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Activities for Daily Living
Activities for Daily Living or ADL's are lessons provided to you from HOPE to help you with the outcome of your treatment and make living with Lymphedema easier for you.

Lesson 1

Physiology of the Healthy Lymphatic System
Our blood carries oxygen and nutrients to all the cells of the body. Our cells use oxygen and nutrients the same way we use food and oxygen - to create energy in order to perform our daily functions. And like our own digestive system, each cell produces cellular waste material, 90% of which is removed by the venous system. The remaining 10% of cellular waste materials are removed by the lymphatic system. This 10% contains protein particles that are too large to fit through the capillary walls of the venous system. Every inch of skin contains many lymphatic vessels. These vessels absorb the proteins and fluids that surround them. Lymphatic vessels drain into larger lymphatic vessels, which drain into even larger lymphatic vessels. The larger lymphatic vessels work by means of a system of one-way valves, similar to venous system. Eventually, all lymphatic fluid passes through lymph nodes. Lymph nodes are pea-sized chambers lined with white blood cells. These white blood cells clean the lymphatic fluid of invaders like bacteria and viruses by phagocitizing or "eating" them. This is why, when we have an infection, the lymph nodes that drain the infected area usually feel swollen and sore. They are working overtime! The lymph nodes also break down proteins for easier elimination by the kidneys. Lymph nodes are generally located in joint areas because movement of the joints helps to pump fluid through the lymphatic system. All lymphatic fluid eventually travels to the area at the base of the neck, just above the collar bone. At this point, the fluid enters the venous system, gets carried to the kidneys and washed away with the urine.

Pathophysiology of the Compromised Lymphatic System
The lymphatic system can be compromised by a variety of things, including surgery and trauma and circulatory problems. The removal or radiation of lymph nodes or chemotherapy as a part of treatment for cancer can also damage lymph vessels or nodes. Sometimes people are born with fewer or malfunctioning lymph vessels or nodes. The lymphatic system can be compromised by anything that normally causes swelling, such as an injury, surgery, infection or insect bites. When swelling occurs the compromised lymphatic system cannot drain away all the fluid. When fluid stays in the affected limb for an extended length of time the one-way valves in the larger lymphatic vessels can fail or become "incompetent." When these one-way valves fail, gravity tends to pull the fluid down to the lowest part of the limb. An accumulation of fluid in the tissues is called edema. When edema is present for long periods of time, the edematous limb or body part is vulnerable to infection or ulcers. Sometimes lymphatic fluid leaks or weeps from the skin. Pooling of fluid in the tissue for an extended length of time creates hardened areas known as fibrosis, that increase the risk of infection.

Fibrotic Tissue Lymphatic fluid is full of large protein particles. When fluid accumulates and stays in the tissues for any length of time, these protein particles cause the affected area to become hard or fibrotic. Manual lymph drainage (MLD) can help to break up fibrotic tissue, which allows it to be carried away by the lymphatics. This process is most successful on fibrosis that is relatively new. If it has been present for years, the success will be limited. Your therapist may use pads made of small pieces of firm foam in your bandaging to help break up fibrosis.

Healthy lymphatic pathways are the routes that the lymphatic system uses to move fluid towards its intersection with the venous system. A typical pathway may start with the tiny lymphatic vessels close to the surface of the skin (perhaps in the hand or foot) moving towards larger lymphatic vessels (up the arm or leg) to the lymph nodes near the joint (the armpit or groin) and from the lymph nodes to the junction with the venous system. Your therapist will explain to you, which of your pathways are nonfunctional, and the routes to be created by performing manual lymphatic drainage (MLD).

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HOPE Lymphedema Treatment Center | 134C Eldridge Road | Sugar Land, TX 77478