Lymphedema

September 19, 2014

A cancer diagnosis can be extremely difficult to deal with physically and mentally.  New medical advances are enabling more people to fight this disease successfully. But there are still side effects of the surgery and treatments even though there has been much advancement.  One of the side effects from cancer can be lymphedema.

 

The circulatory system is made up of arteries and veins and the lymphatic system.  The lymphatic system relies on movement of muscles to circulate the lymph fluid throughout the body.  Our blood-circulatory system uses the heart to move fluid around.  You can think of the lymphatic system as a road system.  When one or more roads are blocked due to lymph node removal, the system does not flow smoothly.  The “traffic congestion” can cause swelling.  This protein rich fluid collects when the lymphatic system can not pump it back to the heart.

 

Lymphedema is swelling (edema) of a body part and is a disorder of the lymphatic system. Too much lymph fluid can accumulate in an area of the body that has been damaged. When lymph nodes are removed or radiated there can be damage to the lymphatic system.  Lymph movement or drainage can change causing swelling. Fibrosis of the axilla due to surgery or radiation can cause lymphatic obstruction.  Symptoms include a feeling of tightness, leathery skin texture, and heaviness.

 

The more lymph nodes removed the greater the chance of developing lymphedema. Even if you have had a few lymph nodes removed, you should still understand the lymphedema precautions.  For example, if you had a sentinel node biopsy your risk is 5 -7%.  It is important to monitor for lymphedema since it is always easier to treat it when caught early.  It can happen right after surgery or years afterwards.

 

One of the most important things that you can do to decrease your risk of lymphedema is to keep your weight at a good level.  The individuals whom I have worked with who had lymphedema, typically see a marked reduction of swelling  in conjunction with weight loss. Proper nutritional is important and decrease salt.

 

Exercise is very important for lymphedema control. It is important to perform range of motion stretches and techniques to improve venous drainage. Start by elevating the affected area above heart level. Strength training is not only safe- it might help. You must proceed slowly under the guidance of a physical therapist or cancer exercise specialist. It is important to learn the right exercises for your particular situation, and how to do them properly and with good form.

 

Dr. Schmitz, as a follow up from her 2009 study, stresses the importance of starting slowly and using proper form with a well trained certified professional. Her study demonstrates the importance of exercise after cancer and doing it safely with slow progressive improvement in order to decrease risk of lymphedema. Begin resistance exercise as soon as you receive medical clearance.  More information on exercise and lymphedema can be found in the next installment.

 

A compression garment or sleeve, which supports the muscle and helps bring the lymphatic fluid to the heart, can be worn while exercising and at other times. Get advice from a lymphedema specialist as to when you need to wear a sleeve.

 

There are things that one should do to decrease the chance of developing lymphedema.  Try to avoid extreme temperatures, avoiding sunburns.  Also there should be nothing on your body that is too tight, which can restrict lymph circulation.  Examples of this would be taking blood pressure on the affected arm, carrying a heavy bag on your arm, or wearing tight clothing and jewelry.

 

Check regularly for infections and call your doctor immediately if this occurs. Insect stings, scratches, skin punctures, and bites can cause infections. Wash the affected area frequently and avoid cracks in the skin through moisturizing.  Your lymphedema specialist can recommend more precautions.

 

A goal of understanding lymphedema is to prevent it from developing into a bigger problem. There are 3 classifications.  In stage 1 there is pitting which may be reduced with arm elevation.  In stage 2 it does not reverse and fibrosis occurs and  Stage 3 is elephantiasis in very extreme cases. Your lymphedema specialist will teach you Complex Decongestive Therapy consisting of skin care, manual lymph drainage, and exercise.  If you meet with your lymphedema specialist at the first signs of swelling, pitting, redness, heaviness, etc. lymphedema can be kept under control.

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