M2How the treatments work in detail. Diagnosis and treatmentDiseases of the lymphatic system are usually diagnosed when lymph nodes are enlarged. This may be discovered when the lymph nodes become enlarged enough to be felt or are seen on imaging studies such as CT scans or MRIs.The majority of enlarged lymph nodes are not dangerous; they are the body’s way of fighting off an infection, such as a viral upper respiratory infection. If the lymph nodes become significantly enlarged and persist longer than the infection then they are more worrisome. There is no specific size cutoff, but typically nodes that persist at larger than a centimeter are more worrisome and examination by a doctor. Common symptoms of any lymphatic disorder include swelling of the arm or groin, weight loss, fever and night sweats.The diagnosis of lymphadenopathy depends on the location of the abnormal lymph nodes and other things that are going on with the patient. If the patient has a known infection, then the lymph nodes can simply be followed to await resolution with treatment of the infection. If the nodes are growing quickly and there is no obvious explanation then typically a biopsy is guaranteed to look for a cancer or an infection. If the node can be felt then this can be done at the bedside with a needle. If the lymph node is deeper, such as in the abdomen or pelvis, Hamrick said the biopsy might need to be done by an interventional radiologist using image guidance to place the needle into the node. Sometimes the biopsy needs to be done by a surgeon in the operating room. This is often where the most tissue can be obtained to make a diagnosis.With many types of lymphoma and leukemia, there are unique treatment options for each type. Treatment options can include traditional chemotherapy, immunotherapy (such as using antibodies or immune modulating drugs), and even radiation.Treatment of lymphatic diseases depends on treating the basic cause. Infections are treated with antibiotics, supportive care (while the immune system does its job, as in a viral infection) or antivirals. Lymphedema can be treated by elevation, compression and physical therapy. Cancers of the lymphatic system are treated by chemotherapy, radiotherapy, surgery, or a combination of those modalities. In last several years there has been explosion of new treatment options. There are a handful of newly approved drugs that target the actual disease causing processes within cells. Ibrutinib, idelalisib, obinutuzumab, lenalidomide have been approved in various indications.When doctors treat swollen lymph nodes,will take into account the person’s age, medical history, how sick they are, and how well they tolerate certain medicines.If the cause of the swollen lymph nodes is HIV, antiretroviral drugs are used to manage the infection. Antiretrovirals cannot cure HIV, but the drugs are able reduce the amount of HIV in the bloodstream, also known as the viral load.The goal of antiretrovirals is to reduce the viral load to undetectable levels.People with HIV whose viral loads are at undetectable levels are known to stay healthier for longer and are less likely to transmit the virus to other people. However, having an undetectable viral load does not mean that the person is completely free of the virus.Standard treatment for swollen lymph nodes may include pain relievers and medicine to lower a fever, such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol). Home remedies such as warm compresses and elevation may help reduce and resolve swelling.If the cause of the swelling is infection, the doctor may prescribe antibiotics or antiviral medications.If there is a localized pocket of infection (abscess), it may need to be drained by cutting open the skin, draining the infected fluids, and then filling the opening with packing.For swelling due to malignancy, the treatment may involve surgery, radiation, or chemotherapy.If a person has an immune disorder, he/she may be prescribed medication to help with the disease.CAUSES OF LYMPHEDEMA Primary lymphedema is caused by mutations in some of the genes involved in the development of the lymphatic system.Causes of secondary lymphedema :Cancer surgery cancer may spread through the body via the lymphatic system. Sometimes surgeons remove lymph nodes to stop the spread. There is a risk the lymphatic system may be affected, leading to lymphedema.Radiation therapy (radiotherapy) – the use of radiation to destroy cancerous tissue can sometimes damage nearby healthy tissue, such as the lymphatic system; this can result in lymphedema.Infections – severe cellulitis infection may damage tissue around the lymph nodes or vessels. This may lead to scarring, increasing the risk of lymphedema. Some parasite infections can also increase the risk of lymphedema.Inflammatory conditions – conditions that cause tissue to swell (become inflamed) may permanently damage the lymphatic system, such as rheumatoid arthritis, dermatitis, and eczema.Cardiovascular diseases – these are diseases that affect blood flow. Some patients with cardiovascular diseases have a higher risk of developing lymphedema, such as DVT (deep vein thrombosis), venous leg ulcers, and varicose veins.Injury and trauma – more rarely, severe skin burns or anything that results in excessive scarring may raise the risk of developing lymphedema.There’s no cure for lymphedema. Treatment focuses on reducing the swelling and controlling the pain. Lymphedema treatments include:Light exercises in which people need to move the affected limb as this may encourage lymph fluid drainage,exercises shouldn’t be strenuous or tire you but should focus on gentle contraction of the muscles in your arm or leg.Various massage treatments may benefit people with active cancer.They need to make sure to work with someone specialised in these techniques but some people need to avoid massage if they have a skin infection or blood clots.Bandaging the entire limb encourages lymph fluid to flow back towards the trunk of your body. The bandage should be tight around your fingers and loosen as it moves up your arm or leg. A lymphedema therapist can show you how to wrap your limb.Pneumatic compression. A sleeve worn over your affected arm or leg connects to a pump that intermittently inflates the sleeve, putting pressure on your limb and moving lymph fluid away from your fingers or toes.Compression garments. Long sleeves or stockings made to compress her arm or leg encourage the flow of the lymph fluid out of her affected limb.People need to wear compression garment when exercising the affected limb to obtain a correct fit for their compression garment by getting professional help.Complete decongestive therapy (CDT). This approach involves combining therapies with lifestyle changes. Generally, CDT isn’t recommended for people who have high blood pressure, diabetes, paralysis, heart failure, blood clots or acute infections.A CT scan can reveal blocked areas in the lymphatic system contributing to lymphedema.D2 Philippa Laughton has a primary lymphoedema she was born with it but it did not show until she was 12 and her right leg swelled up.She wasn’t been diagnosed that she had lymphoedema however when she was 30 her left leg sweelled up,she has this illnesses because she does not have lymph vessels that work in her leg and as a consequence of this her legs are swollen.Lymphoedema it can affect people in different parts of the body.She did not had any treatment until in her 30s and been diagnosed of this illness.Her treatment consisted of multi-layered bandaging and involves intensive treatment over 2 weeks the effect of this was to reduce swelling in both her legs.Now she needs to continue wearing the compression stockings and this kept the swelling at the size it was when they finished the multi-layered bandaging treatment and it made a huge difference.She now needs to be careful in terms of making any adjustments because of primary lymphoedema.The biggest problem for her is appearance,clothes,footwear is a bit of an inconvenience as certain things are difficult.For example aeroplane journeys is not good for her leg it makes it worse but this did not made her stop it.The main thing to manage her condition is that she wears her compression stocking daily also to avoid cellulite that means she needs to be very carefully about her skin care and to ensure she do not get infections.Advice that she has received through hospital treatments has gave her more confidence on understanding how to manage her condition.First time when she had cellulitis she had no idea what was happening to her and she didn’t knew any information but now she is aware of what to look and what to do a lot of the treatment is about self-help and the support network helps her with the self-help.She has an advice for people that suffer from this illness and are wondering if they got lymphoedema to not let it spoil what they want to do in their life as is something everyone can manage but just you need to be careful and find information that’s on the Lymphoedema Support Network website and ensure they get treated.However at the end of the day is not a life threatening condition.Treating and managing lymphedemaLymphedema therapy restores function, reduce physical and psychological suffering also to prevent the development of infection.Initiate therapy for lymphedema as early as possible before extensive, irreversible fibrosclerotic changes occur in the interstitium. Strict compliance with treatment techniques is essential, even though they are often cumbersome, inconvenient, and time-consuming, with treatment lasting throughout the lifetime of the individual. The majority of complaint can be treated with conservative measures.In secondary lymphedema, the underlying etiology should also be properly treated, in order to relieve the lymphatic obstruction.A few pharmacologic therapies have been found to be effective in the treatment of lymphedema. For example, the benzopyrones when combined with complex physical therapy, have been successful against the disease.Hygiene and skin careSuitable skin care are stressed in the treatment of lymphedema, to prevent frequent cellulitis or lymphangitis. Meticulous hygiene is essential to remove bacteria and keratinous debris. Cleanse the skin regularly and dry thoroughly is needful to identify any open wounds or developing cellulitis. Bland skin moisturizers applied conservatively may ameliorate cracking and furrowing.Physical therapy and compressionThe first treatment for lymphedema is complex physical therapy this is aimed at improving lymphedema with lymphatic drainage, exercise and massage. It advocates the use of compression stockings or pneumatic pumps. Leg elevation is necessary DLT is an intensive stage of therapy, during which she may receive daily treatment for several weeks to help reduce the volume of the affected body part.This is followed by a second phase called the maintenance stage. She will be encouraged to take over her care using simple self-massage techniques, continue to exercise and wearing compression garments. This treatment stage aims to maintain the reduced size of the affected body part a good thing about this is that she will have reviews every few months to check how her treatment is progressing. It is important for her to take good care of the skin as like this she will reduce the risk of developing an infection, such as cellulitis. Movement and exercisesLymphoedema care team will help her devise an exercise and movement plan designed to strengthen and stimulate the muscles involved in lymph drainage.They’ll also will help her lose weight, exercise plan will be tailored to the requirements and ability.Her plan may also involve specific limb exercises, as well as gentle activities that involve the whole body, such as swimming and cycling.MassagePeople that suffer from lymphedema receive specialised massages to move fluid from the swollen areas into working lymph nodes. Lymphoedema therapist will also teach her a range of simpler massage techniques that she or her carer can use during the maintenance phase of treatment to help keep the swelling down. Self-massage techniques are known as simple lymphatic drainage .SurgeryIn a small number of cases, surgery may be used to treat lymphoedema. There are three main types of surgery :removal of sections of excess skin and underlying tissueremoval of fat from the affected limb restoration of the flow of fluid around the affected section of the lymphatic system for example, by connecting the lymphatic system to nearby blood vessels These treatments may help reduce the size of areas of the body affected by lymphoedema, but some are still being evaluated particularly lymphaticovenular anastomosis and aren’t in widespread use.Also taping is another way of managing lymphoedema, lymphoedema specialist applies special tape on your skin. The idea is that the tape lifts the skin and helps the muscles work to help the lymph fluid to drain.The tape is waterproof and you wear it for several days. It is also called Kinesiotaping. Your lymphoedema specialist can tell you more about this treatment.Research is looking at other types of treatment for lymphoedema and ways of spotting it earlier.