To break down Lymphedema – it can be VERY frustrating for patients who might have this lymphatic system dysfunction and are having a difficult time within their medical care communities to get answers, get a proper diagnosis and more importantly understand what to do and how to care for their own lymphedema. This becomes increasingly important with the fact that two of the four stages of lymphedema are reversible.
I break down the 4 stages:
Stage 0: Latent Stage a “pre-stage”
Latent stage includes some intermittent swelling, folks in the “risk factor” category – cancer patients, surgical patients who have had any lymph node removal that might now have swelling fall also into this category.
Stage 1: Spontaneously Reversible
This stage includes puffy appearance of the hand or foot (farthest point on the limb). There may be impressions from pushing on the skin—referred to as “pitting” edema. Responds well to elevation and compression therapy.
Stage 2: Spontaneously Irreversible
In this stage the swelling takes on a spongy consistency and “pitting” is less present. At this stage, lymphedema does NOT respond to elevation. This tissue consistency change is caused by the formation of fibrosis, or scar tissue, with gradual thickening of the tissues on the limb as it increases in size.
Stage 3: Lymphostatic Elephantiasis
At this stage, the skin typically becomes very dry and scaly and the limb or other affected body region becomes very large. There may be fluid leaking from the limb and skin infections are common. The weight of the limb can be debilitating. Excess skin projections (including blisters) can form to attempt to contain the fluid, and these projections pose an even greater infection risk.
While these stages are all different, they are continuous. When lymphedema remains untreated, it will progress.
Proper Lymphedema Treatment focuses on halting this progression while also improving the symptoms. Specifically, treatment focuses on reduction of fluid volume but also on softening tissue fibrosis, reducing risk of infection, and maintaining or enhancing the function of the limb.
As a Certified Lymphatic Therapist – these are the recommendations for lymphedema management and lymphedema self care for patients:
1. Grab fresh ginger tea
2. Always Wear Compression Wraps and Stockings (depending on stage, eve wear is all you need)
3. Practice Good Skin Care
4. Implement Manual Lymphatic Drainage Techniques at Home
5. Dry Skin Brush
I have a few videos about this:
DIY Lymphatic Drainage Exercises for Swollen Legs: How to Reduce Swelling and Lymphedema in Ankles: https://youtu.be/5LtSFqpRHn4
Dry Skin Brushing: DIY Self Lymphatic Drainage Massage of the Breast and Upper Extremities: https://youtu.be/uXB6LTAjARU
Viewer Q & A: How Long Should I Wear My Compression Garments After Surgery for Maximum Healing: https://youtu.be/rt9YwI-4UAg
To watch more way to successfully reduce swelling in your body and move your lymphatics with lymphatic drainage therapy techniques watch my Lymphatic Drainage Therapy Play List:
Is Lymphedema Reversible? There’s many different stages of Lymphedema and factors. There’s two core types. Primary, people who are genetically born with lymphedema, it can be a genetic, passed on trait. And then there’s what we call secondary lymphedema which i something that tends to occur to many people for a lot of different reasons. I’ll tell you some of the top patient profiles that come to me with secondary lymphedema. They are breast cancer survivors, any type of cancer survivor that lymph nodes were removed, people with vascular insufficiency or history of blood clots, deep vein thrombosis, and even some chemo patients that may not have had lymph nodes removed but are on medications like tamoxifen that can sometimes lead to lymphedema. Other folks have actually had lymphedema kick off from an accident or surgery. A lot of my lower extremities, belly button down particularly legs, ankles, knees, calves. Folks I have seen that came to me after a spider bite with a lot of vascular insufficiency where there skin is a redish, rusty color. It almost looks like the blood isn’t moving and it’s actually red blood cells that are in excess because the veins are not moving, there’s vascular insufficiency and the veins are not pushing the blood up and that pours out into lymphatics and causes lymphedema.
There are a lot of different causes but there are also different phases or stages. So one of the things that myself and many other certified lymphatic therapists have been trained on is the lymphedema staging. It is challenging to get staged and diagnosed. There’s not true lymphedema specialist, as in a doctor that you can go see that specializes in lymphedema. There are an assortment of doctors that may have some understanding that can get you there. A lot of vascular surgeons or doctors will recognize it, or oncology doctors, radiation oncologists. They recognize it because of oncology related lymphedema.
4 Stages of Lymphedema
The actual first is not even called a stage. It’s called latency stage. It’s something that can be really challenging to get diagnosed. In the latency phase, it is a unique phase. It is a reversible phase. I see it a lot in the case of my breast cancer patients. This is considered a pre-stage. Folks are considered at risk, they are not at a stage 1 but sometimes they might get some swelling here and there. Nothing major, nothing on a consistent basis but management and prevention is going to be crucial. Any type of lymph node removal from the body would put you in the latency stage.
In stage 0 you want to manage your air travel appropriately to minimize lymphedema development. I’ve had patients who have had surgery and lymph nodes or organs removed and then gone on a trip, flown on a plane and came back with stage 1 lymphedema. What is most important is wearing compression stockings while on your air travel, staying really well hydrated, getting magnesium in your body so you’re flushing, drinking ginger tea to flush the lymph out and get things moving, manage your stress levels and also look at dry skin brushing.
I have a guide, I hope you’ll check it out, it’s free and it tells you how to do dry skin brushing. This is great for all of the stages but particularly that latency stage zero, stage one, two and three.
Stage 1 is actually the reversible stage. This is where the edema, or pitting, is soft. It’s squishy, it doesn’t feel firm, it hasn’t turned fibrous, there are no secondary tissue changes, the actual texture of the limb or extremity is in tact. Stage 1 is the most important stage to address in management, maintenance and preventive type of treatments. If an individual has stage 1 lymphedema and they don’t manage it, they can move into stage 2. Stage 2 is irreversible. Generally in stage 1, if elevation reduces your swelling, that is how we categorize stage 1. Stage 1 can be reversed with a specialized plan.
Stage 2 is what we call spontaneously irreversible. Unlike stage 1, there is more of a fibrotic nature to the actual limb. You’ll have tighter, tougher skin. Sometimes people get more frequent infections. Cellulitis is a big one. In stage 2 you can get quick redness, stressful trigger, the cellulitis.
Stage 3 is what we call lymphostatic elephantiasis. That tend to be where folks are holding way more fluid in an extremity. You’re going to know if you are in stage 3 if your limb or extremity is much bigger than the other part, much bigger. An arm, a leg, an ankle, a foot, a wrist can hold pounds of water or lymphatic fluid. I have some patients who are holding 60-80 pounds of fluid in an extremity. Stage 3 is where we see an increase in the volume and tissue changes in regard to the swelling. Sometimes there are deep folds, particularly in the lower extremities. In the folds we will find that the tissue is fibrotic, it gets tough and tight. There are sometimes papillomas, or a raised nodule. In stage 3, skin care becomes crucial to minimize the textural change and seeping of fluid.