Listen to Lymphedema patient Laurine as she describes her experience…
AZH provided “everything I needed, in one spot”.
Case of the Month
This 60 year old non-diabetic female with chronic venous insufficiency, ulceration and lymphedema presented to AZH Wound & Vascular Centers with BLE venous ulcers. She was evaluated and treated by both wound care and the lymphedema specialist. Wound treatment included topical antimicrobial and compression. Lymphedema treatment was started on the LLE first due to severity of wound and affected functional movement. Therapy included decongestive phase of manual lymphatic drainage, application of multiple layers of short stretch bandages, home exercise program, kinesiology taping, and skin/nail education. The left leg ulcer healed and limb was decongested within 2 weeks. The patient was then transitioned to an inelastic, short stretch Velcro garment on the LLE which was used 24/7. The RLE was then treated with same lymphedema protocol and limb was decongested within 10 days and transitioned to maintenance inelastic, short stretch Velcro garment also worn 24/7. During decongestive phase of LLE, the RLE began reducing (without compression) and right leg ulcer demonstrated enhanced healing trajectory as well. The patient’s right ankle girth decreased from 40 cm to 28.3 cm; right calf girth decreased from 67 cm to 50.5 cm; left ankle girth decreased from 41 to 30 cm and left calf girth decreased from 67.5 cm to 52.5 cm.
Services & Technologies
Lymphedema is a chronic swelling condition that results due to an existing impairment or insult to the lymphatic system. This disease process may affect one or more parts of the body and disfiguring swelling can develop.
Acknowledging the lymphatic system is important as it serves immunological functions of creating and circulating lymphocytes and defense cells. It helps establish homeostasis within the tissues by transporting fluids as well as removing molecular waste and proteins. Additionally, the lymphatic system transports essential nutrients from the intestinal lymphatics.
The two types of lymphedema are Primary and Secondary. Primary Lymphedema is a congenital defect, damaging the lymphatics. Secondary Lymphedema develops from a variety of pathologies including chronic venous insufficiency, wounds, infection, injury or trauma, surgery, obesity, cancer and cancer treatment.
Fortunately, there is a growing awareness of lymphedema secondary to post cancer diagnosis and treatment; however, the understanding of lymphedema related to chronic venous insufficiency, wounds and post-surgical procedures is much less. Edema lasting longer than 6 weeks damages the lymphatic vessels, causing a disease process. Because of the close-working relationship the lymphatic system has with the vascular system, it is important to understand that if chronic venous insufficiency is left untreated, damage to the lymphatics is likely. Repair to the lymphatics is much more difficult than repair to the veins for insufficiency.
Because lymphedema is a disease process, it is best treated with an approach called Complete Decongestive Therapy. This treatment protocol is two-phased. The first phase includes Manual Lymphatic Drainage, individualized home exercise program, skin/nail care and education, and skilled application of multiple layers of short stretch bandages (varying types of textured foams as needed for fibrosis). Once the limb is reduced, the second phase consists of varying types of maintenance garments for both day and night and an experienced LANA certified lymphedema therapist will be able to determine best course of action for type of compression. In the second phase, progressive home exercise program and proper skin and nail care is crucial. Pneumatic compression pumps, kinesiology taping and scar management should also be considered as part of the treatment protocol. The sooner lymphedema is treated, more can be accomplished to decrease disease process.
What healthcare professionals need to know about lymphedema:
- By diagnosing and treating lymphedema early, we can prevent disease progression.
- Lymphedema not only causes physical changes but also psychological effects.
- Lymphedema treatment and maintenance is complex and costly.
The AZH Wound and Vascular Center provides a comprehensive assessment and treatment protocol for Lymphedema. By combining the complimentary treatment by a LANA certified lymphedema therapist with wound care and vascular treatment, optimal results are achieved.
Our LANA certified lymphedema therapist and occupational therapist, Vicki Magnan, welcomes new referrals:
Victoria Magnan is the Director of Lymphedema Services at AZH Centers. She has been a practicing Occupational Therapist for 25 years and has dedicated her career to the specialized treatment of chronic swelling disorders. Over the past 10 years, Vicki has treated lymphedema in the private practice setting and has spoken nationally on the treatment of swelling disorders related to wounds and vascular disease as well as connective tissue disorders, including Ehler’s Danlos Syndrome and Noonan’s Syndrome. Certified in lymphedema treatment through the Lymphology Association of North America (LANA), Vicki’s treatment approach is based on the Vodder Method of Manual Lymphatic Drainage and Complete Decongestive Therapy. Additional certifications as a compression fitter, kinesiology-taping practitioner and Healthy Steps instructor allow Vicki to provide a unique, multi-faceted approach in treating chronic swelling conditions. As Director of Lymphedema Services at AZH Wound and Vascular Centers, Vicki has developed a comprehensive treatment program that is complimentary to the wound care and vascular setting. By utilizing a multi-disciplinary approach of combining lymphedema therapy with vascular and wound care treatment, optimal results are achieved. Vicki lives with her husband, David (who has been an incredible support with her journey of this unique specialty) and their two children Gregory and Mary. She enjoys outdoor activities with her husband and kids, including gardening, kayaking and biking. Additional joys are spending time in the kitchen, taking long walks and crocheting. Her passion is the treatment and education of lymphatic dysfunction.