Scott Webb (Host): Today we're going to learn about the two common forms of lymphedema and how physical therapists can help in the management of lymphedema from Dana Georgeson. She's a physical therapist with Northern Inyo Health Care District.

 Welcome to Mountain Medicine, a podcast from Northern Inyo Health Care District.

I'm Scott Webb.

Dana, it's nice to have you here today. We're going to talk about lymphedema, and I have to confess, I don't know a lot about lymphedema, but you probably do. You're the expert, so it's good that you're here. So let's start there. What is lymphedema, and how does it impact the body?

Dana Georgeson, PT, MPT, CLT: So lymphedema is an abnormal accumulation of lymphatic fluid in the lymphatic system, because of some either genetic malformation of the lymphatic system or an insult to the lymphatic system. When you have either of those situations occur, the lymphatic fluid has nowhere to go, and it builds up, and then you end up with the symptoms of lymphedema.

Host: Yeah, so let's talk about the development of lymphedema. Are there specific, because you used the word insult. I don't know if the insult is the same thing. Is it a tomato tomato with injury? Uh, but so like, are there specific conditions or risk factors that make somebody more likely to experience lymphedema?

Dana Georgeson, PT, MPT, CLT: Primary lymphedema is, again, a genetic situation where you just got the short straw and your lymphatic system, it doesn't flow freely. Secondary lymphedema occurs or develops when you've had surgery or an injury, like you fractured something so severely that some soft tissue was involved.

And then you've got a system that can't flow freely because of scar tissue or missing tissue. And secondary lymphedema is the most common cause of lymphedema.

Host: Alright, so it's the sort of genetic lottery, the genetics, family history, so let's just say that there are folks out there who are predisposed, if you will. What would be some of the early indicators or early warning signs that you, obviously it would be good if you knew your family history, that would probably be helpful, of course, but either way, what are some of the early warning signs of lymphedema?

Dana Georgeson, PT, MPT, CLT: The most obvious symptom that you'll observe in your body with, something happening is a swelling or an enlarging limb that doesn't match the others, and you didn't break anything, you didn't smash anything, you know there wasn't a traumatic event that happened to cause this swelling, and typically not associated with pain.

And primary lymphedema usually the onset is at an early age, because that's the system that you're, you're born with. There is also, kind of lumped into that same general category, lipolymphedema. And again, from an early age, you might feel like you're struggling with, obesity or like it really hurts to exercise because your tissue just feels so sensitive and painful. That sensitivity, that tissue sensitivity, like skin, and then just really like it almost feels like you're, you just cannot shed this weight. That is strong correlation with lipolymphedema or lipedema. And along with that genetic makeup of your tissue, the lymphatic system has developed in such a way that that fluid just doesn't drain easily and you're at risk of the same things as if you were to have lymphedema. It's not that your system is scarred down or injured, it just is inefficient.

Host: All right, so some folks are at greater risk, of course, family history, genetics, seems like the signs, symptoms, warning signs, if you will, come on fairly early for most. Is there a cure for lymphedema or is it a condition that needs to be managed long term? And is that why I'm speaking with a physical therapist?

Dana Georgeson, PT, MPT, CLT: Right? We exist for a reason. Um, yeah, currently there isn't a cure. There are some surgeries that might be available in more severe situations. Some surgeons are able to complete like a lymphoplasty, if you will. Like, take some vessels from here and put them over there. But, surgery is surgery, and scar tissue develops anyway, you might be able to improve a situation, but you won't necessarily be able to resolve a situation.

Host: Yeah no cure per se.

Dana Georgeson, PT, MPT, CLT: Right. And then liposuction in some cases where the tissue is so significant that it really limits your function and day to day life, so just going for a walk, playing with your kids, whatever it might be, just some simple things, it's not like you're trying to run a marathon or anything crazy.

That tissue volume is so significant that you might speak with your surgeon, speak with your doctor, of course, about liposuction to reduce the volume of tissue, but then you're going to continue on with the compression and the treatment, the classic gold standard. But it will make life more livable, in regards to body habitus, like what tissue you're dealing with.

Host: So what are the most effective treatments that you use? We're obviously, we're talking about managing it, right? So what are the most effective treatments and how do they generally help improve a patient's quality of life?

Dana Georgeson, PT, MPT, CLT: So the gold standard is called complete decongestive therapy. That includes a lymphatic massage, it's a very specific type of massage, followed by compression and exercise. The lymphatic massage is very important to address the accumulation of the not only fluid but the proteins which include bacteria, all the things that your immune system has to fight is collected in that lymphatic system and it needs to be removed.

It's basically your body's waste system. So, the massage is absolutely essential because you need to move that, those proteins out of the system and then you compress the tissue so that it doesn't return. If you have a system that is so inefficient and struggling so much, it can't really make up for the, it's own self management and you have to compress to prevent the return of that fluid to the insulted area. And then exercise is really important. Your muscles are internal pumps and exercise with compression facilitates again, lymphatic flow.

Host: Interesting. I love when I learn new things and I'm definitely learning a lot from you today. And as I was putting my notes together, things to ask Dana today, I came across axillary cording, which is words I've just never said out loud. So what is axillary cording and how is it related to lymphedema?

Dana Georgeson, PT, MPT, CLT: So, axillary cording is actually adjacent to lymphedema. It's more specifically related to breast cancer. Depending on the type of surgery that you had to have, the extent of the surgery that you needed to have, scar tissue develops. It's our body's protective mechanism when it thinks we're falling apart.

 So there's that. And the more extensive it is, of course, the more involved it's going to be. Followed by that, with breast cancer, specifically, radiation to the involved area. And if lymph nodes are involved in the armpit or the axilla, radiation combined with surgery will lead to this formation of this

fibrotic tissue that forms and it can be very limiting to shoulder movement and be pretty painful. So, when it develops, it's this fibrotic tissue, it's scar tissue and it may compound lymphedema in your arm. And also be painful to just shoulder, trying to get back to moving your arm again can be painful and limiting.

So you want to address that as early on as possible.

Host: For sure. Well, as I said, this has been very educational. My daughter wants to be a physical therapist, and I think when she thinks of PT, yeah, she thinks of just helping people with like, you know, injuries, sports injuries, things like that, and that's fine if that's what she wants to do, but I can't wait to tell her that I spoke with a physical therapist today and what exactly you do and how you help folks with lymphedema and, you know, there's no cure per se, but there is managing it and improving quality of life, which it sounds like you do, so thank you so much.

so much.

Dana Georgeson, PT, MPT, CLT: Yeah, I appreciate your time.

Host: And for personalized evaluation and management of lymphedema, please contact Rehabilitation Services at Northern Inyo Health Care District by calling 760-873-2122. And for more information about the services available at Northern Inyo Health Care District, visit NIH.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Scott Webb. Thanks for listening to Mountain Medicine from Northern Inyo Health Care District.