Private outpatient lymphedema therapy is offered in our Garden Grove office. Kim Marshall, DPT, CLT is a certified lymphedema specialist with more than 15 years of experience in this very specialized field of care. In recent years, Kim has been working closely with the country’s leading reconstructive plastic surgeons who are pioneering micro-vascular procedures to reduce lymphedema. She is developing pre- and post-surgical physical therapy protocols for lymphovenous bypass and vascularized lymph node transfers. These innovative surgical procedures may be effective for many patients to help reduce the swelling, pain, and discomfort that occurs with lymphedema. In addition, she has a STAR certification in oncology rehabilitation. Personalized programs are designed for each individual with an emphasis on education and self-management. Learn more about our Breast Cancer Rehabilitation and Head and Neck Cancer programs. Private treatment rooms are available.
What is lymphedema?
The lymphatic system collects lymph (excess fluid, proteins, and other substances) from the body tissues and carries them back to the bloodstream. Lymph is moved slowly through lymphatic vessels and is passed through the lymph nodes. Swelling (“edema”) may occur when the lymph increases in the body tissues. Lymphedema occurs when the normal drainage of fluid is disrupted by a blockage or a cut in the lymph nodes in the groin area or the armpit. Lymphedema can be a hereditary condition, but it’s most commonly the result of blockages caused by infection, cancer, and scar tissue from radiation therapy or the surgical removal of lymph nodes.
Lymphedema risk factors:
- Had surgical removal of lymph nodes in the underarm, groin, or pelvic region
- Received radiation therapy to the underarm, groin, pelvic region, or neck
- Have scar tissue in the lymphatic ducts, veins, or under the collarbones caused by surgery or radiation therapy
- Have cancer that has spread to the lymph nodes in the neck, chest, underarm, pelvis, or abdomen
- Have tumors in the pelvis, abdomen, or chest that involve or put pressure on the lymphatic vessels and/or the large lymphatic duct thereby blocking lymph drainage
- Have inflammation of the arm or leg after surgery
- Are older
- Have an inadequate diet or are overweight, as these conditions may delay recovery from surgery and radiation therapy and may increase the risk for lymphedema
Signs and symptoms of lymphedema
- Swelling in your arms, legs, shoulders, hands, fingers, or chest
- Skin that feels tighter, harder, or thicker than normal in the affected area
- Aching or a feeling of heaviness in your arm or leg
- Weakness in your arm or leg
- Inability to move certain joints, such as your wrist or ankle, as freely as usual
- “Pitting” in the tissues of your limb (an indentation that is made by pressing a finger on the skin that takes time to “fill in” after the pressure is removed)
- Clothing, rings, bracelets, or shoes that fit tighter than before
- Repeated infections in your arm or leg
- Joint pain
- Difficulty doing your daily activities
If you have fever and chills, and your limb with lymphedema is red, swollen, or painful, and feels warm to the touch, you may have an infection.
How is lymphedema diagnosed?
A complete review or your medical history and medications is taken along with a thorough physical examination that includes the following information:
- Your actual weight compared with your ideal weight
- Measurements of your arms and legs
- How well you are able to do activities of daily living
- History of edema, previous radiation therapy, or surgery
- The time between surgery and when you first noticed the swelling
- Other conditions such as diabetes, high blood pressure, kidney disease, heart disease, or phlebitis (inflammation of the veins)
How a physical therapist can help
A physical therapist serves as an important member of your health care team and will work closely with you to design a lymphedema therapy program to help control the swelling and meet your goals for returning to your activities. In the early stages of lymphedema, when the swelling is mild, it can often be managed by compression garments, exercise, and elevation of the affected limb to encourage lymph flow. For more severe swelling, treatment called “complete decongestive therapy” may be used.
The initial step often includes manual lymphatic drainage, which feels like a light form of massage and helps improve the flow of lymph from your arm or leg. This is followed by compression bandaging that helps to reduce the swelling. Your therapist will carefully monitor the size of the limb throughout your treatment sessions.
Once the limb has decreased to the desired size, your physical therapist will help you begin to take over your own care by:
- Developing a safe and sensible exercise program that will increase your physical fitness without unnecessarily straining your affected arm or leg
- Updating your compression garments to ensure proper fitting, working with you to find the type of garment that best meets your needs
- Educating you about proper diet to decrease fluid buildup in your tissues and skin care to reduce the risk of infection.
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