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Deborah Howell (Host):  You know, there are so many conditions that physical therapy can help treat, but is lymphedema, one of them? This is the podcast series from Deaconess, The Women's Hospital, a Place For All Your Life. I'm Deborah Howell. And our guest today is Dusty Fiester, a Certified Lymphedema Physical Therapist at the Women's Hospital. And today we'll talk about how physical therapy can help patients with lymphedema. Welcome Dusty.

Dusty Fiester, PT, CLT-LANA (Guest): Thank you so much for having me.

Host: Thanks for making time for us in your day. So, what is lymphedema?

Dusty: Well, lymphedema is a diagnosed condition, which means that it is not a symptom of some other broken problem within the body. It in and of itself is the diagnosis. And lymphedema is progressive, which means that it can worsen over time without treatment and primarily is identified by swelling of one extremity. So, one arm or one leg, because of an abnormal accumulation of that lymphatic fluid under the tissue of the skin.

Host: Got it. And where does lymphedema often occur in the body?

Dusty: Lymphedema can occur anywhere in the body. So, when we talked about what lymphedema is, I said one arm or one leg, but in reality, lymphedema can occur in both extremities. It may be more prevalent in one than the other. So, any region in your body could have lymphedema, including the head and the neck because of lymph nodes being affected in those areas.

Host: Now do we know what causes lymphedema?

Dusty: There are a couple of main reasons that we have identified can be the cause or the reason behind the swelling occurring. Most prevalent that most commonly recognized and understood is due to someone having had cancer and having lymph nodes removed. And when you take a piece of the system away, it's kind of like taking a piece or a part out of a car. It doesn't work the same. So, that's considered secondary lymphedema because there was something that caused the swelling to start. The other type of lymphedema, which is less commonly diagnosed because it's less commonly occurring is primary lymphedema and primary lymphedema is something that someone maybe is born with an insufficient lymphatic system. And so they may present with swelling very early in life, as an infant or a young child, or it may be something that their system is never overwhelmed or taxed enough to show any symptoms until much later in life.

Host: Okay. And what's the difference between lymphedema and edema?

Dusty: So, a very difficult question and something that is a really important topic to me because honestly, when we start treating patients for lymphedema, we start having referrals for pretty much any kind of swelling, because the discrepancy between the two is somewhat difficult. Lymphedema is protein and water that is accumulating under the skin and edema is just water. So, being able to differentiate between the two can be somewhat challenging unless you know the medical history of that person, to know, is this related to the lymphatic system in some way being damaged from either surgery or radiation, or some other trauma, or is it edema and there's maybe another disease process that's causing the swelling, like heart or kidney issues.

Host: Okay. And does lymphedema affect my body in any other way than swelling? Is it painful?

Dusty: It's actually not painful. And some of the pictures that you can look for on the internet can be really overwhelming and scary. So, a lot of people will, think you have this big swollen limb, it's going to be really, really uncomfortable and painful. And there really Is no pain associated with it. It might be heavy, but not painful. But in addition to swelling, because of the swelling being present, those patients are at a higher risk of having a skin infection, which we call cellulitis. And so sometimes they'll see their doctor because they are having these repeated skin infections, because there's so much swelling there that the circulatory system can't respond quick enough to prevent that from happening.

Host: Okay. And can it make you feel kind of isolated or alone?

Dusty: Absolutely. Absolutely. And I think having connections with others that can identify with what you're going through, is super, super, helpful and impacting for patients to know that they're not alone. And so sometimes as therapists, we're able to connect them with other individuals that are experiencing similar things so that they don't feel so isolated. And like they're battling a battle that no one else has experienced.

Host: Sure. Does lymphedema affect my daily activities?

Dusty: Not necessarily. It's very, very similar to, I guess managing diabetes. We unfortunately are not able to make the lymphatic system work on its own without some kind of external support. So, patients will often wear compression wraps or compression garments to contain the fluid. They are encouraged actually to resume all of their daily activities. We don't want it to affect their lifestyle in a negative way. We want to be able to provide them with the tools that they can control the swelling and keep it down so that they can resume all of their normal functional activities.

Host: Well that's good. And how do you treat lymphedema?

Dusty: So, lymphedema treatment is something that you definitely want to have a certified lymphedema therapist providing those services, which we are so, so lucky here at the Women's Hospital, to be able to provide. We have four certified lymphedema therapists. And what certified lymphedema therapists do is they include all four components to treat lymphedema. So, the components that are used to treat the swelling include compression, which we mentioned earlier. So, that could be compression bandages or a compression garment. We do a manual therapy technique called manual lymph drainage, which has kind of a massage like technique, but it helps to redirect that fluid and move it out of the limb or out of the area where it's accumulating. And then we teach them exercises that help to move the fluid through circulation. And then also how to properly take care of their skin because of that whole issue with prevention for infection. We want to prevent that from happening for them down the road.

Host: And what about at home pneumatic compression pumps?

Dusty: So, we actually utilize those a lot for longterm management. It's not necessarily something that we would utilize to what we call decongest the limb, or to get rid of that initial fluid. We would use just the four components I mentioned earlier. But the pump is something for long-term management for the patients to be able to use at home once they're no longer seeing us to maintain those effects and benefits that they received while they were seeing us.

Host: Okay. And how do I know which area of the body is at risk?

Dusty: So, our body is divided into four areas, essentially when it comes to knowing what lymph nodes may have been affected and caused the swelling to start. So, for an arm, if you had lymph nodes that were affected in the armpit area or the axilla, that could affect the arm and it could also affect the trunk. So, any like area in the breast area or on the rib cage on that same side. For the legs, you're looking at the lymph nodes that are right at the bend of the hip. And those lymph nodes are responsible for draining any fluid in the leg, as well as any fluid that would be in the lower quadrants or anything below the belly button.

So, if you have swelling in the lower abdomen or in the leg, it's most likely due to those lymph nodes at the groin, which we call inguinal lymph nodes, and then the third area, I said there were four, but there's really three. The third area, it would be the head and neck. So, anything above the collarbone. If any radiation or damage has been done to the lymph nodes on either side of the neck, you can have swelling in the face or the neck area from that.

Host: Signs and symptoms. How do I know if I have lymphedema?

Dusty: The first thing we usually teach people to monitor for is just a feeling of fullness or heaviness on the effected side. So, this is obviously only helpful if number one, you've received the education preventatively. And number two, if you have had a specific occurrence, like for a breast cancer survivor, they know okay, I've had lymph nodes removed from underneath my arm. So, I'm going to watch for swelling on this side. So, fortunately, or unfortunately the only way to really know preventatively or to watch for lymphedema, is if you have a known insult to that system. If they have just in general swelling and they're not really sure if it's lymphedema or edema, I would just encourage that they see their doctor and have that conversation with them to decide, you know, is this something that you think is related to lymphedema or could it be just swelling due to some other organ issue?

Host: Yeah. If you're swelling or your clothes or your shoes, or even your jewelry, feel tighter, time to go see your doctor, right?

Dusty: Absolutely.

Host: Dusty. Is there anything else you'd like to add to our conversation today?

Dusty: Well, I just number one, want to thank those listening for being proactive and educating yourself on a topic that you may know something about, or you may know very little about. I think lymphedema is often misunderstood and a lot of individuals don't know that there are treatments available. And so we are so lucky to have the ability to serve this population in a pretty impacting way. And so I just thank you for giving me the opportunity to share a little bit about what we do, and I hope that it makes the ripple effect in someone else's life.

Host: We do too. And thank you so much for helping us get that word out. Thank you, Dusty for shedding some light on the benefits of physical therapy for patients with lymphedema.

Dusty: Thank you so much.

Deborah Howell (Host): And that wraps up this episode of the podcast series from Deaconess, The Women's Hospital, A Place For All Your Life. To learn more, head on over to deaconess.com/highpoint or call (812) 842-2820. And for more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.