The Lymphatic System and Affected by Lymphedema

Lymphedema does not sound like a disease at all; in fact, it sounds more like a playful children’s toy.  Names can be misleading, since Lymphedema is far from a child’s play toy.  Lymphedema is an intriguing and bizarre disease that, most notably, can cause the limbs of a person to expand almost three times their original size.  Swelling of the limbs is only the tip of the iceberg when it comes to lymphedema; much more captivating facts are to be revealed (Lynch, 2005).

            Lymphedema is a disease characterized by localized fluid retention instigated by a weakened lymphatic system.  The lymphatic system is impacted negatively by lymphedema, but only in the affected areas.  A complex network of lymphoid organs, lymph nodes, lymph ducts, and lymph vessels make up the lymphatic system that produces and transports lymph fluid from tissues to the circulatory system (Lynch, 2005).    

            The lymphatic system functions normally by producing immune cells, removing excess body fluids from tissue, and absorbing and transporting fatty acids (Wikipedia, 2003).  Lymphocytes are the immune cells produced by the lymphatic system; they fight off infection, viruses, bacteria, and fungi.  The lymphatic system removes excess body fluids from tissue to avoid buildup and keep the lymph circulatory system flowing smoothly (Mershon, 1975).  The transportation of fatty acids after digestion takes place in the lymphatic system.  Fatty acids are first processed in the liver then are transported to the circulatory system via the lymphatic system (Wikipedia, 2003).

            Lymphocytes, the functional unit of the lymphatic system, are immune cells produced by the lymph nodes and organs such as the thymus and bone marrow (Mershon, 1975).  Lymphocytes primarily defend the body from foreign matter such as bacteria, infection, etc.  Lymphocytes can also be categorized into two groups: large granular cells and small cells.  Large granular lymphocytes are known as natural killer cells.  They attack foreign cells by reading each cell’s peptide bonds and determine whether it poses a threat to the body or not.  Small lymphocytes, T-cells and B-cells, are involved in the adaptive immune system.  This means these cells can identify viruses and bacteria as harmful and neutralize them in order to keep the body free from infection (Wikipedia, 2003).

            Two main categories cover the ways lymphedema can be caused.  Lymphedema can be inherited, which is known as primary lymphedema, or it can be caused by injury to the lymphatic system,– usually through surgery or radiation therapy relating to cancer treatment– which is known as secondary lymphedema.  A possible injury to the lymphatic system that could cause lymphedema is trauma to the lymph nodes or thymus gland that prevents the proper flow of bodily fluids through the lymphatic system.  Another possible cause of Lymphedema is a disease that stops the proper flow of interspatial lymph fluid through the lymphatic system (Dale, 1985).

            Symptoms of Lymphedema can vary from person to person; however, many people share common symptoms.  Common symptoms of Lymphedema include: a heavy swollen limb, extreme fatigue, discoloration of the skin around the affected area, deformities of the affected limb, and skin ulcers/infections (Weissleder & Schuchhardt, 2006).  The first symptom that many patients first notice is the swelling of a limb.  As the disease worsens other symptoms such as extreme fatigue and discoloration of the skin may become more apparent.  Physicians devised four stages to describe the severity and progression of lymphedema (Wikipedia, 2003).

            The first of these stages is Stage 0, also known as the latent stage.  In Stage 0, the lymphatic vessels have sustained some damage to their fluid draining abilities; however, the symptoms of lymphedema are not yet present.  In the second stage, Stage 1, mild symptoms of lymphedema are present, such as minor swelling of an extremity and slight fatigue.  Stage 1 is commonly referred to as the “spontaneously reversible” stage.  The third stage is Stage 2.  In Stage 2, the swelling of the limbs begins to harden and discolor slightly.  Fatigue is more apparent in this stage than any of the previous stages.  Stage 2 is also known as the “spontaneously irreversible” stage.  The final stage of lymphedema is Stage 3.  Stage 3 is the most severe stage of any and all lymphedema cases.  All symptoms are present and are their most severe in the final stage.  Extreme fatigue and skin discoloration occur around the affected area, and the extremities affected have enlarged to as much as three times their original size.  Stage 3 is also called “lymphostatic elephantiasis” (Mershon 1975).  In order to treat lymphedema and avoid reaching Stage 3, which is almost completely irreversible, many treatments exist to do such.  

            Current treatments for Lymphedema have been quite successful, and can treat the disease almost perfectly, if treated when the disease is first detected.  Currently the most prescribed treatment for Lymphedema is Complete Decongestive Therapy (CDT).  CDT involves manual lymphatic drainage, compression bandaging, prescribed exercise, and skin care.  Manual lymphatic drainage involves rhythmic massage to the affected areas to open the lymph vessels and allow the lymph fluid to drain.  Compression bandaging consists of several compression bandages applied to the affected area.  When combined with prescribed exercise, the lymph fluid will drain much more quickly than if no treatments were used.  Skin care is used as treatment because people with Lymphedema are more prone to skin infections; this helps keep the skin healthy and normal looking (Weissleder & Schuchhardt, 2006).  Nearly 85% of patients treated with CDT show improvement in their condition (Dale, 1985).  Even though all of these treatments are very successful, there is one treatment that looks even more promising that is looming over the horizon.

            A future treatment that is soon to become a reality is a special method called Kinesio Taping.  It is a tape that has 140% flexibility, matching that of skin.  It provides compression and support to affected areas and allows fluids to still flow uninterrupted underneath the skin.  Kinesio tape is now being used as a prototype by Japan’s finest physicians and trainers on athletes and lymphedema patients alike (Mershon, 1975).  Kinesio tape looks to be a promising new treatment for all sufferers of lymphedema.

This is a picture of a person with Stage 3 Lymphedema.  This person’s foot has swollen greatly and has much discoloration to the skin of the affected area.  Lymphedema to this severity is nearly irreversible without CDT and reconstructive surgery.  Even with reconstructive surgery this patient’s foot will never look the same again (Wikipedia, 2003).     

Lymphedema is an intriguing disease.  Many different things can cause lymphedema, but the symptoms always remain the same.  The symptoms, perhaps the most intriguing part about lymphedema, are quite bizarre.  Lymphedema is perhaps one of the most unusual diseases of the lymphatic system.

References

Dale, R. F. (1985). The inheritance of primary lymphedema. Journal of Medical Genetics

22:274-278

Lymphedema. (2003). Wikipedia, the free encyclopedia. Retrieved November 16, 2006, from

Reference.com website: http://www.reference.com/browse/wiki/Lymphedema

Lynch, T. (2005). General Information: Lymphedema. Retrieved November 15, 2006, from The

American Society of Lymphology

Web site: http://www.lymphology.org/page.asp?xqp=specialists

Mershon, J. P. (1975). Lymphedema diagnosis and treatment. New York: Springer-Verlag

Weissleder, H., & Schuchhardt, C. (2006). Sick!: Diseases and disorders, injuries and

infections. (1st ed) New York: UXL Publishing