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NEW HORIZONS PHYSICAL THERAPY
11622 El Camino Real, Suite 100
San Diego, CA 92130
Phone | 858.764.2409
Fax | 858.764.2410
Email | info@newhorizonspt.com

Lymphedema Services
Tammy E. Mondry, DPT, MSRS, CLT-LANA
Doctor of Physical Therapy
Master of Science in Rehabilitation Sciences
LANA Certified Lymphedema Therapist
Certified Cancer Exercise Specialist
Phone | 858.764.2409 ext. 1057
Email | tammy@newhorizonspt.com

It is estimated that between three and five million patients suffer from Lymphedema in the United States. The most common cause of Lymphedema is the impaired or disrupted flow of lymph fluid by the draining lymphatic vessels and lymph nodes, usually the consequence of surgery and/or radiation therapy. Without appropriate and timely intervention, Lymphedema can lead to progressive swelling, fibrosis (thickening) of the soft tissues, neurologic changes such as pain or paresthesias (sensation of numbness or tingling), and infection.

Because patients who undergo surgery and / or radiation therapy are at a higher risk of developing Lymphedema, patients should be monitored both pre-surgery as well as post-surgery to identify the signs and symptoms of Lymphedema at it's earliest stages. We recommend that patients at risk for Lymphedema be evaluated every three months for the first two years post-cancer treatment, and then every six months for a lifetime. Research has proven that patients that have early dectection of lymphedema have the greatest benefit from intervention. With early intervention, complications of Lymphedema can be minimized significantly, and the duration of formal lymphedema treatment is also significantly reduced.

There are two classifications of Lymphedema: Primary and Secondary. Primary Lymphedema develops as a consequence of a pathologic congenital and/or hereditary etiology. Meaning, patients are born with this condition. Significantly more common is Secondary Lymphedema, caused by mechanical insufficiency due to surgery, radiation therapy, trauma, infection, tumor blockage, chronic venous insufficiency, immobility, or tourniquet effects. In the United States, the most common cause of Secondary Lymphedema is due to breast cancer treatment intervention, especially axillary (armpit) surgery and radiation therapy of the breast and axillary tissue.

Lymphedema is NOT considered to be a curable condition due to the permanent damage to, or absence of, various lymphatic system components that bring about the condition. Once a patient has developed Lymphedema, they begin a life-long diligence to avoid exacerbations and manage their condition as best as possible.

The risk of developing Lymphedema is life-long once exposed to the common causes such as surgery and radiation therapy. Therefore, the onset of Lymphedema may be immediate, at the time of the initiation of cancer treatment, or it may be delayed for several decades. It is for this reason that girth and volume assessment are recommended every six months for all at-risk patients in order to identify Lymphedema at its earliest onset.

Providing the opportunity to assess limb girth and volume on a consistent, scheduled basis is critically important for the appropriate management of lymphedema. At New Horizons Physical Therapy, we can provide a precise assessment of the smallest edema changes using our Perometer®. The Perometer® is the most technologically advanced method for assessing lymphedema in an extremity, and it is only available at New Horizons Physical Therapy within all of San Diego County.

All clinical efforts should be made to prevent the onset of Lymphedema. This can occur by performing pre-operative evaluations and assessments of limb girth and volume prior to the initiation of any cancer treatment. As noted above, frequently scheduled limb volume assessments can provide a baseline for future comparison to identify the presence of any edema in the affected limb. Formal lymphedema treatment can be initiated at the earliest onset of edema, which has been proven to reduce the duration of treatment. In addition, prevention education can also occur for all patients who are to receive the high-risk treatments of surgery and radiation therapy. Education should include review of arm or leg care guidelines as well as review of other risk factors to consider.