Lymphedema Management
About lymphedema:
Lymphedema occurs when the lymph system is damaged or blocked. Fluid builds up in soft body tissues and causes swelling. It is a common problem that may be caused by cancer and cancer treatment. Post therapy, patients may have swelling in the upper limb. It may be perceived as increased girth of upper extremity, heaviness, skin changes in form of fine pitting at hair follicles etc.
Causes of lymphedema:
- Due to extensive axillary dissection→ disruption of lymphatics
- Heavy cancer cell budon blocks the lymph nodes and main lymphatic channels
- Radiation creates fibrosis and destruction of lymphatic pathways.
Precautions:
Keep skin and nails clean and cared for, to prevent infection.
Bacteria can enter the body through a cut, scratch, insect bite, or other skin injury. Fluid that is trapped in body tissues by lymphedema makes it easy for bacteria to grow and cause infection. Look for signs of infection, such as redness, pain, swelling, heat, fever, or red streaks below the surface of the skin. Call your doctor right away if any of these signs appear. Careful skin and nail care helps prevent infection:
- Use cream or lotion to keep the skin moist.
- Treat small cuts or breaks in the skin with an antibacterial ointment.
- Avoid needle sticks of any type into the limb (arm or leg) with lymphedema. This includes shots or blood tests.
- Use a thimble for sewing.
- Avoid testing bath or cooking water using the limb with lymphedema. There may be less feeling (touch, temperature, pain) in the affected arm or leg, and skin might burn in water that is too hot.
- Wear gloves when gardening and cooking.
- Wear sunscreen and shoes when outdoors.
- Avoid blocking the flow of fluids through the body.
- Do not carry handbags on the arm with lymphedema.
- Do not use a blood pressure cuff on the arm with lymphedema.
- Do not use elastic bandages or stockings with tight bands.
- Keep blood from pooling in the affected limb.
- Keep the limb with lymphedema raised higher than the heart when possible.
- Do not swing the limb quickly in circles or let the limb hang down. This makes blood and fluid collect in the lower part of the arm or leg.
- Do not apply heat to the limb.
- Studies have shown that carefully controlled exercise is safe for patients with lymphedema. is important to keep body fluids moving, especially through an affected limb or in areas where lymphedema may develop.
- Do not cross legs while sitting.
- Change sitting position at least every 30 minutes.
- Wear only loose jewellary and clothes without tight bands or elastic.
The goal of treatment is to control the swelling and other problems caused by lymphedema.
Treatment of lymphedema may include the following:
- Pressure garments
- Exercise
- Bandages
- Skin care
Damage to the lymph system cannot be repaired. Treatment is given to control the swelling caused by lymphedema and keep other problems from developing or getting worse. Physical (non-drug) therapies are the standard treatment. Treatment may be a combination of several of the physical methods.
Treatment of lymphedema may include the following:
Exercise
Both light exercise and aerobic exercise (physical activity that causes the heart and lungs to work harder) help the lymph vessels move lymph out of the affected limb and decrease swelling. Breast cancer survivors should begin with light upper-body exercise and increase it slowly.
Some studies with breast cancer survivors show that upper-body exercise is safe in women who have lymphedema or who are at risk for lymphedema. Weight-lifting that is slowly increased may keep lymphedema from getting worse. Exercise should start at a very low level, increase slowly over time. If exercise is stopped for a week or longer, it should be started again at a low level and increased slowly.
Pressure garments
Pressure garments are made of fabric that puts a controlled amount of pressure on different parts of the upper limb to help move fluid and keep it from building up. Some patients may need to have these garments custom-made for a correct fit. Wearing a pressure garment during exercise may help prevent more swelling in an affected limb. It is important to use pressure garments during air travel, because lymphedema can become worse at high altitudes. Pressure garments are also called compression sleeves and lymphedema sleeves or stockings. Once the lymph fluid is moved out of a swollen limb, bandaging (wrapping) can help prevent the area from refilling with fluid. Bandages also increase the ability of the lymph vessels to move lymph along. Lymphedema that has not improved with other treatments is sometimes helped with bandaging.
Skin care
The goal of skin care is to prevent infection and to keep skin from drying and cracking. See skin care tips, in the Managing Lymphedema section.
Compression device: lymphapress
Compression devices are pumps connected to a sleeve that wraps around the arm or leg and applies pressure on and off in a sequential and graded manner ie more distally and less proximally. The sleeve is inflated and deflated on a timed cycle. This pumping action may help move fluid through lymph vessels and veins and keep fluid from building up in the arm or leg. The use of these devices should be supervised by a trained professional because too much pressure can damage lymph vessels near the surface of the skin.
