A DAY FOR VINDICATION, MARCH 12, WORLD ELEPHANTIASIS DAY
March is recognized worldwide, as the month to highlight lymphedema, its most severe late-stage is known as “elephantiasis”. The Elephantiasis stage is not only located in poor developing countries, but also can be found in European and high-tech Western nations. The medical term elephantiasis is used to identify, a part of the body which has undergone progressive deformity and trophic skin changes as a result of chronic lymphatic dysfunction. Throughout the world, the lack of treatment or under-treatment of lymphedema, makes the elephantiasis stage a condition that is still present today.
WHAT IS ELEPHANTIASIS - MYTHS AND FACTS
Lymphatic dysfunction (Organic impairment) is not a rare disease but a major public health
problem, and it is necessary to sensitize governments and
international health organizations, that access to treatment for
lymphedema and lymphatic diseases should be a global priority. Up to
10 million Americans may be affected by lymphoedema, and it's
estimated that over 250
million people worldwide suffer from the disease,
creating pain, swelling, disability, and suffering for
patients of all ages, including children. The only way to avoid
elephantiasis (Stage III lymphedema) is to provide early lymphatic therapy and compression garments necessary for lymphatic
disorders. Read more about why the world is not treating a treatable disease like elephantiasis HERE.
The conservative treatment is indicated for all edema stages including Stage III, and as a preventive treatment that will avoid the initial
progression toward the elephantiasis stage. Radical
reductive ablative surgery, aimed to remove subcutaneous tissue, should always be the last option,
for it is associated with possible significant blood loss, morbidity,
infections, permanent disfigurement, and recurrence of symptoms.
The elephantiasis stage is preventable in the majority of cases, if the underlying cause which is lymphedema, is treated in its initial stages. In the case of lymphatic filariasis (Secondary Lymphedema), it is recognized that in many cases it is first acquired in childhood, often as many as one-third of children are infected before age 5. This fact needs urgent implications by international health organizations and public health systems, for prevention campaigns and management of this likewise childhood illness. The cornerstone for the PREVENTION of the elephantiasis stage is lymphatic therapy and compression treatment of initial mild lymphedema, which will reduce the incidence of dermatolymphangioadenitis (infectious cellulitis) and Lymphangitis, which are the causes of the subsequent worsening of the condition. Read more about dermatolymphangioadentitis (DLA) in lymphedema HERE.
WHAT IS LYMPHATIC FILARIASIS AND PODOCONIOSIS?
Lymphatic Elephantiasis
is one of the world's most disfiguring, disabling, and life-threatening
conditions, and is nearly always the
result of non-treatment or undertreatment of lymphedema. There
is a safe and effective treatment
for lymphatic dysfunction, which helps to stop the
progression of the disease towards its severe late stages. The
best treatment for lymphedema is COMPLETE DECONGESTIVE THERAPY (CDT), which is considered the “Gold Standard” conservative treatment. This specialized treatment consists
of Manual Lymphatic Drainage (MLD) and multi-layered bandage wrapping
conducted by specialized lymphedema therapists, as well as other
components such as skin care, diet, and exercises.
The elephantiasis stage is preventable in the majority of cases, if the underlying cause which is lymphedema, is treated in its initial stages. In the case of lymphatic filariasis (Secondary Lymphedema), it is recognized that in many cases it is first acquired in childhood, often as many as one-third of children are infected before age 5. This fact needs urgent implications by international health organizations and public health systems, for prevention campaigns and management of this likewise childhood illness. The cornerstone for the PREVENTION of the elephantiasis stage is lymphatic therapy and compression treatment of initial mild lymphedema, which will reduce the incidence of dermatolymphangioadenitis (infectious cellulitis) and Lymphangitis, which are the causes of the subsequent worsening of the condition. Read more about dermatolymphangioadentitis (DLA) in lymphedema HERE.
Apart
from the patient daily basic self-care needed, consisting of washing limbs and skin moisturizing, they also need to wear compression
garments throughout the day.
Without
compression garments, it is impossible to stop the progression of
lymphatic edema. The daily use of standard bandages is not practical, for they tend to loosen and slip off when undertaking work that requires continuous physical activity, and likewise, soiled bandages can also be an important source of infection. Wearable compression garments are the best option by which a person can carry
out their daily activities. Basic
self-care alone without compression is not enough by itself to
control the disease,
and will not stop the progression towards the elephantiasis stage. Read more about the best treatment for elephantiasis HERE.
Compression alone without Manual Lymphatic Drainage (MLD) for the Initial Reduction Phase I, can cause displacement of lymph to other previously non-affected areas, which in the case of lower limbs can cause Genital Edema. People with lymphedema need access to specialized care throughout their lives, both to manage the disease and to prevent progression to more advanced stages such as elephantiasis. Read more about the principal functions of Manual Lymphatic Drainage HERE
International
awareness campaigns are needed for access to lymphatic therapy and compression garments for patients diagnosed with chronic lymphedema, many
of them children,
since this is the only possible way to stop the progression of the
disease. The elephantiasis stage is a treatable condition, but it will never be eradicated from the
world
as long as there is non-treatment or under-treatment of lymphatic
dysfunction (lymphedema).
IMPORTANT NOTICE
Lymphedema is a serious chronic and progressive disease due to an organic disability. The clinical treatment of lymphedema is neither a cosmetic nor an aesthetic treatment. The treatment of lymphedema is to control its progression and alleviate the symptoms related to dysfunction of the lymphatic circulatory system.
To prevent and avoid serious complications associated with treatment, such as the possible displacement of edema to previously unaffected areas when compression therapy is applied for volume reduction, patients should use highly specialized and experienced therapists.
Professional qualification and instruction delivered remotely online are not the same as live hands-on practical instruction in the clinical training and certification of lymphedema therapists, similar to all other rehabilitation, medical, and surgical training programs, and especially for developing the necessary manual skills to treat a disease as complex as lymphedema.
Patients should also take special care when choosing a "Multidisciplinary Center of Reference for Lymphedema", as not all countries and centers provide the same treatment options. The best choice is a center of reference that provides “Complete Decongestive Therapy (CDT)”, which is recognized as the “Gold Standard” treatment for lymphedema.
- Read more about the best treatment option for Lymphedema HERE.
- Read about the principal functions of Manual Lymphatic Drainage HERE.
- Read about the differences between the two principal lymphedema treatment protocols HERE.
- Read about the strategies for the implementation of low-cost treatment options for Lymphedema HERE.
REFERENCES
(Click on the texts to read the research articles)
SCIENTIFIC SOCIETIES
PATHOPHYSIOLOGY
- lymphedema.
- Biology of Lymphedema
- Lymph vessels: the forgotten second circulation in health and disease
- Lymphatic Vessel Network Structure and Physiology
- Lymphatic System Flows
- Organ-specific lymphatic vasculature: From development to pathophysiology.
- The lymphatic vascular system: much more than just a sewer.
- The unresolved pathophysiology of lymphedema.
- Lymphedema: A Practical Approach and Clinical Update.
- Coagulation in Lymphatic System.
- Regulation of immune function by the lymphatic system in lymphedema.
- Oxidative stress in chronic lymphoedema.
- Regulatory T Cells Mediate Local Immunosuppression in Lymphedema.
- Hemostatic properties of the lymph: relationships with occlusion and thrombosis.
- Secondary lymphedema: Pathogenesis
- Gastrointestinal Lymphatics in Health and Disease
- Intestinal lymphangiectasia in adults
- Role of the lymphatic vasculature in cardiovascular medicine
- The lymphatic vasculature in disease
- Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema.
- The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review
- Peripheral Edema
CUTANEOUS COMPLICATIONS
- The lymphatic system and the skin. Classification, clinical aspects, and histology.
- Lymphedema and cutaneous diseases.
- Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.
- Serum Immune Proteins in Limb Lymphedema Reflecting Tissue Processes Caused by Lymph Stasis and Chronic Dermato-lymphangio-adenitis (Cellulitis).
INFECTIOUS COMPLICATIONS
- Lymphatic Flow: A Potential Target in Sepsis.
- Infectious complications of lymphedema.
- Acute inflammatory exacerbations in lymphoedema.
- Inflammatory Manifestations of lymphedema.
CELLULITIS / DERMATOLYMPHANGIOADENITIS
- Cellulitis.
- Clinical features, microbiological epidemiology, and recommendations for the management of cellulitis in extremity lymphedema.
- Challenges of cellulitis in a lymphedematous extremity.
- Diagnosis and management of cellulitis.
- Cellulitis risk factors for patients with primary or secondary lymphedema.
- Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg.
- Prevention of dermatolymphangioadenitis by combined physiotherapy.
- Erysipelas: a common potentially dangerous infection.
TUMOURS
- Malignant tumors as complications of lymphedema.
- Lymphedematous areas: Privileged sites for tumors, infections, and immune disorders.
- Lymphedema-related angiogenic tumors and other malignancies.
- Lymphedema: an immunologically vulnerable site for the development of neoplasms.
- Lymph stasis promotes tumor growth
- A retrospective analysis of Stewart-Treves syndrome in the context of chronic lymphedema.
- Stewart-Treves Syndrome
PAIN
- Congenital lymphedema complicated by pain and psychological distress: case report
- Lymphatic Pain in Breast Cancer Survivors
- Does Manual Lymphatic Drainage Have Any Effect on Pain Threshold and Tolerance of Different Body Parts?
- Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer
- Quality of life in patients with primary and secondary lymphedema in the community
TREATMENT
- Treatment of limbs lymphedema.
- Nonoperative treatment of lymphedema.
- Lymphedema: From diagnosis to treatment.
- Lymphedema-clinical picture and therapy.
- Physiotherapeutic rehabilitation of lymphedema: state-of-the-art.
- Diagnosis and management of lymphatic vascular disease
- Effective treatment of lymphedema of the extremities.
- Lymphoscintigraphic aspects of the effects of manual lymphatic drainage.
- Intensive Treatment of Lower-Limb Lymphedema and Variations in Volume.
- Effectiveness and safety of Complete Decongestive Therapy of Phase I.
- Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities.
- Effects of Phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer-related lymph edema.
- Does lymphoedema bandaging reduce the risk of toe ulceration?
- Study of 700 referrals to a Lymphedema Program.
- Worldwide assessment of healthcare personnel dealing with lymphoedema.
- Földi M, Földi E. Földi’s textbook of lymphology for physicians and Lymphoedema therapists.
- Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients
- Visualization of Accessory Lymphatic Pathways, before and after Manual Drainage, in Secondary Upper Limb Lymphedema Using Indocyanine Green Lymphography
- The risk of genital edema after external pump compression for lower limb lymphedema.
- The management of genital lymphoedema
- The management of deep vein thrombosis in lymphoedema: a review.
- Lymphedema-associated comorbidities and treatment gap.
COMPRESSION GARMENTS
- A study of the advantages of elastic stockings for leg lymphedema.
- Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement.
- Medical compression stockings for chronic venous diseases and lymphedema: Scientific evidence and results of a patient survey on quality of care.
- Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic edema: a randomized controlled trial protocol.
- Compression Therapy Is Cost-Saving in the Prevention of Lower Limb Recurrent Cellulitis in Patients with Chronic Edema.
- Occupational leg edema-use of compression stockings.
DISABILITY
- Disability and lymphedema.
- Lymphedema and employability.
- Worse and worse off: the impact of lymphedema on work and career after breast cancer
- Functioning in lymphedema from the patient's perspective using the International Classification of Functioning, Disability and Health (ICF).
- Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors
- Postural Stability in Patients with Lower Limb Lymphedema
- Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema
DISFIGUREMENT
- Adjusting to disfigurement: processes involved in dealing with being visibly different
- Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments
- Quality-of-life and body image impairments in patients with lymphedema
- Association of lower extremity lymphedema with pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancers
QUALITY OF LIFE
- The impact of lower limb chronic oedema on patients' quality of life
- Quality of life in patients with primary and secondary lymphedema in the community
- Evaluating the effect of upper-body morbidity on quality of life following breast cancer treatment.
- Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study
- The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema
PSYCHOSOCIAL IMPACT
- Psychosocial Impact of Lymphedema.
- Associations between chronic disease, age and physical and mental health status
- A network analysis of psychological flexibility, coping, and stigma in dermatology patients
- 'Abandoned by medicine'? A qualitative study of women's experiences with lymphoedema secondary to cancer, and the implications for care
- People are neglected, not diseases.
- Chronic edema/lymphoedema: under-recognized and under‐treated.
- Lymphatic Medicine: Paradoxically and unnecessarily ignored.
- Medical education: a deficiency or a disgrace.
PEDIATRIC LYMPHEDEMA
- NORD: Rare Disease Database - Lymphedema
- Medical management of lymphedema.
- Primary lymphedema in childhood.
- An approach to familiar lymphedema
- Pediatric Children Lymphedema
- Primary Lymphedema French National Diagnosis and Care Protocol (PNDS).
- Lymphatic filariasis: an infection of childhood.
- Lymphatic filariasis in children: clinical features, infection burdens and future prospects for elimination.
LYMPHATIC FILARIASIS / PODOCONIOSIS
- Podoconiosis: Clinical spectrum and microscopic presentations.
- Podoconiosis: A Possible Cause of Lymphedema in Micronesia.
- A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis, and leprosy.
- The impact of acute adenolymphangitis in podoconiosis on caregivers.
- Neglected tropical diseases and disability-what is the link?
- Locomotor disability in bancroftian filarial lymphoedema patients.
- Neglected patients with a neglected disease?
- Neglected tropical diseases and mental health: a perspective on comorbidity.
- People are neglected, not diseases.
- Addressing Inequity: Neglected Tropical Diseases and Human Rights.
- Neglected Tropical Diseases, Conflict, and the Right To Health.
BLOOD VASCULAR SYSTEM
- Peripheral Edema
- Phlebolymphedema
- Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management
- Role of the lymphatic vasculature in cardiovascular medicine
- Communication between lymphatic and venous systems
- Phlebopathies and occupation
- Phlebopathies and workers
- Evidence of health risks associated with prolonged standing at work and intervention effectiveness
- Leg edema formation and venous blood flow velocity during a simulated long-haul flight
Articles that may also interest you:
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WHAT KIND OF DOCTOR TREATS LYMPHEDEMA/LYMPHOEDEMA - WHICH MEDICAL SPECIALITIES ARE RELATED TO LYMPHEDEMA?
WHAT IS THE BEST TREATMENT OPTION FOR PAEDIATRIC AND PRIMARY LYMPHOEDEMA?
WHAT ARE THE PRINCIPAL FUNCTIONS OF MANUAL LYMPHATIC DRAINAGE
WHAT ARE THE MAIN DIFFERENCES BETWEEN THE TWO PRINCIPAL LYMPHEDEMA TREATMENT PROTOCOLS
WHAT ARE THE STRATEGIES FOR THE IMPLEMENTATION OF LOW-COST TREATMENT OPTIONS FOR LYMPHEDEMA
WHY IS A BUTTERFLY THE SYMBOL OF LYMPHEDEMA?
WHAT DOES INTERMITTENT PNEUMATIC COMPRESSION PUMP THERAPY (IPC) DO, AND DOES NOT DO FOR LYMPHEDEMA?
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