Lymphedema a treatable sideline of obesity

Chances are, if a patient sees Rhonda Haley, the patient's obesity already has turned into lymphedema.

There's no cure for lymphedema, but the BenchMark Physical Therapy specialist said treatment plans can make life with swollen tissues from a faulty lymph system more livable.

"There's no special diet plan for lymphedema," said Ms. Haley, a certified lymphedema specialist. "It's just important (for the patient) to live a healthy lifestyle."

The majority of patients she sees are overweight, she said. Obesity often leads to chronic venous insufficiency (when the veins have trouble sending blood from the legs back to the heart), which can develop into lymphedema, she said.

Weight loss can improve lymphedema, Ms. Haley said, because it allows patients to be more mobile and better able to take care of themselves. Often, she said, abdominal fat restricts blood flow below the waist and keeps the lymph system from working properly.

While the legs are the primary site for lymphedema, the arms are often affected and, more rarely, the trunk, face and genitals, she said.

To treat the condition, certified lymphedema specialists work with patients and then help them prepare to manage it themselves.

BenchMark's four-step program involves skin care, manual lymph drainage (a kind of light massage), compression therapy (the application of bandages to force lymphatic fluid up from the feet) and exercise (to get the legs moving and the muscles pumping), according to Ms. Haley.

Treatment plans typically call for therapy five days a week for two weeks and then three times a week for the next two to three weeks, she said. After the initial treatment phase, the patient generally has a follow-up visit every six months.

Part of the intensive phase of treatment is to teach the patient how to do maintenance therapy, Ms. Haley said. That includes instruction on how to bandage their legs, how to use compression stockings, how to perform manual lymph drainage and how to do home exercises.

George Nye, 81, of Ringgold, Ga., had his legs measured earlier this week prior to the beginning of treatment. His primary care doctor had recommended the treatment after he gained 35 pounds since two heart failures several years ago.

"My feet have been swelling for more than a year," he said.

Mr. Nye's heart doctor said the swelling is not related to his heart, so the retiree said it probably is linked to his diabetes. He will start treatment when Ms. Haley returns from vacation.

"It takes a special physical therapist to handle this kind of thing," he said.

Although obesity is a primary cause of lymphedema, secondary causes may include trauma and surgery, Ms. Haley said. Heart, knee and breast surgeries all have been known to bring on lymphedema, she said.

In fact, according to a 2006 American Society of Breast Disease study, obesity appeared to increase the risk of developing lymphedema after axillary lymph nodes are removed during breast cancer surgery.

About 36 percent of obese patients developed the condition compared to about 16 percent of overweight patients, about 7 percent of normal weight patients and no underweight patients.

Ooltewah-based BenchMark has treated lymphedema patients for about seven years, according to Priscilla Smith, executive administrator. Presently, eight clinics with a treatment program in East Tennessee and North Georgia average 130 patients and approximately 2,000 visits a month, she said.

"There was a great need to develop a program to treat patients with the condition," she said, "because we noticed that many patients were looking for a program, and a comprehensive program like the one at BenchMark didn't exist at the time. Travel for patients with lymphedema is not easy, so it was important the program be available in as many clinics as possible to accommodate and add convenience for the patient."