Chronic Swelling and Lymphoedema

Chronic swelling is any swelling not associated with an acute injury and that hasn’t gone away within a normal amount of time after the injury.  Some chronic swelling can also be associated with other medical conditions (eg heart, kidney or vein problems).  Whatever the cause of your chronic swelling, it can be treated. Lymphoedema is a specific type of chronic swelling which occurs when there is damage to the lymphatic system. The lymphatic system is a series of vessels (similar to veins) which pick up the fluid from under our skin and transport it back into he blood supply.  On the way the lymphatic fluid is filtered through the lymph nodes and this is a large part of how our immune system works. Sometimes the lymphatic system is damaged – for example through cancer treatment, injury, being overweight or infection. This disrupts the vessels and the nodes, and then the fluid builds up under the skin, causing the chronic swelling. Other people are born with a lymphatic system which is not formed correctly.If chronic swelling is left untreated, over time the affected area will increase in size. This is both due to the accumulation of swelling but also protein build up, which eventually turns to fat. 
Treatment for all chronic swelling follows the same 4 main principles: 1.	Skin care2.	Compression3.	Manual Lymphatic Drainage4.	Exercise.

Skin care

Skin care is really important because unhealthy, dry skin can lead to an increase in a skin infection called ‘cellulitis’. Cellulitis occurs when bacteria gets through little cracks or scratches in the skin and starts multiplying under the skin, causing infection. This can spread rapidly and if the infection becomes advanced it can cause an infection in the blood. People with chronic swelling are more prone to cellulitis because the flow of the fluid and filtration is slower – giving the bacteria more time to multiply before it is filtered out. Treatment for cellulitis involves IV antibiotics and quite often a stay in hospital. Cellulitis will also damage the lymphatic system making the swelling worse in the long term. To help prevent this, a good skin care regime is essential:Moisturise daily with a good thick moisturiser. Creams which are in a tub are good. The brand doesn’t matter but some brands people tend to like are Aveeno, Dermaveen, Ego, QV, CeraVe. Regularly inspect your skin, especially around the nail bed and between your toes. Treat any cuts / scratches / broken skin promptly using an antiseptic and cover until healed.Prevent sunburn.Wear long trousers / sleeves when gardening to prevent scratches (especially from thorns like roses).Take care cutting your nails and see a podiatrist for this if necessary. 

Compression

Compression helps the swelling in two ways. Firstly it stops any more fluid from coming out under the skin, and secondly it helps to move the fluid which is under the skin up the limb and to an area where the lymphatic system is working. There are many different types of compression from bandaging, stockings / sleeves, wraps, and compression pumps. What will work best for you depends on the severity of your swelling and other personal circumstances. Your compression needs may also change with the seasons (eg some people experience more swelling in summer) and where you are in your treatment. It is important to see a professional to get advice on the type of compression you need. It is easy to get the type and / or sizing incorrect and a badly fitting garment can cause more harm than good. 

Manual Lymphatic Drainage

This is a type of massage which helps to move the lymphatic fluid from the areas where it has accumulated to a part of the body where the lymphatic system is still working. It encompasses several techniques to move the fluid and break up the protein which causes permanent changes. You can also learn how to do this massage yourself at home – daily massage is very beneficial to reducing long term skin changes. 

Exercise

Exercise stimulates lymphatic flow – especially when wearing your compression garments. Exercising in the water is very beneficial for leg swelling because the weight of the water provides excellent compression. There is no one exercise which is ‘best’ for swelling, but generally an exercise with take the limb through it’s range of movement is good. Your therapist can help you work out an exercise regime which works for you. 

What is an accredited Practitioner?

Erica ia an advanced accredited Lymphoedema practitioner and can help treat all types of swelling. She is accredited with the Australasian Lymphology Association. This means she has completed a recognised course in lymphoedema and has maintained professional development requirements (50 hours every two years) continuously. The accreditation program exists because there are many ‘therapists’ out in society who say they treat swelling / lymphoedema, however they do not have appropriate qualifications. By seeing an accredited therapist you are guaranteed that your therapist is using the most up to date knowledge available. You can find an accredited therapist here: https://www.lymphoedema.org.au/accreditation-nlpr/find-a-practitioner/

Funding options to help with treatment

To help with appointment costs, you can ask your GP if you qualify for a Medicare ‘Chronic Disease Management Plan’.  This will get you a medicare rebate of $60.35 back for 5 appointments each year. If you are a cancer patient, Can Assist Orange can help with funding for appointments as well as compression garments. There is a NSW state government scheme called Enable which will help to cover the cost of compression garments (this is means tested). Many health funds will help cover costs of appointments and compression garments. If you are an NDIS client the cost of your treatment will be fully covered by NDIS.