According to conservative estimates, about one million people in Germany suffer more or less from some disease of the lymphatic system and phlebedemas. Most patients have learnt details about the disease and the appropriate modes of treatment inadvertently from therapists or self-help groups. Throughout the entire course of medical studies, little attention is devoted to the diseases of the lymphatic system, and consequently students and doctors in Germany have little acquaintance with the problems of lymphedema. Because of the increasing numbers of surgical operations, the incidence of lymphedema has certainly increased, but improvements in treatment and refined therapeutic techniques have done much to lessen the burden of the disease. Depending on its severity, oedema is subdivided into different stages
Lymphedema in Stage 0
There is damage to the lymphatic vessels primary or secondary, but it has not yet become apparent. Transport capacity is still sufficient for the loads that have to be removed in the lymph (latent stage). Lymphedema is not present.
Lymphedema in Stage 1
Oedema appears only towards the evening. The swelling is due to high protein oedema and disappears completely or partially when the limb is elevated. The swelling is of soft consistency, and pitting can easily be demonstrated.
Lymphedema in Stage 2
The lymphedema does not disappear even after moderately prolonged rest. The swelling persists. Indurations are already present. The skin is hard, and pitting cannot be demonstrated at all or only after vigorous pressure. Elevation of the limb has no effect on the swelling.
Lymphedema in Stage 3
The swelling is associated with complications such as skin lesions with warty outgrowths (papillomatosis), small vesicles (cysts), breaks in the skin through which lymph exudes (fistulae) and definite indurations, sometimes amounting to the condition known as elephantiasis.
Phases of therapy
The intensive therapy consists of two-phase treatment as devised by Földi
Phase I (decongestion phase)
•Manual whole-body lymphatic drainage(5times per week)
•Compression therapy with bandages
•Special gymnastic exercises
Phase II (maintenance phase)
• Hygiene/skin treatment
• Manual whole-body lymphatic drainage(once to twice a week)
• Compression therapy with compression stockings
• Special gymnastic exercises
Treatment as an inpatient in hospital is necessary in cases of primary and secondary lymphedema in stages II and III
• Cases of lymphedema with complications (erysipelas, other concurrent diseases, cancer recurrences)
• Cases of lymphedema with lymph fistulae, lymph cysts or lymphoceles
• Lymphedema of the face or lymphedema of the genitals
• Lymphedema of internal organs
• Children up to 8-10 years of age, accompanied by a person with parental rights
• Cases of post-traumatic lymphedema and lymphedema associated with Sudeck's bone atrophy.
In our clinic inpatient treatment comprises daily manual whole-body lymphatic drainage, intermittent pneumopresso-therapy with devices, pulsed magnetic field therapy (we saw a better outflow of liquid while using the field), followed by compression bandaging. In the afternoon we apply the central lymphatic drainage and gymnastics. Cross walking (with walking sticks, special exercises) and if necessary aftercare and treatment for any concomitant diseases.
Furthermore, patients are put on a reduction diet, because any overweight will have adverse effects on lymphedema. In the event of pain, patients also receive soft laser irradiation, which is also employed to loosen or soften scars and for ulcers of the legs, together with appropriate foot baths and ulcer treatment with O3 gas and later on CO2- gas for better oxygenisation.
Inpatient treatment also comprises decongestion exercises, therapeutic dancing and relaxation exercises and Qigong. When there is fibrosis we treat the patients with sound waves and we treat in an electrostatic field. In addition patients are given comprehensive information regarding psychiatric relief, correct nutrition and the entire complex of lymphatic diseases.
Summary of clinical treatment
• Manual whole-body lymphatic drainage
• soft laser radiation
• pulsed magnetic field
• infrared cabin
• Compression bandages
• Active exercises, therapeutic dancing, Qi-Gong
• Cross-country walks
• Reducing diet
Dr. med. Schingale