Lymphedema After Breast Cancer

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Lymphedema is a condition that affects up to 10 million people in the United States.  Sometimes people are born with not enough lymph vessels or lymph nodes.  They will develop lymphedema later in life (usually noticed during ages 7 to 15 and becomes a larger problem by mi-20’s).  By far, most cases of lymphedema are developed because of injury to the lymph system.  This is common after cancer treatment.  It is important to understand that many times the cancer itself does not cause the lymphedema, but rather the TREATMENT for it.

  • Surgery
    • Many times cancer will be treated with surgery.  During surgery, the doctor will remove anything that is affected by cancer – including lymph nodes. When the lymph nodes are gone, they cannot drain the lymph from this area.  (This theory should not be difficult to understand)
  • Radiation
    • Radiation kills cancer, but it also kills everything else as well.  During radiation treatment, the lymph nodes in the immediate area are often radiated and no longer work.  When they are no longer working, they are unable to drain the lymph from the area.

Obviously these techniques are needed to prevent the cancer from spreading or re-occurding.  That is always the first goal.  The side effect of this is that lymph nodes will no longer drain lymph from these areas.

The areas of your body will the most lymph nodes are:

  • Abdomen
  • Neck
  • Armpit/Groin

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During breast cancer, surgery and/or radiation is often required to fully remove cancer from the area.  Often lymph nodes in the armpit are removed due to surgery or damaged due to radiation.  Lymph nodes of the armpit drain lymph and excess items from the arm.  When the lymph nodes are no longer working, fluid builds up in the arm.

 

The process of fluid build up in the arm may be fast or slowly accumulating, depending on how many lymph nodes were affected.  Some people notice excess fluid in a matter of weeks.  Others notice it in years.  Sme never develop lymphedema.  The important thing is to be aware of the signs of lymphedema and get treatment AS SOON AS POSSIBLE!

Let’s Talk About Lymph Fluid:

This fluid is water as well as other “gunk” that your body needs to get rid of.  Since there are more items in this fluid than water, lymphedema is different than other edema.  It is much thicker and more dense than regular swelling.  We call this “fibrous” or “high protein” fluid.

Signs of Lymphedema:

  • Swelling that occurs in the arm/leg on the side of cancer
  • Dull achy pain occur, worse at the end of the day
  • Swelling is first noticed, but improves with elevation
  • You have difficulty fitting into your clothes
  • You notice changes in your skin (discoloration, skin folds, excessive peeling, breaks/cracks in the skin)

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How Can Therapy Improve Lymphedema

Successful Treatment of Lymphedema Includes 4 Phases:

  1. Skin Care
    • The skin over your treated arm as in Breast cancer) is much more sensitive than your other skin.  It is VERY important to take good care of it!
      • Was with non-scented, non-colored soap
      • Keep moist with non-scented, non-colored lotion
      • Keep out of the sun!  This skin will burn MUCH easier than your other skin
      • Be careful of cuts/scrapes!  This skin will get infected EASILY
        • Infection will spread faster
        • Infection will worsen quicker
        • Be sure to cover this area with antibiotic ointment and band-aid
        • If signs of infection occur, see your doctor IMMEDIATELY!
          • Redness
          • Heat
          • Swelling
          • Tender to touch
          • Draining yellow/green fluid
  2. Manual Lymph Drainage
    • This process is similar to massage and feels GREAT! (HOORAY!)
    • The lymph vessels are between your skin and muscles.  This will be a specialized kind of massage that is very light.
    • The MLD will stimulate the lymph vessels to remove more fluid rapidly
    • The fluid can be “re-routed” around missing/broken lymph nodes
      • I like to think of this as a traffic detour.  If you are on your way from Point A to Point B, the best route as they say is a straight line.  But when you head out to work on Monday morning, you find there is a traffic detour.  (UGH!)  So in order to get from Point A to Point B you have to go around in a big circle to avoid that construction site.  You will eventually get to Point B, but its just not the fastest route.
      • Your lymph system is much like this!  Your lymph vessels do not have valves like your arteries and veins do. The arteries or veins are designed for a one way flow.  There is no way to hcange this. This is good as you do not want blood flowing backwards and overloading the heart.  But the lymph vessels do not have valves.  This means the direction of their flow can be changed.  So when we bring that excess lymphedema out of your fingers, up your forearm and into your arm we find that there are missing lymph nodes in your armpit.  No Worries!  We can just re-route the flow to lymph nodes at are present and working!  So we route some of the fluid to your hip and some to your opposite armpit.  this way all of the fluid gets removed from your body.  It may take the long route, and may take a big longer to remove…but it will leave.
      • All the fluid ends up draining near your heart, through your belly and ends up in the toilet. So when you receive MLD, you know that it is working if you can’t stay out of the bathroom!
      • This whole process is very relaxing and works immediately!  (YAY!)  Many people lose a considerable amount of weight the next day (Double YAY!)
  3. Bandaging
    • In order to keep the gains we receive in therapy, you need to keep compression on your arm.  This will make sure the fluid continues to drain properly not only while receiving the MLD, but for a long time afterwards!  This is important to keep improving and not let the fluid creep back into your system.
    • Each visit you will be wrapped in bandages to keep the fluid out.  They are very similar to ACE wraps, only not quite as stretchy.
    • These are used as the size of your arm will likely change with each visit.  This way we can custom wrap your arm after each treatment!
    • When your limb has improved as much as possible, you will be measured for a custom sleeve.  This will be measured exactly for your and will be worn for the rest of your life.  Every day.
    • It is important to remember lymphedema is a LIFE LONG issue.  It can be managed, but NOT cured.
  4. Low-Level Exercise
    • Exercise stimulates your lymphatic system
    • Exercise will help to continue pupming the extra lymphedema out of your system
    • Lymphedema is very sensitive.  Only low level exercises, with little to no weights, are used.

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Following these steps will be the BEST way to manage your lymphedema.  Lymphedema is a LIFE LONG issue.  It cannot be cured, only managed.  Following these steps and being treated at FIRST SIGHT of these symptoms, will allow you to live a healthy normal life.  Be sure to contact a Certified Decongestive Physical Therapist for more information!

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Blogger: Dr. Sara S. Morrison, PT, DPT, Complete Decongestive Therapist (CDT)

 

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