Your lymphoedema practitioner or another health professional will ask about your medical history and assess the level of swelling and any pitting, thickening or damage to the skin. The size of the affected limb will be compared to the other limb, and any differences assessed.
This is done in different ways:
- using a tape measure to measure circumference
- using an electric charge (bioimpedance spectroscopy) to calculate the amount of fluid
- taking photos of more difficult to measure areas, such as the head, neck, trunk and genitals
- using a doppler ultrasound to rule out a blood clot (deep vein thrombosis)
- less commonly, using magnetic resonance imaging (MRI), computed tomography (CT) or an ultrasound to show extra fluid in tissues or tissue changes
- using infra-red imaging to show differences in skin temperature, which may be a sign of infection or the lymphatic system not working well.
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There are several staging systems used to describe lymphoedema, and the system most commonly used in Australia was developed by the International Society of Lymphology (ISL). It divides lymphoedema into mild, moderate and severe – from no swelling to gentle pressure leaving an indent on the skin (known as pitting). In the severe stage, the skin becomes hard and more fatty.
It is important for all stages of lymphoedema to receive ongoing treatment and care.
Lymphoedema usually requires care from a range of health professionals including a lymphoedema practitioner, your GP, podiatrist and dietitian.
Lymphoedema practitioners – may be an occupational therapist, physiotherapist or nurse with specialist training in treating and managing lymphoedema. A lymphoedema practitioner assesses people with lymphoedema, develops treatment plans, prescribes compression garments, and provides ongoing treatment and care. They may work as part of a lymphoedema service in a public or private hospital or in private practice.
Doctors – your GP, oncologist or surgeon may diagnose the condition, coordinate your medical treatment and refer you to a trained lymphoedema practitioner. Your GP will work with you to develop a treatment plan to manage cellulitis.
The Australasian Lymphology Association maintains an online national register of trained lymphoedema practitioners. Visit the website and click on “Find a Practitioner” to search the register for a practitioner near you.
Some public and private hospitals may assess and treat lymphoedema through physiotherapy or occupational therapy departments.
Anya Traill, Head, Occupational Therapy and Physiotherapy, Peter MacCallum Cancer Centre, VIC; Dawn Bedwell, 13 11 20 Consultant, Cancer Council QLD; Gillian Buckley, Senior Physiotherapist – Lymphoedema, Peter MacCallum Cancer Centre, VIC; Asha Heydon-White, Senior Physiotherapist and Lymphoedema Therapist, MQ Health Lymphoedema Clinic, ALERT – Australian Lymphoedema Education Research and Treatment, Macquarie University, NSW; Prof Sharon Kilbreath, Deputy Dean, Academic, Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, NSW; Pamela Lamont, Consumer; Prof Neil Piller, Vice Chair, International Lymphoedema Framework, Director, Lymphoedema Clinical Research Unit, Patron, Lymphoedema Support Group SA; Hildegard Reul-Hirche, Physiotherapist, QLD.
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