Joe Arringtion Cancer Center

JACC
4101 22nd Place
Lubbock, Texas 79410

phone: 806-725-8000
fax: 806-723-6412

General Information:
info@joearrington.org

Lymphedema/Edema Clinic

The Joe Arrington Cancer Research and Treatment Center (JACC) opened Lubbock's first lymphedema center in April 1997. It is the only facility in the Lubbock region which provides a comprehensive management program specializing in the treatment of primary and secondary lymphedema and other edema-related conditions.

What is Lymphedema?
Lymphedema is an abnormal accumulation of protein-rich fluid which appears as swelling in the arms, legs, face, neck or trunk. Normally, fluid is removed from these areas both by veins and by lymph channels. When the lymphatic system is not functioning properly, lymphedema can result. Following surgery and/or radiation to treat cancer, the lymphatic system that removes fluid and waste proteins from the limb and adjacent area is less effective. When the amount of fluid filtered into the tissues exceeds the amount that can be taken away by the lymphatic system, swelling may occur. Lymphedema is a chronic and progressive condition. It increases the risk of developing repeated infections (cellulitis), causes pain and discomfort, can cause thickening, hardening and loss of elasticity of the skin, and can interfere with the normal use of involved limbs.

Types of Lymphedema:
Primary lymphedema occurs without any obvious cause; it can occur at birth or later in life. It is generally more common in females and in the legs. There is often a familial connection and multiple members of a family may develop lymphedema at some stage in their lifetime.

Secondary lymphedema develops after the lymphatic system is altered by surgery, radiation treatment, trauma or repeated infections. Common treatments of cancer of the breast, uterus, bladder, ovary, prostate, testicles, hernias and malignant melanomas and lymphomas are components for the development of lymphedema. Secondary lymphedema can develop any time after cancer therapy, from immediately after surgery to many years later.

It is estimated that there are 2.5 million cases of secondary lymphedema in the United States. Most of these cases are caused by breast cancer therapy.

Lymphedema's Effects:
If left untreated, lymphedema can cause any or all of the following medical problems:

Swollen limb(s) and body parts
Decreased mobility and pain with heaviness of limb(s)
Skin thickening and increased fibrotic (scarred tissues)
Episodes of infection
Cosmetic problems
General worsening of the patient's life
Anxiety, frustration and depression concerning the unresolved condition

Early Detection
Typically, patients in the United States are not monitored routinely for the development of lymphedema after cancer surgery nor are they taught how to examine themselves for possible signs and symptoms. It is therefore difficult to determine an actual and accurate figure as to the percent of patients who develop lymphedema. If you have had lymph nodes removed and/or been treated with radiation, your limb closest to the treated side is considered an "at-risk" limb.

Signs / Symptoms of Early Lymphedema
Many patients will experience some swelling following cancer surgery. In general, the signs and symptoms during this early post-cancer treatment interval will more likely represent the acute effects of the surgery; most changes will be transient and will resolve with time. However, subjective complaints and objective findings that intensify rather than diminish during the healing phase warrant greater concern. Before any clinical signs of lymphedema exist, subjective complaints which may be very subtle may include the following:

A feeling of heaviness, tightness or fullness in the limb or other body region
The limb may tire more easily and feel achy when you use it

These symptoms may be present before the limb is obviously swollen and may indicate edema that is mild or of new onset. Early visible findings may include the following:

Rings / watches / socks and clothing items leaving an impression or fitting tighter
Decreased pliability of skin at end of day
Warmth and redness of the skin
Decreased limb strength
Reduced / restricted limb movement

Tips on Examing for Signs of Swelling
Make a fist with both hands. Examine the area between the first and second knuckle. A fullness on the surgical side could be an indication of early swelling.

Make a fist with both hands. Examine the area between the first and second knuckle. A fullness on the surgical side could be an indication of early swelling.
Bend your elbows so that you can see them in the mirror. Compare the two sides, looking for changes in shape and size which may indicate swelling on the surgical side.
Feel your limbs, comparing the two sides and note any change in density or thickness of tissue on the surgical side.
Be aware of any indentations/pitting that may be present upon removal of socks and shoes. Be aware of shoes that seem to fit tighter at end of day.

Gradual Return to Activity
Patients are encouraged to return to normal activities, including exercise, once released from their physician. However any increase of activity should occur gradually over time. Lymphatic fluids move with body movements; however, too much activity performed too quickly may cause an increase of lymph flow in the "at-risk" limb. The "at-risk" limb may not be able to handle the increase fluid effectively, causing swelling. Therefore one needs to learn to use their limb as a barometer on how well the body is handling the activity. The patient is encouraged to speak with a lymphedema therapist if signs and symptoms are produced with any activity.

How is Lymphedema Treated?
Lymphedema has traditionally been treated by the use of elevation, compression pumps, compression garments and in some cases, surgery. Although there is no cure for lymphedema, effective treatment is available. Lymphedema is most easily treated when caught early, before the protein is allowed to accumulate in the tissues. Longstanding protein in the tissue may cause irreversable changes in the limb which may include fibrosis and hardening of the limb. Therefore, treatment should be implemented at the first signs.

At present the most effective and least invasive approach is referred to as Complex Decongestive Physiotherapy. This therapy has been used successfully in Europe for decades and is now available at clinics in the United States with trained and specialized staff. The length of treatment is individualized and based on an evaluation of the patient’s needs.

A multi-faceted treatment program, CDP is recognized as the most effective approach to lymphedema and consists of the following four components:

Manual Lymph Drainage (MLD)
MLD is a gentle manual pressure designed to move fluid from the tissues and promote the normal functioning of the lymph vessel system.
Bandaging and Compression
After the MLD session, the swollen limb is wrapped with a short stretch bandage to enhance lymph drainage and prevent stagnating lymph fluid from returning to the decompressed extremity. At the end of the intense program, the limb is then measured and fitted with a compression garment.
Remedial Exercise
While wearing the bandages, the patient exercises each muscle and joint of the affected limb.
Patient - Family education and training in all aspects of care
Education begins at the initial session and continues throughout the treatment process. It includes teaching and training on the lymphatic system, limb/skin protection, MLD, self-bandaging, exercise and nutritional guidelines. In addition, a quarterly support group is available.

If you think your arm or leg is swollen...
Contact your physician promptly. Discuss with your physician and/ or nurse both your symptoms and any visible signs of swelling. Patients are also encouraged to reinforce lymphedema prevention strategies and to discuss with their physician their concerns regarding lymphedema, as still many healthcare professionals may not be totally aware of this condition and the implications of it going untreated.

Lymphedema Support and Awareness Group
"Take control and be informed" is advice from women with breast cancer for those who may have or be at risk for developing lymphedema. Often people with lymphedema are left with the message, spoken or implied, that there is little or nothing that can be done - they just have to live with the condition. As the awareness of lymphedema increases among the general public, and most importantly the medical community, those who have lymphedema will soon see they are not alone in living with this frustrating and often undiagnosed condition.

Knowing others who have lymphedema can provide comfort, enhance self esteem and strengthen an individual’s ability to cope with this challenging condition.

The purpose of the Lymphedema Support and Awareness group is to bring together patients, family members and friends to share their experiences, as well as ways to cope with and manage lymphedema. The group is open to all who have lymphedema, think they may have lymphedema, or anyone who would like to learn more about it. The Lymphedema Support and Awareness Group, known as the “Swell Gang,” meets quarterly. Please call (806) 725-8005 to verify date, time and location of group.

About our Staff
The Lymphedema / Edema Center has certified lymphedema therapists based on European standards.

Mari Knettle received certification in MLD/CDT (Vodder technique) through the Klose Norton School of Lymphedema Therapy. She worked in a variety of therapy settings in Ohio prior to joining the Covenant staff in 2001. Mari graduated in 1999 with a degree in Physical therapy from the Medical College of Ohio in consortium with the University of Toledo.

Referrals to the Lymphedema / Edema Center
Referrals to the Center need to be from a physician. Upon referral, patients will be scheduled for an evaluation (as soon as possible) by a qualified physical or occupational therapist trained in CDP. For further information or to schedule an appointment, contact us at (806) 725-8005.

ACBC \| Cancer Registry \| Genetic & FCP Program \| Hematology \| Lymphedema/Edema Center \| Medical Oncology \| Patient & Community Services \| Pediatric Oncology \| Pharmacy \| Preventative Oncology \| Radiation Oncology \| Research \| Tumor Boards		JACC 4101 22nd Place Lubbock, Texas 79410 phone: 806-725-8000 fax: 806-723-6412 General Information: info@joearrington.org
Lymphedema/Edema Clinic
The Joe Arrington Cancer Research and Treatment Center (JACC) opened Lubbock's first lymphedema center in April 1997. It is the only facility in the Lubbock region which provides a comprehensive management program specializing in the treatment of primary and secondary lymphedema and other edema-related conditions. What is Lymphedema? Lymphedema is an abnormal accumulation of protein-rich fluid which appears as swelling in the arms, legs, face, neck or trunk. Normally, fluid is removed from these areas both by veins and by lymph channels. When the lymphatic system is not functioning properly, lymphedema can result. Following surgery and/or radiation to treat cancer, the lymphatic system that removes fluid and waste proteins from the limb and adjacent area is less effective. When the amount of fluid filtered into the tissues exceeds the amount that can be taken away by the lymphatic system, swelling may occur. Lymphedema is a chronic and progressive condition. It increases the risk of developing repeated infections (cellulitis), causes pain and discomfort, can cause thickening, hardening and loss of elasticity of the skin, and can interfere with the normal use of involved limbs.
Types of Lymphedema: Primary lymphedema occurs without any obvious cause; it can occur at birth or later in life. It is generally more common in females and in the legs. There is often a familial connection and multiple members of a family may develop lymphedema at some stage in their lifetime. Secondary lymphedema develops after the lymphatic system is altered by surgery, radiation treatment, trauma or repeated infections. Common treatments of cancer of the breast, uterus, bladder, ovary, prostate, testicles, hernias and malignant melanomas and lymphomas are components for the development of lymphedema. Secondary lymphedema can develop any time after cancer therapy, from immediately after surgery to many years later. It is estimated that there are 2.5 million cases of secondary lymphedema in the United States. Most of these cases are caused by breast cancer therapy.
Lymphedema's Effects: If left untreated, lymphedema can cause any or all of the following medical problems: Swollen limb(s) and body parts Decreased mobility and pain with heaviness of limb(s) Skin thickening and increased fibrotic (scarred tissues) Episodes of infection Cosmetic problems General worsening of the patient's life Anxiety, frustration and depression concerning the unresolved condition Early Detection Typically, patients in the United States are not monitored routinely for the development of lymphedema after cancer surgery nor are they taught how to examine themselves for possible signs and symptoms. It is therefore difficult to determine an actual and accurate figure as to the percent of patients who develop lymphedema. If you have had lymph nodes removed and/or been treated with radiation, your limb closest to the treated side is considered an "at-risk" limb. Signs / Symptoms of Early Lymphedema Many patients will experience some swelling following cancer surgery. In general, the signs and symptoms during this early post-cancer treatment interval will more likely represent the acute effects of the surgery; most changes will be transient and will resolve with time. However, subjective complaints and objective findings that intensify rather than diminish during the healing phase warrant greater concern. Before any clinical signs of lymphedema exist, subjective complaints which may be very subtle may include the following: A feeling of heaviness, tightness or fullness in the limb or other body region The limb may tire more easily and feel achy when you use it These symptoms may be present before the limb is obviously swollen and may indicate edema that is mild or of new onset. Early visible findings may include the following: Rings / watches / socks and clothing items leaving an impression or fitting tighter Decreased pliability of skin at end of day Warmth and redness of the skin Decreased limb strength Reduced / restricted limb movement Tips on Examing for Signs of Swelling Make a fist with both hands. Examine the area between the first and second knuckle. A fullness on the surgical side could be an indication of early swelling. Make a fist with both hands. Examine the area between the first and second knuckle. A fullness on the surgical side could be an indication of early swelling. Bend your elbows so that you can see them in the mirror. Compare the two sides, looking for changes in shape and size which may indicate swelling on the surgical side. Feel your limbs, comparing the two sides and note any change in density or thickness of tissue on the surgical side. Be aware of any indentations/pitting that may be present upon removal of socks and shoes. Be aware of shoes that seem to fit tighter at end of day. Gradual Return to Activity Patients are encouraged to return to normal activities, including exercise, once released from their physician. However any increase of activity should occur gradually over time. Lymphatic fluids move with body movements; however, too much activity performed too quickly may cause an increase of lymph flow in the "at-risk" limb. The "at-risk" limb may not be able to handle the increase fluid effectively, causing swelling. Therefore one needs to learn to use their limb as a barometer on how well the body is handling the activity. The patient is encouraged to speak with a lymphedema therapist if signs and symptoms are produced with any activity. How is Lymphedema Treated? Lymphedema has traditionally been treated by the use of elevation, compression pumps, compression garments and in some cases, surgery. Although there is no cure for lymphedema, effective treatment is available. Lymphedema is most easily treated when caught early, before the protein is allowed to accumulate in the tissues. Longstanding protein in the tissue may cause irreversable changes in the limb which may include fibrosis and hardening of the limb. Therefore, treatment should be implemented at the first signs. At present the most effective and least invasive approach is referred to as Complex Decongestive Physiotherapy. This therapy has been used successfully in Europe for decades and is now available at clinics in the United States with trained and specialized staff. The length of treatment is individualized and based on an evaluation of the patient’s needs. A multi-faceted treatment program, CDP is recognized as the most effective approach to lymphedema and consists of the following four components: Manual Lymph Drainage (MLD) MLD is a gentle manual pressure designed to move fluid from the tissues and promote the normal functioning of the lymph vessel system. Bandaging and Compression After the MLD session, the swollen limb is wrapped with a short stretch bandage to enhance lymph drainage and prevent stagnating lymph fluid from returning to the decompressed extremity. At the end of the intense program, the limb is then measured and fitted with a compression garment. Remedial Exercise While wearing the bandages, the patient exercises each muscle and joint of the affected limb. Patient - Family education and training in all aspects of care Education begins at the initial session and continues throughout the treatment process. It includes teaching and training on the lymphatic system, limb/skin protection, MLD, self-bandaging, exercise and nutritional guidelines. In addition, a quarterly support group is available. If you think your arm or leg is swollen... Contact your physician promptly. Discuss with your physician and/ or nurse both your symptoms and any visible signs of swelling. Patients are also encouraged to reinforce lymphedema prevention strategies and to discuss with their physician their concerns regarding lymphedema, as still many healthcare professionals may not be totally aware of this condition and the implications of it going untreated. Lymphedema Support and Awareness Group "Take control and be informed" is advice from women with breast cancer for those who may have or be at risk for developing lymphedema. Often people with lymphedema are left with the message, spoken or implied, that there is little or nothing that can be done - they just have to live with the condition. As the awareness of lymphedema increases among the general public, and most importantly the medical community, those who have lymphedema will soon see they are not alone in living with this frustrating and often undiagnosed condition. Knowing others who have lymphedema can provide comfort, enhance self esteem and strengthen an individual’s ability to cope with this challenging condition. The purpose of the Lymphedema Support and Awareness group is to bring together patients, family members and friends to share their experiences, as well as ways to cope with and manage lymphedema. The group is open to all who have lymphedema, think they may have lymphedema, or anyone who would like to learn more about it. The Lymphedema Support and Awareness Group, known as the “Swell Gang,” meets quarterly. Please call (806) 725-8005 to verify date, time and location of group. About our Staff The Lymphedema / Edema Center has certified lymphedema therapists based on European standards. Mari Knettle received certification in MLD/CDT (Vodder technique) through the Klose Norton School of Lymphedema Therapy. She worked in a variety of therapy settings in Ohio prior to joining the Covenant staff in 2001. Mari graduated in 1999 with a degree in Physical therapy from the Medical College of Ohio in consortium with the University of Toledo. Referrals to the Lymphedema / Edema Center Referrals to the Center need to be from a physician. Upon referral, patients will be scheduled for an evaluation (as soon as possible) by a qualified physical or occupational therapist trained in CDP. For further information or to schedule an appointment, contact us at (806) 725-8005.