Progression of Lymphedema
The last 3 stages of lymphedema (1)
Lymphedema is a condition that progresses over time and includes 4 different stages beginning with stage 0 to stage 3 (1).
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Stage 0: Non-visible (1,2)
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Patients have lymphedema symptoms present without any swelling caused by an abnormal flow within the lymphatic system
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Heaviness, aching, discomfort
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Newer addition to lymphedema progression
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Stage 1: Reversible lymphedema (1,2)
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Patients have a measurable amount of swelling caused by the build up of only protein-rich fluid​
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Regions that have been affected can be returned to normal through proper treatment - elevation and compression
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Stage 2: Consists of 2 substages (1,2)
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Stage IIa- Spontaneously irreversible initial lymphedema:
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Occurs when there is fibrosis in the interstitial space and cannot be treated without the use of the fibrolytic decongestive treatment
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Decreased lymph transport capacity and pitting edema
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Stage IIb- Spontaneously irreversible increasing lymphedema​:
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​Increased presence of lymphedema and lymphostatic skin changes, worsening disability, no visible pitting due to the fibrosis progression, along with fat hypertrophy
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Does not resolve with elevation
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Stage 3: Lymphostatic elephantiasis (1,2)
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The presence of dermal metaplasia​
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Papillomas, keratin deposition, and verrucous hyperplasia patches the skin become visible
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Large deformed limb, skin thickening​, and extensive scarring
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(2)
Interactions
There are many additional impacts that lymphedema has on individuals which affects their daily lives and ultimately their interactions with others. The physical symptoms experienced by individuals with lymphedema is extremely debilitating and impacts daily activities greatly (1). Lymphedema causes immense pain and could result in enough discomfort that any and all daily activities would be too hard to perform. In addition, the amount of swelling an individual experiences varies from day to day. The amount of swelling can also impact daily activities and any and all interactions the individual has planned may be too strenuous. Many individuals around the world experience psychological stressors in addition to their physical symptoms (3). These stressors include but are not limited to body image distortion, impacts on social activities, and depressive symptoms. Any and all psychological stressors greatly impact ones ability to perform daily activities along with interactions with others. These effects on mental health can also vary on a daily basis and this will greatly influence one's participation in any form of interaction.
References
(1) Kayiran, O., De La Cruz, C., Tane, K., Soran, A. (2017) Lymphedema: from Diagnosis to Treatment: Turk J Surg, 33 (2): 51-57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508242/
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This article outlines the causes, symptoms, diagnosis, and treatment options for lymphedema. This article highlights the differences between primary and secondary lymphedema. Various diagnostic methods regarding the staging of this condition have been explained in detail such as magnetic resonance lymphangiography. Other non-imaging and non-invasive diagnostic methods such as tape measurement, water displacement and skin evaluation were also explained.
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(2) Manrique, O. J., Bustos, S. S., Ciudad, P., Adabi, K., Chen, W. F., Forte, A. J., Cheville, A. L., Jakub, J. W., McLaughlin, S. A., & Chen, H. C. (2020). Overview of Lymphedema for Physicians and Other Clinicians: A Review of Fundamental Concepts. Mayo Clinic Proceedings, 0(0): 1-16. https://doi.org/10.1016/j.mayocp.2020.01.006
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This article outlines the four lymphedema stages and explains in detail the cause, symptoms, and treatments of each stage. Along with the stage symptoms this article outlines many other symptoms that occur in individuals living with lymphedema.
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(3) Keast, D., Kuhnke, J., Hettrick, H. (2019). Lymphedema: Issues and Interactions. Wound Care Canada, 17(2). https://www.woundscanada.ca/docman/public/wound-care-canada-magazine/2019-vol-17-no-2/1474-lymphedema/file
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This article summarizes the condition Lymphadema and provides a detailed outline on who can be affected by lymphedema, what the impacts of lymphedema are on an individual, and provides statistics based on the prevalence of lymphedema in Canada. In addition to framing the scope of the condition, it provided helpful statistics to understand the chronic lymphedema community.
Media References
(1) Kruppa, P., Georgiou, I., Biermann, N., Prantl, L., Klein-Weigel, P., Ghods, M. (2020). Lipedema—Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int​, 117: 396-403. https://www.aerzteblatt.de/int/archive/article/214184/Lipedema-pathogenesis-diagnosis-and-treatment-options
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This article summarizes lymphedema and how it is often misdiagnosed or not diagnosed at all. This article also outlines the stages of lymphedema and provides visual representations of these stages.
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(2) Manrique, O. J., Bustos, S. S., Ciudad, P., Adabi, K., Chen, W. F., Forte, A. J., Cheville, A. L., Jakub, J. W., McLaughlin, S. A., & Chen, H. C. (2020). Overview of Lymphedema for Physicians and Other Clinicians: A Review of Fundamental Concepts. Mayo Clinic Proceedings: 0(0), 1-16. https://doi.org/10.1016/j.mayocp.2020.01.006
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This article outlines the four lymphedema stages and explains in detail the cause, symptoms, and treatments of each stage. Along with the stage symptoms this article outlines many other symptoms that occur in individuals living with lymphedema.