Lymphedema is a swelling of a body part, most often the extremities. It may also occur in the face, the trunk, the abdomen or the genital area.
Lymphedema is the result of an accumulation of protein-rich fluid in the superficial tissues, which can have significant pathological and clinical consequences for the patient if left untreated. Once present, this chronic and progressive condition will not disappear without treatment.
Prevention is better than having to cope with Lymphedema. Patients who have been treated very successfully, so that they no longer have to wear a compression sleeve, must remember that their limb is still “at risk” (with an impaired lymphatic system). These points are still vital if the limb is to stay “normal”.
Recognizing Symptoms of the Onset of Lymphedema
The following are a list of symptoms and signs which a person with a “limb-at-risk” should note:
- An increase in the size of the limb
- A feeling of heat in the limb
- A bursting sensation of the limb
- Red patches may indicate an infection – patients must see their physician immediately! This may be the cause of, or indicate the onset, of Lymphedema
- Pitting of the skin if pressed
- Aching limb (or shoulder, particularly the back of the shoulder area in the afternoon)
- Any swelling, or heat, in the trunk on the same side as the operation; and enlarged and at times warmer breast after a lumpectomy
- A swelling of the opposite side (e.g. if after a mastectomy the other breast or chest walls start to increase in size)
Signs Your Lymphedema is Progressing
- Any of the previous signs for its onset
- A compression garment gets too tight
- Pins and needles in the fingers or toes
- Lack of feeling in any areas of a limb
- Leaking areas (fistulae) start to occur
If this happens:
- You should see your physician and ask to be referred to a lymphedema therapist at once if these occur
- If you have a bad infection and suddenly cannot wear your garment, you should bandage, if you can, until you can return to your therapist (2 or 3 days of treatment may be all that are necessary to reduce a limb so you can wear the garment again)
Do’s & Don’ts
If you have a limb “at risk”, or lymphedema
- Keep your lymphedamatous limb spotless clean. When drying, be gentle but thorough (a hair-dryer may help for difficult areas). Make sure your underclothes and compression garments are regularly washed. Keep the skin supple with a good moisturizer.
- Avoid any trauma (knocks, cuts, sunburn, insect bites). Be careful cutting nails, do not cut the cuticle or push back too hard (this can injure it and allow bacteria to enter, thus leading to infection). If you are sewing, wear a thimble; if gardening, wear a glove and long sleeves; if bush-walking etc. wear protective clothing.
- Never allow the limb to become sunburned. Always use a broad spectrum high SPF cream. You can burn through many compression garments, particularly synthetic; they do not protect you against it.
- Keep the limb as cool as possible in hot weather. Be careful of the water temperature in showers and spas. If traveling for a long time in a car, drape a white shirt over limb in the sun. Move it if possible when you have to sit for a long time, flex and stretch fingers.
- Do NOT pick up heavy loads with an arm “at risk”, e.g. a case or heavy shopping. Do not carry a heavy bag or handbag on this arm.
- Any redness (infection) should be treated AT ONCE.
- It is very important to keep the skin supple and moist.
- You MUST NOT allow ANYONE to measure blood pressure, to take blood, or to give an injection in a lymphedematous limb or one at risk.
- To remove hair, a properly maintained electric razor is better than safety razors, depilatories, or abrasive mitts.
- If traveling by air it is a good precaution to wear a compression garment (and glove, for arms) or an inflatable splint may be used. If lymphedema is present, additional pressure bandages may be needed for a long flight. Bandages may be used on fingers and hand if necessary.
- There should be no redness or indentation when you remove clothing; otherwise it is stopping some of the lymphatic drainage that you do have left!
- Try not to lie on an arm at risk when sleeping or resting.
- A normal balanced diet is best. Lymphedema is a high-protein edema but eating too little protein will not help. Rather it weakens the connective tissue, thus making an edema worse. Dieting will not reduce lymphedema, but is advisable if a patient is overweight.
- If you are under severe psychological stress, concentrate on relaxing the shoulders, back and neck. Extend your spine and “stand straight”. Constant tension in these areas will worsen lymphedema or may precipitate it if you are at risk.
How Can Lymphedema Be Reduced?
Referral to an Occupational or Physical Therapist that specializes in Complete Decongestive Lymphedema treatment also called Manual Lymph Drainage.
The therapist may treat it with all or some of the following:
- Self massage
- Compression garment and/or compression bandages
- Complete decongestive therapy (manual therapy by the therapist)
“Four years after breast cancer surgery, I began experiencing pain and swelling in my arms. Together with massage technique I do at home and in the water plus therapeutic massage at Biomax Rehab at the Bonutti Clinic, the swelling is going down and the pain is diminishing. My only regret is that I didn’t see therapist Zenda Bright sooner.”