LYMPHEDEMA THERAPY RESTORES QUALITY OF LIFE AND LIMB FUNCTION TO CHRONIC SUFFERERS
A symptom appearing on a hot summer day during a vacation in Hershey, Pa. nearly a decade ago would change 35-year-old Tony Martin’s life forever. “My wife said, ‘your ankle is swelling up,’” he recalls. By the time Martin made it home to Greenbrier County, the swelling had spread to the calf area of his left leg, what he calls his clutch foot because of his dependence on it for his occupation as a concrete truck driver.
The swelling abated and the incident dismissed, Martin didn’t realize it was the wave before the tsunami. Six months later, the internal deluge returned with a vengeance when his leg swelled four times its normal size and stayed there. Martin had a condition it was difficult for doctors and his determination to lasso down. What caused the circumference of his leg to swell to the point of deformity and extreme discomfort was lymphedema.
As RGH’s certified lymphatic therapist Heather Gragg explains, the lymphatic system, responsible for managing fluid called lymph within the body’s tissues, I an intricate, temperamental web. A compromised lymphatic system will allow fluid to collect in the tissues, causing extreme and often painful swelling. “If anything disrupts the lymphatic system, lymphedema can result,” Gragg states. “Anything” could mean a commonplace surgery or biopsy removing one or more lymph nodes, including biopsies for breast cancer diagnosis, mastectomies and radiation therapy. Obstruction of lymph nodes and genetic malformations can also cause the condition. In Martin’s case, as far as Gragg can determine, it was a minor surgery in the groin area leading to his lymphatic system imbalance. Triggers such as extreme heat, surgery or air travel are often the backdrops against which a hidden lymphatic problem will revel itself.
Armed with a diagnosis from his family physician, to whom he’s grateful for discovering the problem, didn’t end Martin’s ordeal. It was just beginning. Traditionally prescribed oral therapies like diuretics were ineffective to Martin, as they are for most patients suffering from lymphedema. His only true relief came when he was eventually referred to the physical therapy department at Raleigh General Hospital, where was he treated by Gragg. At the RGH PT office, Martin’s swollen leg lost nearly 20 pounds in the three weeks of treatments, a dramatic change for the man who had battled his illness without relief for seven years.
Before today, Martin had to wear baggy carpenter’s pants instead of his jeans, which would no longer accommodate his leg. Patients coping with lymphedema often cannot wear normal-sized pants or shoes, or they have trouble with shirts and jewelry when the arms are affected. Either type experiences limited mobility. Other troubling symptoms appearing with lymphedema include tingling, heaviness, burning. And tightness related to the increase in internal turgor or fluid pressure for the affected limb.
“I couldn’t wear dress clothes. I had to self-medicate,” says Martin. When he bought a one-size-fits-all diabetic compression stocking, it created a tourniquet effect, disturbing his circulation and further increasing his discomfort. He purchased a pneumatic compression pump online, but his attempts at returning his left leg to even close to its normal size proved expensive and futile.
In addition to patient discomfort, untreated lymphedema can be dangerous to life and limb. Martin has undergone surgeries due to staph infections secondary to tiny cuts and scratches that would be negligible to a normal patient, but which are unable to heal themselves in those affected by lymphedema. “Ladies with lymphedema can’t use regular razors for shaving their legs. Lymphedema patients have to always protect themselves against sunburn and bug bites which can lead to infection,” states Gragg. The constant pressure makes their skin generally more fragile than that of a personal without lymphedema, she explains.
The therapy Gragg employed to help Martin involved three main components: targeted massage which re-route the excess lymph to healthy areas of the lymphatic system to be returned to the circulatory system; bandaging of the affected area, which involves building up of and applying proper pressure to limbs to avoid the tourniquet effect of wraps; and patient and family education necessary to transition control for the chronic condition back to the patient. “Everything is non-invasive,” Gragg states about the approach that, once completed, allows a patient’s appendage to remain at a normal or close to normal size by wearing a custom-fitted compression garment once the excess fluid is progressively shed. A trained professional therapist like Gragg must initiate and manage the process. “Damage to the tissue can occur if you bandage too tightly or bandage the limb without the proper dressing layers.”
Patients are ultimately able to curtain their weekly visits and manage their conditions at home, once the fluid loss from the affected limb plateaus and the patient is fitted with a custom compression garment. Should patients be non-compliant, the complications associated with lymphedema will return. “If you go without compression, it will come back eventually. This condition isn’t curable, but it is manageable,” Gragg explains.
Gragg is so enthusiastic when she encounters patients she knows she can help like Martin, she admits, “(Patients) don’t believe I’ve ever done this before I get so excited with each visit.” In fact, she keeps a sizable album of before and after images to chronicle the lives she has been able to positively affet with the therapy. The sustained and quick results Martin experienced have made him a willing advocate in a short amount of time, an ordinarily quiet and reserved man excited to share his success story in the spirit of helping others who may suffer the same.
As he leaves RGH following his most recent therapy, one of 1 to 2 he’ll undergo weekly until his left leg returns to as close to normal as possible, he is able to wear his jeans once again. Bandages and all, there is still plenty of leg room, something that to him had been unattainable just a few weeks before.
“Now I have somebody who knows how to treat this. I had tried everything other than physical therapy, and that’s what worked.”
Originally published in the March/April edition of THRIVE as Life or Limb.