and we then depend on external support & therapy methods.

00:05:11: what this means is...i always essentially have certain kind of progression so..i have an injury.

00:05:17: This injury causes swelling And this swelling, particularly if it remains untreated will either over the course of day or a lifetime – years.

00:05:27: Or days rather increase than decrease So that a lymphedema would just resolve by itself.

00:05:34: There's nothing that doesn't exist but you cannot and should not wait for that now.

00:05:39: Well putting aside the obvious fact these kinds of swellings are naturally quite uncomfortable Can a lymphedema also trigger additional complications or even become a serious health risk?

00:05:53: Therefore, a lymphodema really should be treated.

00:05:56: The more intense and the longer this swelling persists within the tissue... ...the greater pressure that is exerted upon it which then leads to hardening of the tissue.

00:06:06: Elasticity decreases so susceptibility to infections increases.

00:06:13: Patients with lymphedema are very prone to infections in the affected limb.

00:06:19: This is where the dreaded cellulitis can easily develop.

00:06:23: For one, the penetration of germs is much easier but also dealing with an infection is simply much harder.

00:06:30: in lymphedima this means that patients are at risk from this particular aspect.

00:06:35: In cases of long-standing infections or even inflammations within the tissue The risk for tumour development in the tissue can even be significantly increased.

00:06:45: Open sores can also develop, these were I would say rather local problems.

00:06:51: however one must also not disregard i'd say the systemic problems affecting the entire organism.

00:06:58: So patients who have swelling are often I'd say from a mental aspect.

00:07:03: they tend to isolate themselves a bit.

00:07:05: They no longer dare go swimming pools They no longer dare to participate in certain social events, because a certain sense of shame sometimes plays a role.

00:07:15: This means that it often leads to a state of isolation.

00:07:18: Patients sometimes become more immobile –because naturally if I have a swollen leg-I can no longer move as i was accustomed to from

00:07:26: before.".

00:07:27: Then secondary diseases arise such as obesity diabetes cardiovascular disease and so on.

00:07:36: Long story short, it is very important to treat lymphedema as soon as possible.

00:07:42: However swellings are often perceived as harmless and even some doctors classify them that way.

00:07:48: Is it difficult for those affected to receive a diagnosis?

00:07:52: And then also treatment?

00:07:54: Yes!

00:07:54: That's in fact a considerable problem within society which once again has many different dimensions.

00:08:02: Firstly its condition that often begins insidiously and anything that truly progresses slowly is often not even noticed by the patient.

00:08:11: And patients themselves sometimes truly need a while until they realise something's wrong, and that it's something they should see a doctor about.

00:08:19: many believe they've simply gained some weight but even once that step has taken to go to the Doctor.

00:08:25: unfortunately The well education...the information isn't as widespread we would wish.

00:08:32: So, sadly I also hear from many patients that they were with a doctor –a colleague– who didn't take them quite seriously.

00:08:40: Who told them just lose a little weight again move more and it'll be fine.

00:08:45: so there's still a lot of room for improvement when it comes to public education & awareness And yes!

00:08:52: so that diagnoses are simply made earlier & Awareness is raised among both the patients AND professional medical groups.

00:09:00: Now, the Whitlinger Therapy Center is as we all know a specialized clinic.

00:09:05: When then it's clinical stay or an inpatient admission truly necessary for patients suffering from lymphedema?

00:09:13: I always say its when out-patient measures are no longer sufficiently effective.

00:09:18: For instance if patient wears compression stockings as an outpatient remains physically active and receives regular lymphatic drainage treatments.

00:09:28: And yet, despite all these truly stabilizing efforts there is still a progression of the underlying condition.

00:09:35: It must also be said we often have patients who come with milder variants sometimes even for a shorter stay where A LOT can be done preventatively and to keep this entire illness well under control.

00:09:48: So that too is possibility not just when theres complete escalation.

00:09:53: How are you able help at your therapy centre?

00:09:56: and how do you provide treatment?

00:09:59: Yes, the patients usually stay with us for about three weeks.

00:10:02: They're then integrated into a very structured therapy plan.

00:10:05: I'd say this involves daily exercise sessions such as gymnastics groups so physical activity is given high importance.

00:10:14: naturally The centerpiece of the treatment is lymphatic drainage which takes place daily performed by very experienced therapists With very capable hands who can effectively transport the fluid that is in the tissue well back out of the tissue and into the lymphatic pathways using specific techniques.

00:10:33: Following this, bandaging is applied meaning patients receive a bandage on the affected extremity so that the success of this achieved treatment Is maintained And they don't have to start from scratch again The next day during the subsequent treatment but Can instead build upon their progress Day after day.

00:10:53: But topics such as skin care are also given very high priority, because –as I've already explained at the outset–the skin is relatively sensitive when one has lymphedema.

00:11:04: And you must be careful to ensure that no infections develop.

00:11:08: Patients aren't only treated for this but they're made aware and educated so training and awareness of disease hold a significant importance.

00:11:18: Many lectures are held there's information exchange.

00:11:22: We also provide in-house psychological support, ensuring that this aspect is fully covered along with nutritional counselling.

00:11:30: to round off the entire concept.

00:11:33: How well are you able through this method alleviate the symptoms of lymphedema or perhaps even achieve a complete cure?

00:11:41: Unfortunately ,a complete cure is not possible for lymphedima.

00:11:46: we're dealing with chronic recurring medical condition But I wouldn't want to say one hundred percent, but actually it is one-hundred per cent.

00:11:54: so patients always leave our clinic with a significant improvement.

00:11:58: So we always achieve volume reduction in the affected extremity plus what values are lowered?

00:12:05: Potentially also an improvement in mobility and with that An overall enhancement of quality life meaning an improvement A decongestion.

00:12:15: Three weeks of rehabilitation would always be possible in principle.

00:12:19: As I've mentioned, there are always exceptions.

00:12:22: but this is truly the standard procedure where we achieve a significant reduction in swelling here and then it's up to the patient.

00:12:30: so he must have course continue to work at home.

00:12:33: He must continue to wear compression So they also adjusted with us.

00:12:38: The compression stockings are tailored.

00:12:41: He must usually also include air drains in his weekly schedule.

00:12:48: He must remain active, continue to implement the dietary concepts and depending on how consistently the patient can follow them we also need to consider his pre-existing conditions.

00:13:00: Not every lymphedema is the same but The task for outpatient care Is to maintain the decongestion We achieved during rehab.

00:13:09: But even the most perfect therapy whether in the clinic or as an outpatient, cannot prevent the patient from becoming a patient once again.

00:13:17: The time in between how long he remains stable can vary from half-a year to three years... ...or even five years!

00:13:25: On average it's about one year one has to say.

00:13:29: So after approximately a year A point is usually reached where rehabilitation is truly useful again meaning a renewed decongestion.

00:13:39: Yes That is exactly what I was going to ask next.

00:13:43: A clinic stay is always helpful and everyone feels better, but how long does that help truly last?

00:13:50: So for you if i've understood correctly – Does it Last For Roughly a Year ?

00:14:00: A new rehab really makes sense again to achieve intensive decongestion once more.

00:14:15: How do patients typically come to be referred to you?

00:14:19: So what are the essential prerequisites they need to meet, to be treated at your clinic?

00:14:24: I

00:14:25: could simply answer now if you have lymphedema then you're certainly in the right place with us!

00:14:30: We have both private patients meaning patients who pay for their stay entirely out of Formally, there are absolutely no prerequisites required other than the fact that a lymphedema requiring treatment is present and that the patient themselves ultimately defines the necessity of treatment during their rehabilitation stay.

00:14:52: So ,there are significant differences to consider as mentioned patients who present with rather minimal findings but who nonetheless greatly benefit from their time here.

00:15:07: So we have quite a number of patients.

00:15:10: If we now consider the rehab system through the insurance companies and health funds, then –of course–a rehab application must be submitted through The General Practitioner, the outpatient doctor at home which must be approved.

00:15:24: Then we also have to assess whether the patient is suitable Which they usually are if they have lymphedema or lipodema.

00:15:31: There are some forms of edema for instance that has their root cause in heart failure or in kidney failure.

00:15:38: I haven't delved into those particular cases at this moment.

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