Lymphedema is a lymphatic system disease known as elephantiasis in the community. This disease is caused by disorders related to the functioning of the lymphatic system, which is a part of both the circulatory and immune system, which regulates the lymph fluid, which is the intercellular fluid. The most basic indicator of the disease is the appearance of abnormal edema in one or more of the arms or legs. These swellings, which occur due to excessive accumulation of lymphatic fluid, cause an aesthetically unpleasant appearance in addition to the physiological complications of the disease, negatively affecting the patients psychologically. Therefore, in order to prevent serious complications that may develop due to the disease and to relieve swelling, the treatment process should be started as soon as possible and meticulously carried out in patients diagnosed with lymphedema or elephantiasis.
What is the Lymphatic System?
Lymph system or The lymphatic system can be defined as a circulatory network that is distributed throughout the body through lymph vessels, similar to the blood circulation. The lymph fluid circulating in this network is responsible for taking various molecules and proteins in the fluid between the cells and delivering them to the blood circulation. In this way, the transfer of various molecules between tissues is ensured, and body functions are carried out in a balanced manner. While the molecules in the lymph fluid in the lymphatic system are transferred to the capillaries and from there to the veins in healthy individuals, a small part of them remains in the tissue fluid. All lymph vessels pour into the thoracic duct, whose Latin name is "ductus thoracicus", and the lymph fluid is collected here. It is then transferred to the arteries and continues to circulate. In addition to lymph vessels, there are lymph nodes along these vessels. Lymph nodes, which look like a network, are divided into very fine branches and form their unique structure. Lymph nodes are responsible for fulfilling the immune-related tasks of the lymphatic system and ensure the retention of foreign substances caught in the interstitial fluid. The cells in the lymph nodes that perform this task are called lymphocytes. Leukocytes, which are in lesser amount than lymphocytes, donate It is another type of cell that acts as a clique. Apart from the lymph nodes that continue along the lymphatic vessels, lymph nodes are also encountered in different parts of the body, such as tonsils and certain parts of the gastrointestinal tract, where there is a high probability of encountering foreign matter.
What is Lymphedema and What Are Its Types?
Any congenital or subsequent defect in the lymphatic system causes the accumulation of lymph fluid containing protein molecules in certain tissues. This is the simplest answer to the question of what lymphedema means. Due to the fact that it causes severe swelling (edema) in the tissues, this disease is also called elephant disease among the people. Lymphedema is divided into two main types according to the way it develops. These are called primary and secondary lymphedema.
Primary (Congenital) Lymphedema: It is a type of lymphedema that develops due to a congenital defect in the lymphatic vessels or nodes in the lymph system or their congenital absence. Although the disease is present from birth, it usually coincides with the years of youth when significant swelling begins to be observed. Secondary lymphedema, which is much more common than primary lymphedema, is usually chronic. The treatment is difficult and the susceptibility to infection is quite high in the arms and legs where edema is present. Since each infection will further damage the lymphatic vessels and lymph nodes, the fight against infection takes an important place in the treatment.
What are the Symptoms of Lymphedema?
In the initial stage, lymphedema patients may not have any symptoms despite the disorders in the lymph system. . However, in some patients, the symptoms of elephantiasis may not be as severe as lymphedema. As the disease progresses, the symptoms become more severe. Common lymphedema symptoms include:
- Swelling in various parts of the body
- Feeling of heavy legs
- Feeling of tension, loss of strength and pain in the arms and legs
- Old shoes, rings and socks and pans small clothing like tolon
- Decreased mobility and flexibility in the ankles
- Elephant skin appearance with hardening and cracking of the skin on the feet and ankles
- The leg thickens from the knee and looks like a column Although there is swelling in the feet and legs in the first stage of lymphedema, also known as elephant foot disease, this appearance disappears when waking up in the morning. In this stage, which can also be defined as the onset of elephantiasis, the feet gradually swell later in the day. In patients who reached the second stage, signs of skin thickening and cracking began to be observed, while swelling began to appear at any time of the day. At the same time, it is seen that the swollen limb does not collapse when pressure is applied with a finger. The third and most advanced stage is characterized by persistent tissue swellings called elephant foot. The swelling, which is very prominent, is very resistant to treatment and is prone to infections.
What are the Causes of Lymphedema?
A very small portion of lymphedema cases are congenital. The most common cause of elephantiasis, which generally develops later, is the damage to the lymphatic vessels by the treatment methods applied for different reasons. At the top of the list of causes of elephantiasis that cause the most damage in question are surgical operations and radiotherapy applied in the fight against cancer. Especially in the surgical treatment of breast cancer, the possibility of developing lymphedema in the arm is very high. Because lymph vessels are damaged during treatment. Apart from cancer treatments, surgical interventions on the lymph channels and infections that damage the lymphatic ways are some of the conditions that can cause lymphedema.
What Happens If Lymphedema Is Not Treated?
- Bacterial and fungal infections may develop,
- Dysfunction occurs as a result of growth in the arms and trunk,
- There is a decrease in the quality of life.
- Surgical and/or radiotherapy after breast diseases treatment Lymphatic drainage of the upper extremity may be impaired with :
- It is very rare after sentinel lymph node biopsy, but it has been reported to be up to 5% in different publications.
- Axillary di It has been reported that 10% of lymphedema may develop in the arm with sectioning (removal of lymph nodes related to the breast from the armpit). >
Lymphedema Diagnosis and Treatment Methods
Patients who apply to health institutions with persistent foot and leg swelling similar to lymphedema are first performed physical examination. After taking the patient's medical history, information about the current diseases, drugs used, and treatments, the edema problem is investigated together with the physical examination. The patient is then usually asked to take certain diagnostic tests. Chief among these is lymphoscintigraphy, which allows visualization of the flow in the lymphatic system. In addition, one or more of the ultrasound, magnetic resonance (MR) and computed tomography (CT) imaging methods may be required. Since leg swelling can also be caused by problems with the blood vessels, it is often recommended to examine the blood vessels using Doppler ultrasound. In some cases, an imaging method called lymphangiography, in which an X-ray of the leg is taken after an injection of a dye, may also be used. In patients diagnosed with lymphedema, the severity of the disease is also taken into account when planning the treatment process. Unfortunately, there is no definitive and preventive treatment method that can be called elephant disease treatment. However, with the treatments to be applied and some precautions to be taken, it is possible to stop the progression of lymphedema and prevent infections and injuries. If there is an infection, antibiotic treatments must be carried out in a timely manner. In some cases, the use of various bandages or some medical products such as socks and arm cuffs may be recommended. Physical therapy with some applications that may be recommended by the physician, such as exercise and massage, are quite effective in controlling the disease. In some advanced severe cases, surgical procedures called lymphedema surgery may be required. Surgery can be performed with microsurgical techniques in partial occlusions and mild deformities. In the early stages, in more severe cases, the accumulated fluid can be transferred to healthy areas artificially. Innovative applications, also called tunneling operation, can be applied to continue this process. Which of these applications will be preferred during the lymphedema treatment process will be decided by the physician considering the health status of the patient. By taking various precautions, patients can be protected from the serious problems that this disease may cause and can stop the progression of the disease to a large extent. It is very important to wash the arms and legs with edema problem regularly, not to leave them damp and to pay attention to their hygiene. Carrying heavy loads and walking barefoot should be avoided. You should not sit with your legs crossed, as it negatively affects lymph flow. If arm and leg epilation is required, electric shavers with the least risk of infection and injury should be used. If possible, injection should not be performed on the limb with lymphedema, and procedures such as blood pressure measurement should be performed using other limbs. Standing for long periods should be avoided, and care should be taken to exercise regularly. Lotions recommended by the physician should be applied to the arms and legs regularly. In addition, attention should be paid to a healthy diet and adequate water consumption. If you are also experiencing ongoing swelling of the arms or legs and are looking for an answer to the question of which doctor to go to for lymphedema, you can apply to cardiovascular surgeons. By having your examinations and treatments done on time, you can ensure that your possible diseases are treated at an early stage and lead a healthier life.
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