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General details about Lymphoedema

What is Lymphoedema?
Oedema = swelling, Lymphoedema is swelling caused by excessive lymph. It can occur anywhere but is most pronounced in the limbs.

What is Lymph?
Blood is circulated through arteries (carry blood to the tissues), veins (carry blood back) and capillaries where the actual transfer of food and oxygen takes place. This transfer requires a medium - lymph fluid - part of which gets left behind and then is re-transported back to the blood via small vessels called lymphatics.

How is lymphoedema caused?
Transport of lymph in the legs and arms means anti gravity flow - it requires co-ordination of muscular action (present in lymph vessels) and valves. En route, the lymph is filtered through the lymph nodes to check infection causing bacteria and foreign bodies. In Filariasis - a disease caused by a worm which resides in the lymph vessels but spread through mosquito bites - the muscles and valves stop functioning. While during surgery for cancer (notably for breast cancer), the lymph nodes are surgically removed. In both cases, lymph flow is affected and the fluid accumulates in the lower part of the limb.

This accumulated fluid, being a potent culture medium, is very prone to infection which is a recurrent problem in such patients. Repeated infection causes a vicious cycle of secondary lymph vessel blockage and further fluid accumulation making the limb even more swollen and sensitive to infection. It also kills the filaria worm. In later stages the fluid partly precipitates to result in skin changes, hideous warty outgrowths and by now irreversible swelling also called Elephantiasis. Unclean habits make the disease worse as infection sets in more often.

About Filariasis
Filariasis affects 119 million people in the world, 40-50% are in India. It is the fourth highest cause of morbidity in the world and probably the highest in India. It is found in East UP, Bihar, Telengana, Vidharba as well all along the coastal regions of our country. It is spread by various species of mosquitoes who transmit the young worms (microfilaria) to the new victims. Killing the worm by DEC tablets is effective in stopping spread of disease to others. But the infected person, carrying the worm since long, will worsen progressively to elephantiasis even after the worm is dead. Other problems that can occur are hydrocoel (Scrotal enlargement) - Commonest, swelling of upper limb, other areas, as well as leakage of lymph through the urine (chyluria) and through ulcers (chylorrhagia). In North India, lymphoedema is more commonly secondary to cancer and occasionally following injuries.

Treatment of Lymphoedema
So far, no satisfactory treatment methodology had been available for lymphoedema. Surgery had been tried with inevitable recurrence as well as results sometimes worse than original.Whatever the cause of lymphoedema, the treatment is the same. A few simple measures which prevent infection like keeping the limb clean, avoiding barefoot walking is the mainstay of treatment.

In addition, a few specific treatment modalities have shown promising results especially if started early. These have yet not been adopted on a wide scale in India - the place where the disease exists the maximum. These are :

• Heat therapy (discovered and now widely used in China- technology brought to India by Dr Tambwekar, Mumbai)
• Pneumatic Compression (Discovered in US, Brought to India By Dr S B Gogia, New Delhi)
• Certain medicines which act directly to reduce lymphoedema (Introduced in India by Dr S Jamal, Thanjavur)
• Interferential therapy (a physiotherapy machine introduced for Lymphoedema therapy by Vector Control Research Institute, Pondicherry))
• Manual Massage (used widely in the west where post cancer is common, logistical problems yet for widespread introduction in India) - we have started the same in New Delhi as a part of Complex De-congenstive Therapy with Multi layer bandaging as an add on.
• Nodo -Venous Shunts - A minor Surgery again popularised by Dr Jamal
• Customized limb supports as well as crepe bandage - now commercially available in India, cheaper and quality suited to our tropical climate and hence better than imported

Lymphoedema is not a killer disease but is severely disfiguring going on to debilitating in the later stages. Though a complete cure is yet still not with us, an incurable disease is now considered treatable. Without treatment, the despair accompanying the cosmetic disfigurement makes the person ignore recommended precautions like general cleanliness etc making the disease far worse. The psychological effects of therapy are immensely beneficial.