Water-drop for Lymph drainageSynergy Healthcare is pleased to let you know that we now have 2 certified lymphedema practitioners to assist your patients with their recovery and attainment of optimal function. Here follows a brief summary of stage zero and stage one lymphedema. It is important to recognize these early stages as this condition is still reversible if addressed early. Without proper care, the vast majority of stage one cases progress to stage two, which can be managed but not cured.

Lymphedema is a very common and serious condition, affecting at least 3 million Americans. Estimated incidence of lymphedema in the United States includes 1-2 million cases of primary lymphedema and 2-3 million cases of secondary lymphedema. In these cases, the swelling may affect limbs, face, genitals and trunk. The highest incidence of secondary lymphedema in the United States is observed following breast cancer surgery, particularly among those patients who underwent radiation therapy following the removal of axillary lymph nodes.

Primary lymphedema is caused by a developmental abnormality of the lymphatic system, which is either congenital or hereditary. Swelling in primary lymphedema generally affects the lower extremities. Complete Decongestive Therapy (CDT) is a non-invasive, multi-component approach to effectively treat and manage lymphedema and related conditions. Numerous studies have proven the effectiveness of this therapy, which has been well established in European countries since the 1970’s and in the United States since the 1990’s.

Currently there is no cure, or permanent remedy for lymphedema once it reaches stage two. If lymphedema is present, the lymphatic system is mechanically insufficient, which means that the transport capacity has fallen below the normal amount of lymphatic load. The transport capacity in the damaged lymph vessels cannot be restored to its original level.

Although the swelling may recede somewhat during the night in some early stage cases, lymphedema is a progressive condition. Regardless of the cause, lymphedema will in most cases gradually progress through its stages if left untreated

Stage 0 

This stage is also known as the sub clinical, pre-stage, or latency stage of lymphedema.

In this stage the transport capacity of the lymphatic system is subnormal, yet remains sufficient to manage normal lymphatic loads. However, this situation results in a limited functional reserve of the lymphatic system.

Stage I

This stage, also known as the reversible stage, is characterized by soft tissue pliability without any fibrotic changes. Pitting is easily induced and the swelling retains the indentation produced by the (thumb) pressure for some time. In early stage I, it is possible for the swelling to recede overnight. With proper management in this early stage, the patient can expect a reduction of the extremity to a normal size (compared to the uninvolved limb). Without proper care, progression into stage II in the vast majority of the cases is inevitable. It is difficult to distinguish stage I lymphedema from edemas of other origins. The clinician needs to rely upon the history and whether or not the swelling resolves with conventional management such as compression and elevation.

Anyone who had a surgery involving the lymphatic system or trauma and DOES NOT develop visible lymphedema, is considered to be in a latency stage (hidden lymphedema). Notably, 42% of women present with some degree of visible lymphedema one year post-mastectomy; the other 58% are considered to be in a latency stage.

Patients in a pre-stage are “at risk” to develop lymphedema. The reduction in functional reserve results in a fragile balance between the subnormal transport capacity and the lymphatic loads. Any added stress put on the lymphatic system, such as extended heat, or cold, injuries, or infections may cause the onset of lymphedema. Patient information and education, especially following surgical procedures, can dramatically reduce the risk for developing lymphedema.

The importance of having early preventative treatment during this phase shouldn’t be understated. We have discussed the relevance of manual lymphatic therapy, but Synergy also has the skills to mediate scar tissue, lack of range, and weakness that patients experience post surgically. Education and self-lymphatic techniques are provided to patients to teach them to maintain their health and prevent further progression.

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