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Proper Diagnosis Leads to Proper Care Treating Lymphedema Part 2

  January 02, 2019


By Alexander Germanis

There is an old saying: if it walks like a duck, swims like a duck, and quacks like a duck, then it must be a duck.

But, nature has a funny way of proving that adage to be false in many cases. There are entire species that masquerade as other species in order to deter predators. Some insects even employ methods of camouflage so elaborate that they look like inanimate objects.

Nature can play people for a fool when it comes to diseases as well, which is why getting a proper diagnosis before moving forward with treatment can not only be a wise course of action, it can mean the difference between helping a patient or causing more suffering.

Registered Occupational Therapist Julia Rodrick, OTR/L, CLT-LANA, WCC, says there are ailments that may present as lymphedema when they are not, in fact, lymphedema at all.

As she described in last month’s article, lymphedema is a chronic condition resulting from the abnormal accumulation of protein-rich interstitial fluid. That buildup results in persistent inflammation and fibrosis, most often in the extremities.

“First let me say that lymphedema should not be diagnosed simply because of the abnormal size of a limb,” Julia says. “Problematic lymphedema begins to manifest itself with a slow thickening of the tissue and a gradual reduction in functional mobility and strength.”

Just because lymphedema should not be diagnosed simply by a person’s appearance, that does not mean there are not visible and tangible signs that may indeed indicate it. “There may be cosmesis complaints that accompany a feeling of discomfort of the skin,” Julia explains. “It may feel tight and stiff. Clothing may feel disproportionate from one limb to the other. Rings or shoes are too tight.”

More often than not, however, patients come to experts in treating lymphedema because their primary care physicians have noticed problematic swelling in their extremities—swelling that cannot be resolved using medical management such as the use of compression garments or diuretics. “It would be great to say that every patient that comes to our clinic has had extensive diagnostic lab work and testing,” Julia laments, but unfortunately, that is not the case.

Diagnosing lymphedema, she points out, can be done in a variety of ways, utilizing varied medical technologies.

Able to produce detailed, cross-sectional images of your body's structures, CT scans can reveal blockages of the lymphatic system.
“Doppler ultrasound is a type of conventional ultrasound that follows blood flow and pressure by bouncing high-frequency sound waves to identify obstructions that may cause swelling, like a blood clot,” Julia says.

“Radionuclide imaging of your lymphatic system (lymphoscintigraphy) shows lymph flow or accumulation using dye imagery moving through your lymph vessels, highlighting blockages,” she adds. While accurate, radionuclide imaging is expensive, so it is infrequently utilized.

“There are some pretty exciting tests evolving in the area of genetic marks that may identify some forms of primary lymphedema,” she continues. “But they are still in trial.”

There are also evaluating tools like the lymphedema life impact scale and the L-Dex XCA, a bioimpedance analyzer designed to assist in the clinical assessment of lymphedema.

The most modern medical tests are not the only methods employed, of course. Good, old-fashioned detective work is also put into play. “As we evaluate the patient, we look extensively to the patient’s medical history for clues that may suggest there has been lymphatic damage or perhaps a family history of abnormal swelling,” Julia says.

So, even it feels like, looks like, and “quacks” like lymphemdema, only with a proper diagnosis comes the proper care.

To learn more about lymphedema, how it is recognized, diagnosed, and treated, read the article in next month’s issue of Healthy Cells Magazine. If you missed the first article in this series, you may read it online at www.HealthyCellsBN.com, or contact Cheryl at 309-664-2524 Ceash7@gmail.com.

For more information on the lymphedema treatment program at Central Illinois Institute of Balance, or any type of balance or dizziness problem, you may contact them at 309-663-4900, www.dizzyil.com. Their office is located at 211 Landmark Dr., Suite E-3 in Normal.
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January 02, 2019

 

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