This Blog is for people who have had mastectomies; after all, October is National Breast Cancer Month. But it is also for individuals recovering from cancer who have had lumpectomies, radiation treatment, lymph node removal, surgeries, infections , or trauma to an extremity. You may be at risk for developing lymphedema. This Blog will help you understand what lymphedema is and how it can be prevented and managed.
If you know someone who may be at risk for developing lymphedema, share the Blog information with them. National Breast Cancer Month is a great time to create awareness and understanding about lymphedema. My goal is prevent lymphedema from occurring in patients that are at risk.
What is the Lymphatic System?
The lymphatic system consists of lymph vessels located just under the skin and the lymph nodes located in your neck, armpits and groin. As the lymph vessels move fluid out of the tissues; waste products, bacteria, dead cells, and large protein molecules are collected. The waste products are carried to the lymph nodes to be broken down and eliminated, while the protein rich fluid is transported back to the heart to rejoin circulation.
When the lymph vessels have been removed or damaged, lymph fluid accumulates and causes swelling and thickening of the skin. This accumulation of protein rich lymph fluid is known as lymphedema. Once lymphedema occurs, it will continue to worsen without an effective lymphedema management program. It is frightening because a patient can go months and sometimes years without having lymphedema. The symptoms can occur quickly and spontaneously; therefore it is important for the patient to know what to do and who to see.
What Steps Do I Take If Symptoms Occur?
Seek out a Physical Therapist that is specially trained and knows how to effectively treat this unique condition. If your lymphatic system is compromised and swelling occurs, the extremity will need external support. Wearing a compression garment provides external pressure to assist lymph system, and hopefully to prevent additional swelling. Once lymphedema occurs, it can become a chronic condition. It is my recommendation that every mastectomy patient be fitted with a compression sleeve and glove as preventative measures.
The compression sleeve and glove should be worn when you are performing house work, yard work or exercise. It is also important to wear a compression garment when you are flying or taking a long car trip where the elevation will change. The decrease in cabin pressure in the airplane puts stress on the lymphatic and circulatory systems and this can cause swelling.
If you do not have a compression garment, talk with your doctor. Your Physical Therapist can measure and fit you with the appropriate garment. Don’t wait until there is a problem, but prevent lymphedema by wearing the compression garment. I fit patients on a regular basis. I particularly like the Juzo brand compression garments. The material is soft and comfortable; you can customize the color and design. Most of all, they are affordable, because insurance will not cover the cost of the garment. New Stride Physical Therapy sells the Juzo compression garments at wholesale prices, passing the savings onto the patient. Wearing a compression garment is only one component of a comprehensive lymphedema management program.
What Is The Treatment For Lymphedema?
- Manual Lymphatic Drainage (MLD)
- Graduated Compression Garments from Juzo
- Physical Therapy and Therapeutic Exercise
- Meticulous Skin Care
Manual Lymphatic Drainage (MLD)
Manual Lymphatic Drainage is a gentle form of massage that works to manually move the lymph fluid back to midline cisterns in the body; so that the lymph fluid can rejoin the venous system and be cleared from the extremities. Deep tissue massage is not good for the fragile lymph system and can make the problem worse. MLD applied correctly will generally decrease the volume of the affected extremity to a normal or near normal size. The compression garment is then worn to retain the achieved reduction.
Graduated Compression Garments from Juzo
Graduated compression garments are necessary to maintain the reduced limb. There is not a cure for lymphedema but will always need to be managed by wearing the compression garment during the day while you are active. In some cases the compression garments must be worn every day, for life.
Physical Therapy and Therapeutic Exercise
A skilled Physical Therapist can advise you on what exercises are appropriate after a mastectomy or other surgery. Following a mastectomy it is important to restore normal shoulder strength and range of motion. A conservative resistive exercise program is also important for strengthening the bones and minimizing the risk of osteoporosis. Any exercise that causes pain or muscle soreness should be avoided. I routinely use a modified Pilates Exercise Program for mastectomy patients at New Stride Physical Therapy. It is a safe way to strengthen the shoulder and improve posture. I like mind, body, spirit components of Pilates that centers the mind and helps with relaxation.
Meticulous Skin Care
With lymphedema, the skin can be overstretched and inflamed. This is a condition known as cellulitis. A low- pH lotion, free of alcohol and fragrances should be used to maintain the health of skin and to protect it. If an infection develops, consult your physician immediately.
How Do I Live With Lymphedema?
If you are at risk for developing lymphedema or already have it, these recommendations will help you manage the problem. If you have lymphedema, it is important that you avoid injury and over exertion of the affected extremity. You should comply with the wearing schedule of the prescribed compression garments. Form a relationship with your Physical Therapist so that he/she can routinely examine the limb for change. You should see your Physical Therapist at least once every six months to get new compression garments. The garment will lose its compression abilities after six months of wear.
Keep your skin protected using a moisturizing lotion and sunscreen if you will be in the sun. I recommend SPF protective clothing if you will be out in the sun. Living on the coast may make you more susceptible to getting a sunburn, especially if you enjoy boating as much as I do. Use warm water, not hot to bathe. Avoid irritating or allergy causing cosmetics, detergents, deodorants and perfumes. Inspect your feet, hands, and limbs regularly for skin changes. Avoid cuts, pricks, scratches or burns, and insect bites that could increase swelling or promote infection.
Trauma can also increase swelling and further damage the lymphatic system. Avoid blood pressure checks, IV’s, blood draws, and shots in the affected limb. Do not cut into the cuticles when trimming fingernails or toenails. Use an electric razor when shaving. Never allow a Physical Therapist to place a heating pad or cold pad on the affected limb.
Your clothing should never be tight or restrict circulation. Shirt sleeves, bras straps, belts, socks and shoelaces should fit comfortably. Shoes with low heels are recommended. Your jewelry should not feel tight. Avoid carrying heavy purses, luggage or shoulder bags.
Increase weight complicates lymphedema, so maintain a balanced diet of fruit, vegetables, whole grains and proteins. Avoid excessive consumption of fatty foods, sweets, salt and alcohol. Drink plenty of water and unsweetened liquids. If you are a diabetic patient consult with your endocrinologist about a proper diet to maintain weight.
Exercise is very important but should be done in moderation. I highly recommend a Pilates exercise program. At New Stride Physical Therapy we have full Pilates studio and can customize a safe exercise program for the patient. Pilates is a therapeutic exercise program recognized by your physician and covered under your insurance. Consult with your Physical Therapist for the appropriated exercise program. Heavy weightlifting and overly aggressive sports that may cause injury should be avoided.
Traveling is one of the joys of life, but if you have lymphedema, you must always wear your compression garment. When traveling by car;, be sure the seatbelt is comfortable and make frequent stops to get out of the car to stretch the legs. Prolonged sitting may increase swelling. Avoid extreme changes in temperature (over 90 degrees or below zero). Sun bathing, tanning beds, saunas, steam rooms, and hot tubs should also be avoided.
Remember if lymphedema is diagnosed early, it can be managed through manual lymphatic drainage, quality compression garments, and good skin care. That is why prevention is key!