Tuesday, 7 March 2017

My leg keeps getting bigger and bigger...what is happening?!?! (By Stephann Adrien)



       
    Marinette was a young adult who just finished her nursing degree at the local college. At 19 years old, she worked as a nurse at the hospital and was often on her feet for long periods of time. After a few months of working, Marinette noticed that her left calf appeared to be swollen and there was reduced flexibility in her joints. She spoke to her fellow co-workers about her symptoms but they assured her that there was nothing to worry about as they too sometimes had swollen feet after working long hours. Sometime later, Marinette noticed that she could no longer fit into her jeans as her left leg had become extremely swollen and very difficult for her to move normally.   Worried that this may be a serious condition, Marinette set up an appointment with a vascular physician who performed a CT scan followed by an ultrasound of her leg. The specialist ruled out a vascular cause for swelling but suspected she had lymphedema and referred her to a lymphedema specialist.  Marinette was then diagnosed with a form of primary lymphedema known as Lymphedema Praecox.
            Lymphedema is swelling in one or more extremities resulting from impaired flow of the lymphatic system. It most commonly affects a single arm or leg but there are situations where both limbs can be affected. Lymphedema is also most commonly found in females rather than males. Primary lymphedema is caused by an abnormality in a person’s lymphatic system at birth but nay not be recognized until later in life. Congenital lymphedema is evident at birth, and Meige disease becomes evident after the age of 35. The most common form of primary lymphedema is lymphedema praecox and most often develops during puberty. There is also secondary lymphedema which occurs when a normally functioning lymphatic system is blocked or damaged. The leading causes of this are cancer treatments, surgical procedures and filariasis (infection of the lymph nodes by the parasite Wuchereria bancrofti).
            The symptoms of lymphedema include swelling of the arms or legs noticed when there is difficulty fitting into clothes and jewellery, fatigue due to added weight, redness and itching, aches and pain and restriction of daily activities. Long-term effects include inflammation of tissues, taut swelling, decreased mobility/flexibility and cracked overlying skin. The immune system is also supressed in the areas affected by lymphedema resulting in frequent infections. Lymphedema is diagnosed by using CT/MRI scans, Doppler ultrasound scans and lymphoscintigraphy to identify abnormalities such as tumours, blood clots in the veins or blockages in the lymph vessels.
            Lymphedema has no cure but there are treatments that can help relive swelling and discomfort. Compression treatments help in reducing swelling as well as light exercised to help
stimulate the arm or leg muscles. Patients may also drain the lymph fluid and have lymph node replacement surgery to help decrease the progression of lymphedema.
            Marinette still works as a nurse, however she spends less time on her feet and often times wears elastic stocking and bandages to help relieve the swelling. She also has to be careful in avoiding cuts and infections as they can enter her bloodstream. Using the compression treatments and having manual drainage of the lymph fluid, Marinette is able to live comfortably without any serious pain and is able to continue with her job with little difficulty.



1 comment:

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    About two years ago, when I was 56, I started feeling foggy and had occasional memory lapses. My wife, Mary, started to notice it, too, but I also have hearing issues so she thought that was the problem. My memory worsened very gradually over the years, and we lived with it, compensating as needed. I became less social. After some months thereafter, it got to the point where we couldn’t keep making excuses or ignoring it. I had gone from doing our grocery shopping without a list to going with a list, to having the list but not buying what was on it.

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