Wound specialists, plastic surgeons and vascular surgeons often have expertise in diagnosis and management
DEAR DR. ROACH: I have lymphedema, which isn’t curable. I use a compression device on a daily basis, and it does help. I take nifedipine and lisinopril for my blood pressure. I am 70 years old and did not have lymphedema until two years ago. Are there any recommendations for this problem? — F.S. ANSWER: Lymphedema is swelling (“-edema”) caused by improper working of the lymphatics (“lymph-”). In many people, lymphedema happens after a medical or surgical problem, such as arm edema after diagnosis/treatment of breast cancer. However, lymphedema can come on for unknown reasons. It may happen in both men and women, in either the upper or lower extremities. Lymphedema can be misdiagnosed. Chronic venous insufficiency, swelling in a limb after a blood clot, and lipedema (a disease of abnormal fat deposition) can all be misdiagnosed as lymphedema. However, it’s also common that the diagnosis can be delayed for years. Wound specialists, plastic surgeons and vascular surgeons often have expertise in diagnosis and management of lymphedema. The diagnosis is usually made by a careful history and physical exam, but sometimes advanced imaging studies are performed to be sure of the diagnosis. Initial treatment for mild lymphedema includes frequent elevation…