Manage Your Lymphedema

As a side effect of breast cancer treatment, many women develop lymphedema in the arm and upper body.

Lymphedema is a result of change to the lymphatic system, often with lymph node removal during surgery or radiation to the area. The main function of the lymphatic system is to move excess fluid and protein from the extremities and return it to the vascular system. With the disruption to the lymphatic system, the body is not able to properly move fluid, waste material and proteins out of the arm. This fluid accumulation results in swelling of the arm and trunk.

The main complaints women express are: heaviness in the arm, tightness in the skin, limited flexibility of the arm, sensitivity to touch, change in sensation, skin changes, and limited functional use of the hand and arm.

There are strategies you can take in your cancer treatment and recovery to reduce your severity of lymphedema and improve the normal use of your arm.

Daily self-massage: Your arm hangs down for most of the day, which means it is subject to the effects of gravity. Over the course of the day, fluid can accumulate in your hands and lower arm, as gravity pulls fluid down (and the lymphatic system is not working properly to bring it back up to circulate). Therefore, you should practice self-massage to assist the fluid return to the circulatory system.

To perform this technique, you will lightly stroke the surface of your skin, with the pressure you would use to pet a cat (too much pressure will make the lymphedema worse). Start at your chest and lightly stroke toward your midline. Then move from your armpit through your chest to your midline. Next, stroke your upper arm, to your armpit, chest and midline. Then, stroke your lower arm, to your upper arm, armpit, chest, and midline. Finally, stroke your hand, to your lower arm, upper arm, armpit, chest, and to your midline.

It is important to follow this pattern. Your stroking pattern is meant to clear away upper arm fluid and make room for the rest of the fluid you will move from your lower arm. Your lymphatic system is made of one way valves, moving fluid toward your heart. This pattern guides the fluid through the normal path of clearance through an intact lymphatic system. Your self-massage will only take approximately 10 minutes to perform.

Use your arm functionally: It may be tempting to avoid using an arm that is affected with lymphedema. However, it is important to keep using your arm as you normally would. Using your arm regularly will keep normal range of motion in your shoulder and elbow joints. In addition, using your arm normally will activate a muscle pump phenomenon. Despite the poorly functioning lymphatic system, you can actively move fluid from your arm by contracting the muscles of your arms. The muscle contraction pushes fluid in a similar way that your lymphatic system would. Therefore, normal use of your arm (reaching, opening doors, fixing your hair, doing dishes etc.) will keep your swelling down.

Monitor arm girth and skin condition: One of the most important things you should do is monitor the condition of your arm, including the size of the arm and the skin’s appearance. If you notice the arm is getting bigger over the course of several days, it may be necessary to contact your physician. You may need to participate in manual lymphatic drainage. Inspect your skin daily to be sure it is intact and free from discoloration, wounds, or insect bites. Limbs affected with lymphedema are at higher risk for infection or cellulitis. If you notice a significant change, contact your physician.

Exercise and maintain a healthy weight: One strategy to reduce your likelihood of developing lymphedema is to maintain a healthy body weight. You should exercise regularly and eat a healthy diet. In a well-designed research study following 138 breast cancer patients for 30 months, researchers found that the risk of developing lymphedema was 3.6 times higher for women with BMIs (body mass index) of 30 or higher (Ridner et al). A normal, healthy BMI range is 18.5-24.9. Therefore, strive to maintain a healthy body weight with regular exercise and a nutritious diet.

Utilize a lymphedema sleeve: Lymphedema sleeves are garments that provide gentle, sustained pressure over the entire length of your arm and hand. The sleeve prevents excess fluid accumulation. Many women benefit from wearing a lymphedema sleeve daily, while others only wear the sleeve when they are going to be exposed to changes in air pressure, such as during air travel.

If you are concerned about your lymphedema, speak with your oncologist or certified lymphedema therapist. Utilize these strategies and take a proactive approach to managing your lymphedema.

http://www.curetoday.com/publications/cure/2014/fall2014/Early-Detection-is-Key

Ridner SH, Dietrich MS, Stewart BR, et al.: Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer 19 (6): 853-7, 2011.