ESCANABA — It is not often that we are able to proclaim a significant advance in healthcare law. Too often, the headlines reveal only new obstacles to care and further reductions in the provision of medicine. But with the arrival of 2024, real progress has been made. The Lymphedema Act was passed, providing for clearly defined benefits in the treatment of this condition, with many options now available for effective care.

At this point in the conversation, a discussion of the lymphatic system and what it does would be appropriate. This is the waste disposal system for our cells. There are several disposal systems in the body such as the waste removal system for our bloodstream, which is urine created by our kidneys. This is quite different from the waste removal system for our gastrointestinal tract which produces solid wastes.

Most of us are familiar with the sight of edema, the swelling that develops following a sprain, although there are numerous causes for swelling. Generally, with occasional exception, it is a collection of water and waste products from cell metabolism that is put back into our system via a vast network of tiny tubes and the nodes they run to. It drains fluids, mostly water, but also salts and various proteins, that are dissolved in our lymph fluids. In brief, this is the lymphatic system.

Lymphedema is the result of an overload of this system, in which an excess of fluids build up in the tissues, more than the lymph vessels are able to drain away. Often, it is experienced in the lower leg, although lymphedema can occur anywhere, often in the arm after breast cancer. Anatomically, because of the ever-present forces of gravity, the lower leg is an extremely common site for this condition.

Numerous maladies can lead to a fluid overload of this system. Whereas it was earlier associated primarily with cancer as mentioned, we are beginning to recognize this fluid overload can develop in a variety of ways, and via differing mechanisms. From kidney problems to heart conditions, trauma or surgery, any accumulation of fluids in the tissues (again, often in the lower leg) which is sufficient to overwhelm the lymph system can result in edema. If it accumulates significantly and for long enough, lymphedema ensues.

The most frequent cause of lymphedema, if not the result of cancer or its treatment, is seen with the vein diseases. Most common amongst these is chronic venous insufficiency (CVI) in which the valves in our veins give out, allowing blood to pool in the lower leg. Various substances leak out of the vein, including plasma, once again overloading the lymphatic system. Consequently, often occurring together are both CVI and lymphedema.

As you might imagine, this affliction is not a rarity, affecting one in a thousand people. That works out to about 10 million Americans suffering with some degree of lymphedema. Age is a risk factor for developing this common condition. Similarly, excess weight or obesity will also increase one’s risk. The same can be said for rheumatoid or psoriatic arthritis. Those occupations requiring prolonged standing will encourage the condition since they aren’t using the calf muscle pump which drives those fluids out of the lower leg and upwards.

As this fluid buildup gradually develops, various changes are seen. Gradually worsening swelling is typical but discoloration, usually redness, also often occurs. Early in this very gradual process, pitting is seen (indentations that remain in the leg after applying finger pressure) although the swelling still reduces with elevation. This changes with time and becomes more entrenched, and most notice the skin thickening progressively.

Compression of some type is a mainstay of treatment, but the technologies utilized have ranged from crude to semi-barbaric. By and large, support hose, aka compression stockings, have been the mainstay of treatment, but their success in relevant studies has been poor. They are difficult to don and uncomfortable when worn since they are so tight. A newer device is a sleeve worn on the lower leg, which uses Velcro tabs on stretch cord to provide the compression. These are noticeably more effective in reducing the swelling and are quite comfortable.

Adjunctive measures include protection of the lower leg since any wounding of the skin will be difficult to heal. Better hydration of the skin with regular moisturizer application will help to make it healthier. And when there is a wound, seeking the care of a wound care specialist is important since the longer an opening in the skin is present, the greater the chance of infection.

There is no cure for lymphedema, but we do have better methods of care than years back. Still, too many Americans simply live with this progressive condition: it generally goes without treatment until serious repercussions occur. Now, millions who couldn’t afford to get effective therapies are able to because of the Lymphedema Act. See a specialist if you think lymphedema is developing and no treatment has been rendered. Prevention is worth its weight in gold.

— — —

Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.