Episode 55: Lymphoedema - A Condition of Many Causes - Anatomy Of Illness

Episode Transcript
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(00:00):
Recently, you've noticed that your left leg

(00:02):
has become swollen,
making it noticeably larger than your right.
It feels tight and heavy as you walk around,
causing discomfort throughout the day.
As you reach for your favorite jeans,
you realise they no longer fit over the swelling,
intensifying your concern.
Due to these troubling symptoms,
you've decided it's time to see a doctor.

(00:35):
Hello and Welcome to Anatomy Of Illness.
Today's episode is about lymphoedema.
Before we get into the condition,
we are going to start with the history.
So why do we know lymphoedema exists?
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We begin in ancient India,
between the sixth and seventh century,
as this is where the oldest written description

(00:56):
of lymphoedema occurs.
This is in the ancient texts, Shushruta Samhita.
In this ancient medical texts,
the condition was known as Slipada, meaning elephant leg.
This was done to describe the swelling
and increase in the size of the leg.
In the text, the swelling was said to be caused
by an accumulation of kapha.
This in ayurvedic medicine is one of the three energies

(01:16):
that are part of the body.
This text was also the first to describe a treatment
for the condition.
It used a combination of diet, medicine,
and lifestyle modifications
in an attempt to treat the condition.
Now we move forward to the fifth century BC,
over to Greece with Hippocrates.
Hippocrates would call this condition elephantiasis.
This condition was characterised by swelling of the legs,

(01:37):
thought to be bought on by a blockage
in the lymphatic system.
Now we move to Bronze Age Minoan society,
between 1700 to 1500 BC.
This is where a statue was found
in the Traostalos hilltop sanctuary.
This figure was a lifelike representation of the condition.
This was most likely part of a healing prayer for lymphoedema,
most likely unilateral lymphoedema,

(01:58):
as only one limb is affected in the statue.
In this case, the person the prayer was made for
may have had this as a result of cancer.
Another representation of lymphedema is in ancient Egypt.
This is in a limestone carving
dated between 1479 to 1458 BC.
This depicts the image of the queen of Punt, Ati,

(02:19):
who is pictured as having larger limbs
than the others in the carving,
leading to the belief that she has lymphoedema.
Punt is nowadays Southern Sudan or Ethiopia.
I was not there at the time of the ancient Egyptians
of the land of Punt, so I cannot give exact coordinates.
Now we move on to Galen, around the second century AD.
He described lymphoedema and recommended the use of massage

(02:40):
and exercise to help with the condition.
Now we are going to jump forward to between 807 and 870 AD
with Ali ibn Sahl Rabban al-Tabbari.
He would describe a disease he called Daa al-Fil,
meaning elephant disease.
The history of the condition would be pretty stable
and stagnant for a while until we get to the year 1869.
This is where we would meet Professor von Monsegeil.

(03:01):
He developed the manual lymphatic drainage technique
as part of lymphoedema management.
This would be improved upon in 1892
in a book called "Billroth's Book of German Surgery."
This was written by an Austrian Belgian surgeon
by the name of Alexander von Winiwarter.
This book contained the four pillars of lymphoedema care.
These were gentle lymphatic massage, inelastic bandages,

(03:21):
which are compression bandages
that did not have any real stretch, skincare, and exercise.
These are very much the foundation
for today's lymphoedema care.
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and think someone else might,
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What actually causes lymphoedema?
Well, there are two main kinds, primary and secondary.
Primary lymphoedema is normally a congenital defect.
So it's like you are normally born with.

(03:42):
This is normally caused by a genetic disorder.
This can be hereditary lymphedema caused by a mutation
on the CELSR1 gene.
With primary lymphoedema, it is more common
for it to occur with other genetic conditions.
Some of the genetic conditions
that can cause lymphoedema are Turner syndrome,
trisomy 21, which we went over in episode 49,
neurofibromatosis type 1, and many others.

(04:03):
Some conditions can cause the development
of lymphedema from birth,
like Millroy's disease or Hennekam's disease.
In other cases, like from puberty or during pregnancy,
up until the age of 35, primary lymphoedema can also occur.
This is through conditions like Meige disease.
This can be referred to as lymphoedema praecox.
For those who are after the age of 35,
you can develop the rare late onset primary lymphoedema

(04:25):
that is limited to the swelling of the legs.
This is lymphoedema tarda.
There is also secondary lymphoedema.
This is lymphoedema that is not genetic.
It is caused by damage to the lymphatic system
or a blockage in the lymphatic system.
Some of the causes include surgery.
In some cases like cancer, lymph nodes will also be removed.
This can cause lymphoedema.
Radiation therapy, trauma or tissue damage,

(04:46):
infections such as filariasis, cancer,
and in some tropical countries,
this condition can be caused by a parasitic worm
as infections with these little threads like worms
can clog up the lymphatic system.
Speaking of threads, if you wanna get some cool new clothes,
check out merchanatomy.com.
How do we test for lymphoedema?
If you start to display signs of lymphoedema
after having something that may trigger it,
it can be easily diagnosed with minimal testing.

(05:08):
An example of this is having surgery to remove breast cancer.
This surgery often removes the lymph nodes in the area,
which can lead to lymphoedema in the nearby arm.
If you wanna learn more about breast cancer,
check out episode 13.
For those who have a less obvious trigger,
there are several tests that can be done.
These include ultrasound.
This is done on the affected limb
to see if there are any obstructions
in the lymphatic system causing the lymphoedema,

(05:29):
and CT scan.
This is another type of scan that can also highlight
if there are any obstructions in the lymphatic system.
We'll get right into the symptoms and presentation
right after this little break.

(05:51):
If you're enjoying this episode,
be sure to check us out on Buy Me a Coffee.
What symptoms might you have if you had lymphoedema?
Some of the symptoms that are common in lymphoedema
are recurring infections,
swelling in part or all of the arm or leg.
This can even be the fingers or toes.
There may be a feeling of heaviness or tightness
in the affected limb or limbs,
restricted range of motions in the affected limb or limbs,

(06:11):
and a hardening and thickening of the skin.
This is known as fibrosis.
What are some complications a doctor should be aware of
when it comes to lymphoedema?
There are several complications that lymphoedema can cause.
These include skin infections or cellulitis.
With lymphoedema, the lymph fluid is often trapped
in one area.
This makes it a very inviting space
for any bacteria or germs.
When you have even a small injury to a limb,

(06:32):
with lymphedema, you can get an infection.
In these cases, the skin will become swollen,
warm to touch, and red.
It can also be painful to touch.
Sepsis.
When these infections go untreated,
the infection can enter the bloodstream, causing sepsis.
This can become life-threatening.
Leakage through the skin.
With the severe swelling that lymphoedema causes,
limb fluid can drain through small breaks in the skin

(06:53):
or cause blistering.
Skin changes.
In some people with lymphoedema,
the skin can thicken and harden on the affected limb,
so it resembles an elephant.
This is where the name elephantitis comes from,
due to the enlargement of the limb
and the changes to the skin.
Elephantitis is a no longer used term for lymphoedema.
Cancer.
In very rare cases, when lymphoedema goes untreated,
it can cause a rare cancer known as lymphangiosarcoma.

(07:16):
How do we treat lymphoedema?
There are several different treatment methods
that can be used to manage lymphoedema.
These include manual lymph drainage.
This is a specific massage technique
that helps to move the lymph fluid.
This technique will not be recommended for everyone.
Compression bandages.
These are bandages that can be wrapped
around the affected area.
They are not stretchy and help to push the lymph fluid
back towards the trunk of the body.

(07:37):
Compression garments.
These are close-fitting garments that can be,
for example, sleeves or leggings.
These garments can be prescription and fitted
to ensure the right amount of compression is applied
and in the right areas.
Sequential pneumatic compression.
This is a device that is attached to a sleeve
that goes over the affected leg or arm.
This device inflates the sleeve intermittently,
which puts pressure on the affected limb,

(07:59):
pushing the fluid back up towards the trunk.
There are also surgical options
for some cases of lymphoedema, not all.
These include lymph node transplant.
For those who are in the early stage of lymphoedema,
a lymph node transplant may be possible in some cases.
This is done by taking lymph nodes from an unaffected area
and attaching them to the lymph vessel network
of the limb that is affected.
This can reduce the amount of compression needed,

(08:20):
but again, doesn't always fix the problem.
New drainage paths.
This is another treatment for some
in early stage lymphoedema.
This surgery creates new connections
between the blood vessels and the lymph network.
This allows the excess lymph fluid to be removed
via the blood vessels.
Fibrous tissue removal.
This is for some severe cases of lymphoedema.
This removes hard and soft tissue,

(08:41):
which helps to improve the limb's function.
When it comes to lymphoedema,
every person is different.
So different treatments will be recommended
as there are many different causes of this condition.
Are there any famous people with lymphoedema?
There is Kathy Bates, the award-winning actress
you may know from "Misery" or "The Office."
She has lymphoedema in her arms,
which occurred after breast cancer surgery.
After her diagnosis, she has become a spokesperson

(09:03):
for the Lymphatic Education and Research Network,
helping to raise awareness of lymphoedema.
If you want to check out someone on social media,
a really great person to check out
when it comes to lymphedema is Bella Does Editing.
She has primary lymphoedema from Hennekam Syndrome,
which causes malformation of the lymphatic system.
Bella is amazing.
She tells it how it is and shows you her day in the life
in the film industry,

(09:23):
whilst also having some really helpful and informative videos
when it comes to compression garments and lymphoedema.
I have linked to her Instagram below
if you want to check it out.
If you want to check out a foundation, there is,
for those in the US, the National Lymphedema Network.
They provide education to practitioners and patients,
as well as networking opportunities.
For those in the UK, there is the Lymphoedema Support Network.

(09:44):
This foundation provides support
for those affected by lymphoedema.
They provide information about treatment options
and are working towards treatment
being more easily accessible.
And there is, in Australia,
the Lymphoedema Association Australia.
They provide information to those diagnosed with lymphoedema,
as well as support and connection.
So those going through lymphoedema
don't have to go through it alone.
If you want to check out the sources, social media links,

(10:04):
or any other links, you can head to anatomyofillness.com.
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(10:32):
Did you know the lymphatic system
is about double the size of the blood circulatory system?
It also manages almost twice the amount of fluid.

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Episode 55: Lymphoedema - A Condition of Many Causes

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Episode 55: Lymphoedema - A Condition of Many Causes