Dolores Steinwall, the president of the Lymphedema Association of Ontario (LAO), introduced the webinar about lymphedema. Ann DiMenna, a physiotherapist and director of LAO, then discussed the lymphatic system, signs and risks of lymphedema, and treatment methods like manual lymph drainage, compression therapy, and exercise. Over 400,000 Canadians are affected by lymphedema resulting from cancer treatment, injuries, or other causes. The LAO aims to support those living with lymphedema and raise awareness.

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Let’s Talk Lymphedema
Presented by:
Lymphedema Association of Ontario
Dolores Steinwall – President
Ann DiMenna – Director
March 4th, 2021, 1:00pm EST

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Dolores Steinwall - President, LAO
Dolores had a long and successful career with Bell Canada and was a Senior Project
Manager, PMP at the time of her retirement. In August 2014 she was diagnosed with stage 3
cancer in her breast and lymph nodes. Although she is now cancer-free, she has
lymphedema in her right arm and side. She is very passionate about helping others with this
condition. Since 2015 she has been a volunteer on the Sunnybrook Patient Family Advisory
Council, and in 2016 she began to volunteer at Wellspring. While doing this work, she has
raised awareness and advocated and raised funds on behalf of patients.
Dolores joined the LAO as a Director in April 2019, and was appointed president in August
2019.

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INTRODUCTION TO THE
LYMPHEDEMA ASSOCIATION OF ONTARIO
Our Mission & History
We are committed to improving the lives of people living
with lymphedema.
We are a not for profit Charity incorporated in Ontario in
1997 to help the community of Lymphedema sufferers in
this Province.

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OBJECTIVE
● SHARE INFORMATION ABOUT THE LAO
● SHARE INFORMATION ON HOW TO ACCESS HELP AND
SUPPORT
● SHARE THE PREVALENCE OF LYMPHEDEMA FOR
CANADIANS AND ONTARIO - Stats & Data on Lymphedema
● SHARE INFORMATION ON HOW YOU CAN HELP SUPPORT
THE LAO IN OUR ADVOCACY EFFORTS
● OVERVIEW FROM A HEALTHCARE PROFESSIONAL

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WHAT WE OFFER
● A directory of qualified Lymphedema Therapists in
Ontario
● A help line for anyone with Lymphedema concerns
to contact us
● Information and resources for patients and their
loved ones

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BENEFITS OF JOINING THE LAO
● New Professionals Directory & Resource Guide for
2021
● Webinars for Patients & Professionals
● Virtual support groups
● Interactive fundraiser events
● Pathways Magazine
● Quarterly E-newsletters, Information line, LE
Pamphlet and Patient card
● Cost $30 annually for Patients

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Impact on Ontarians - 400,000 (*2015-2016)
● Cancer related 31% 120,565
● Primary Lymphedema 2% 7,778
● Surgeries (non-cancer) 4% 15,557
● Disabilities/chair bound 8% 31,114
● Obesity related 57% 221,684

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Infoline 2018 Demographics:

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Infoline 2018 Demographics:

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Infoline 2019 Demographics:

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Infoline 2019 Demographics:

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Help us help you!
Volunteer
Become a member
Donate

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Ann DiMenna - Director, LAO
Ann is currently the Clinic Director and owner of Markham Lymphatic Centre, a
multidisciplinary clinic located in Markham, Ontario. Ann brings expertise from
a wide variety of therapy settings, including hospital, home care and private practice
orthopedic settings. Ann is a graduate of the University of Waterloo, where
she received a degree in Biochemistry, as well as the University of Toronto, where she
received a degree in Physiotherapy. Ann has continued to add to her clinical expertise
with post-graduate training in orthopedic manual therapy, McKenzie back care techniques
and many other courses. In 2008, Ann completed post-graduate training in Combined
Decongestive Therapy and is fully certified to treat patients with lymphedema. She has
developed and taught post-graduate continuing education courses including a Head and
Neck training course. She is a sought-after public speaker for lymphedema associations,
hospital staff, patient education sessions, international conferences and Sunnybrook
Health Sciences Centre. One of Ann’s most recent accomplishments was writing the
book “The Complete Lymphedema Management and Nutrition Guide”, which is designed
to educate patients about self-management strategies.

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Ann DiMenna, PT
(CDT)
25 Royal Crest Court, Unit 101
Markham, Ontario L3R 9X4
Email: adimenna@markhamlymphaticcentre.com
Tel: 647-478-7455
www.markhamlymphaticcentre.com

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Objectives
⮚ To review the anatomy of the lymphatic system
⮚ To provide an overview of the functions of the lymphatic
system
⮚ To highlight the prevention and management of lymphedema

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Structural Elements of the Lymphatic System
▪Components:
▪Lymph nodes
▪Lymph vessels
▪Lymph fluid
▪Lymphoid tissues (thymus, spleen)
▪Lymph fluid is made up of protein and
water

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Functions of Lymphatic System
⮚ To clear debris and toxins
⮚ Circulation of cells that fight bacteria and viruses
⮚ Removal of waste material and proteins from around the outside of
the cells
⮚ Prevention of edema by moving excess water
⮚ Maintenance of the body’s inner balance

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Other facts about the Lymphatic System
⮚ Parallels the vascular system
⮚ The venous system is responsible for 90%
return of fluids and the lymphatic 10%
⮚ The lymph moves via contractions of the
walls of the lymph vessels, and muscular
contractions, deep breathing
⮚ The system is compromised with surgery,
axillary node dissection, sentinel node
dissection, radiation, obesity
Harris et al, 2004

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What is Lymphedema?
▪ Swelling of a body part due to abnormal accumulation of lymphatic
fluid which is fluid high in proteins
▪ Can be present in any area of the body including the arm, leg, chest,
abdomen, groin, head and neck
▪ The most important chronic complication after dissection of axillary
lymph nodes and has a tendency to progress
▪ Incidence rates reported from 23-38% within 2 years after surgery
with the >2cm circumference increase method
▪ Of the people who develop LE, 71% will develop it within 12 months
after surgery for breast cancer

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Incidence of Lymphedema in Cancer Patients
▪Overall incidence in cancer survivors: 15.5%
Treatment Incidence
Rate
Pelvic
dissections
22%
Radiation
therapy
31%
Malignancy Incidence
Rate
Melanoma 16%
Gynecologic 20%
Genitourinary 10%
Head/neck 4%
Sarcoma 30%

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Risk factors
❑Number of nodes removed
❑Extent of radiation
❑Radiation to the axilla or inguinal nodes
❑Postoperative wound infection
❑Postsurgical drainage time
❑Lack of mobility
❑Obesity

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www.mayoclinic.com/health/medical/IM03018

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Signs of Onset of
Lymphedema
▪ After abdominal surgery, a feeling of tenderness in
the groin or bloating in the abdomen
▪ Swelling in the thigh after removal or radiation to
inguinal or pelvic lymph nodes
▪ Infection (cellulitus or lymphangitis) of the affected
limb

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Signs of Onset of Lymphedema
▪ Feeling of heaviness, tightness, bursting sensation
▪ Increased size of the limb or puffiness in a particular
area
▪ Feeling of heat in the limb
▪ Shooting pains, pins and needles, aching
▪ Tightness of jewelry or clothing

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Signs of worsening
lymphedema
▪ Recurrent infection
▪ Compression garment that gets too tight
▪ Pins and needles in fingers or toes
▪ Numbness in any area of the limb
▪ Skin thickening or rough areas
▪ Skin discolouration or hard blister-like nodules
on the skin
▪ Lymphorhea - leaking through the skin starts
▪ Fibrosis or hardened areas under the skin
▪ Decreased mobility and function in the limb

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Combined Decongestive Therapy (CDT)
1) Skin care
2) Compression therapy
3) Manual lymph drainage
4) Exercise

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Skin Care
Follow the general risk reduction guidelines and take
care of your skin:
1. pH 4-6- lotions to keep the skin healthy and free of
cracks (non petroleum)
2. Dry skin well after washing especially between the
toes or in skin folds and creases

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Manual Lymphatic Drainage
▪What is it:
▪ Gentle skin stretch
▪ Stretch skin enough to maximize lymphatic fluid movement to
20-30 beats per minute
▪ Pressure is about as much pressure as you could safely pet a
cat with
▪ Helps remove protein from the tissue
▪How treatment is designed?
▪ Work alternate pathways
▪ starting at the top and work your way down the limb
▪ Surface vessels being used to carry fluid away from a congested
area

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Bandaging
▪ Can be used in the arm and leg
▪ Principles: snug (not tight, not restricting blood flow)
▪Grey foam/channel foam

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Bandaging
Bandaging

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Compression
▪ Sleeves and gloves
▪ Head and neck garments
▪ Stockings
▪ Velcro options
▪ Night wear
▪ Decision for what to prescribe to patients is based on:
▪ Degree and location of swelling, mobility /function, activities,
lifestyle

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Exercise: principle of creating a
muscle pump
▪ Walking vs Nordic Pole Walking
▪ Water exercises, swimming
▪ Postural exercises are important for helping
lymphatic flow
▪ Muscle imbalance require exercises to correct
them and will help improve lymphatic flow

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Available Now…LAO2020