Integrative Medicine

Developed in Europe in the 1930's by Dr. Emil and Estrid Vodder, Manual Lymph Drainage (MLD) is a safe, effective, yet gentle approach to cleansing the body's tissues. MLD drains excess fluid from the tissues and also has a detoxifying effect. It can benefit a healthy person as well as be applied to more than 60 different conditions.

Scientific studies, as well as vast clinical experience, have supported the effectiveness of MLD.

The therapeutic benefits of MLD, evidenced by more than 30 years of research, are well documented. It is widely prescribed by physicians in the United States and Canada also recognize the benefits of MLD for their patients.

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Introduction to Lymphedema and Treatment Options
Lipedema\               
Other Treatment Options
Meet Your Practioners

 

What is Lymphedema?

Lymphedema is a swelling of a body part, most often an extremity, resulting from an accumulation of fluids, in such proportion to be palpable and visible. Lymphedema occurs when the lymph vascular system is not able to fill its function of reabsorbtion and transport of the protein and lymph load. Lymphedema occurs whenever lymphatic vessels are absent, underdeveloped or obstructed.

The condition most often causes embarrassment and causes decreased mobility, discomfort and often repeated episodes of infection, cellulitus and lymphangitis. This can lead to general depression and a general worsening of the patient's life and health.

Fungal infections can be very frequent and these place a greater load on the lymphatics. Severe cases are associated with thickening of the skin, hardening of the limb (fibrosis), leakage of lymph and massive swelling (elephantiasis).

How Does Lymphedema Occur?

A stagnation of protein develops in the tissue. This raises the colloid osmotic pressure and a protein rich edema arises. There are more protein rich fluids in the tissue than can be transported and the proteins attract water by osmosis. The affected area becomes swollen, enlarged and uncomfortable. This swelling decreases oxygenation of the tissues, interferes with their normal functioning and makes them heal more slowly than normal. The excess protein also serves as a stimulus from chronic infection and can result in formation of excess fibrous tissue. Lymphedema is a chronic and if left untreated, progressive condition. It can however, be brought under control by appropriate treatment and care.

Lymphedema may be due to a primary (congenital) cause or of a secondary cause (caused by a known condition), including removal of the lymph nodes or trauma.

Primary Lymphedema

Primary Lymphedema is that which has no known cause. Milroy's disease is a familial (genetically caused) lymphedema which is present at birth. Meige's disease is similar, but appears no later than puberty.

Lymphedema Praecox is the most common form of primary lymphedema. This begins in adolescence. It is predominantly females who suffer from this condition. Seventy five percent of primary lymphedema is praecox.

Lymphedema Tarda is identical to Lymphedema praecox but occurs after the patient is 35 years old. Both praecox and tarda almost always involve just the legs.

The pathological mechanisms which cause primary lymphedema are an absence of lymphatics (aplasia), inadequate lymphatic drainage, too few lymphatics or too few nodes, or lymphatics which are hugely dilated.

Secondary Lymphedema

Secondary lymphedema is an acquired condition resulting from loss or obstruction or previously normal lymphatic channels. The most common cause of secondary lymphedema is due to removal of the lymph nodes, as part of surgery for malignancies. The lymph pathways can be interrupted by radiation, surgery, injury or blockage with parasites.

Trauma or radiation can tear a major lymph trunk or cause the production of excess fibrous tissue, which later constricts the lymph vessel.

Lymphedema may also occur as a result of a chronic venous disease, which always involves the large lymphatic vessels that run beside the veins.

Treatment Problems

Lymphedema patients are constantly frustrated, as they clearly face a major problem, yet cannot find answers to reduce a swollen limb. The most frequently given advise to elevate the limb, wear and elastic sleeve or stocking, avoid salt and take diuretics. Sequential pumps are sometimes recommended and while they may give some relief, the benefits are short lived. Surgery has never solved the problems of Lymphedema, even though dozens of different operations have been recommended and thousands of patients have been operated on Dr. Vodder's Combined Decongestive Therapy offers a practical and long lasting solution to the millions of lymphedema sufferers throughout the country.

What is the Treatment of Lymphedema?

Lymphedema is a serious condition, indicating that the lymph system is unable to handle the lymph load. Treatment should begin as soon as lymphedema is diagnosed.

The goal of treatment is to reduce swelling and facilitate the flow of the lymph fluid to the venous circulation of the affected area.

The most effective approach used by therapists in many European countries is Combined Decongestive Therapy; a four step process, carried out over a 4 week period. The individual elements are Manual Lymph Drainage, compression therapy, remedial exercises, breathing techniques and excellent skin hygiene. The patient visits the clinic once or twice a day, 5 times a week, or in accordance with the physician’s recommendations.

 

Lipedema is a chronic disease of complex causes, many of which we understand little about.

These include hormonal imbalance, an inability to metabolize exudate from blood vessels so that those proteins and cells that would normally be metabolized and returned to the circulation are deposited as adipose tissue in the subcutaneous tissue.

The blood vessels themselves are affected, venous stasis and vasoconstriction occurs and return is diminished especially at the subcutaneous level. This causes arterial constriction which accounts for the cold and often pale skin and leads to an increased lymphatic load(1). The condition worsens over years as tissue channels become progressively narrowed until the condition of a secondary lymphedema, overlying the original lipedema, may lead to a situation where the patient may be either wheel-chair bound or bedridden. Weight gains can be up to or greater than 500 pounds.

At this stage infections and intractable ulcers occur. (Some of the ulcers necessitate skin grafts when lack of oxygenation to the skin causes problems with healing) This can be due to the simplest injury e.g. careless donning of a compression garment or other minor trauma, occur with an even higher frequency.

Lipedema (painful fat syndrome) can be defined as a chronic disease that occurs in female patients and is characterized by bilateral, symmetrical fatty tissue augmentation mainly in the hip region and upper and lower leg combined with a tendency to orthostatic edema.

This condition occurs predominantly in women, and can in some cases be familial; the rare cases of men with lipedema always seem to include a hormonal imbalance which should be treated if possible. The macrophages themselves become overloaded and cease to play an active role in protein proteolysis and look like fat cells.

Lipedema is often misdiagnosed as obesity in its earlier stages but the symptoms are clear and distinctly recognizable clinically from this. In its later stages it may be more difficult to distinguish from lymphedema, although the case history and distribution of excessive tissue should provide an indication. The overlying condition of lymphedema may occur in the later stages.

Lipedema can occur in the legs, buttocks and also, but not necessarily, in the arms. It does not involve either the feet or hands until the onset of lymphedema. The mean age of diagnosis is approximately 35-36 years but it usually starts at puberty. Symptoms of onset, however, can start in childhood, and may be clinically detectable in adolescence. Cellulite, which is a very mild form of lipedema, usually occurs towards or after menopause. It has been suggested that a mixture of primary lymphedema as well as lipedema can occur in some cases.

Fat cells in patients who ave lipedema have a spherical shape and like any other cells contain fat deposits covered by a micro filament-reinforced cell membrane. Groups of fat cells form lobes which are surrounded by fibrous tissue. The septa between the lobes contain blood and lymph vessels and nerves. Fatty tissue has an excellent blood supply but fat cell-associated lymph capillaries are not present. Lipedema is likely triggered by a microangiopathy with an increased fragility of the blood capillaries. The increased capillary permeability then leads to a protein-rich intercellular edema. In subsequent stages, inflammation sets in leading to perivascular fibrosis, a few areas of fatty tissue necrosis, oil cysts and an increase in the number of the macrophages. Prominent mast cell recruitment and other inflammatory effects eventually lead to interstitial fibrosis

Lymphedema is a swelling of a body part, most often an extremity, resulting from an accumulation of fluids, in such proportion to be palpable and visible. Lymphedema occurs when the lymph vascular system is not able to fill its function of reabsorbtion and transport of the protein and lymph load. Lymphedema occurs whenever lymphatic vessels are absent, underdeveloped or obstructed.

The condition most often causes embarrassment and causes decreased mobility, discomfort and often repeated episodes of infection, cellulitus and lymphangitis. This can lead to general depression and a general worsening of the patient's life and health.

Fungal infections can be very frequent and these place a greater load on the lymphatics. Severe cases are associated with thickening of the skin, hardening of the limb (fibrosis), leakage of lymph and massive swelling (elephantiasis).

Linda-Anne Kahn
President Lymphatic Therapy Services of San Diego

Linda-Anne is an Internationally trained Beauty Therapist, Massage Therapist, Aromatherapist, Holistic Health Practitioner, and Lymphedema Therapist.

She is also an Internationally Certified Manual Lymph Drainage Therapist. She is certified by the Dr. Vodder School in Austria, by the Dr. Foldi School in Germany as well as the Dr. Casley-Smith school in Australia. She is re-certified every 2 years by the Dr. Vodder school and regularly attends conferences and workshops.

Linda-Anne is a member of the International Federation of Aromatherapists (IFA), CIDESCO International, North American Vodder Lymphatic Therapists (NAVALT), National American Holistic Aromatherapists (NAHA) and is past Vice President of NAVALT.

Linda-Anne Kahn is nationally certified as a Lymphedema Therapist North American Certification for Lymphedema Therapists

Linda-Anne is also the Director and founder of Beauty Kliniek Aromatherapy Day Spa and Wellness Center, the most complete Health and Beauty center in Southern California. She is also director of Lymphatic Therapy Services of San Diego.

See just a few of the many letters of appreciation that Linda-Anne has received from her loyal clients...