What can I do to help my patient?
Once an assessment has been carried out and a diagnosis of chronic oedema or lymphoedema has been made, the patient should be referred for specialist treatment as soon as possible to prevent further complications such as skin damage, leakage and infection. Whilst lymphoedema is not a medical emergency, the earlier treatment is commenced the easier it is to minimise its severity and associated complications. To find out where your local specialist is, email or telephone the LSN who hold a comprehensive list of specialist lymphoedema services in the UK. If there is no service in your area please go to the section There is no specialist service in my area what can I do to help?
Lymphoedema and Chronic Oedema are long-term conditions and those living with it will need ongoing, holistic management and support. Professor Peter Mortimer, Consultant Dermatologist at the Royal Marsden and St George’s Hospitals London and leading lymphoedema specialist in the UK, states that all patients with chronic swelling should expect:
- An explanation about the most likely cause of their chronic swelling
- Prompt referral to a lymphoedema practitioner
- A treatment programme incorporating the four cornerstones of lymphoedema treatment as appropriate
- Ongoing care according to accepted standards
- The option of additional treatment at intervals as needed
Whilst ultimately you may not be the health care professional providing ongoing care for those with lymphoedema in your practice, there is some helpful general advice which you can offer your patients once an assessment and diagnosis of lymphoedema/chronic oedema has been made.
- Try to use the affected limb as normally as possible as muscle activity will encourage lymph drainage
- Try to keep their weight within normal limits
- Drink plenty of fluids and avoid taking diuretics unless they have another medical condition that requires them to do so. Diuretics are not recommended for routine use in simple lymphoedema. Occasionally they are of benefit where there may be more than one cause of swelling, but when diuretics are prescribed their efficacy should be monitored and if there is no resolution of the swelling then the diuretic should be stopped and specialist advice sought
- Keep their skin clean, moisturised and in the best possible condition, avoiding injections/needles, blood tests and blood pressure readings on the affected limb, whenever possible
Everyone who lives with lymphoedema is different and their experience of the condition is unique but there are four specific areas of treatment that may be used to create an individual plan for your patients.
Skin Care – to keep the skin in good condition and reduce the risk of infection (cellulitis).
Exercise – is essential to maximise lymph drainage, keep the body supple and weight within normal limits.
External compression – this supports the area, assists in reducing the overall swelling, improves shape and helps prevent further build-up of fluid. Initially, this may be done by applying a specialised form of bandaging, but more often will mean wearing prescribed elastic graduated compression garments. It is important that these garments are the correct compression and size. Whilst most are usually prescribed by specialist therapists, the manufacturers do offer training to demonstrate how to measure for hosiery, choose the correct size and class of compression and how to fit the garments.
Lymphatic drainage – this is a special, gentle massage technique aimed at moving fluid out of the affected area. Manual Lymphatic Drainage (MLD) should only be carried out by specially trained practitioners, but a simplified form (SLD) can be taught to patients and/or their partners/carers. The LSN has produced a self-management DVD which features this technique.
Encourage patients to join the LSN
Living with any long-term medical condition is challenging and successful management is vital in lymphoedema. The LSN produces patient information fact sheets about lymphoedema and how best to manage it as well as having a website, information and support telephone line and self-management DVDs. Please suggest to your patients that they contact the LSN to see if these services may be of help to them.