LYMPHEDEMA (SWELLING OF THE ARMS)

What is Lymphedema, and who is at Risk?
Lymphedema is a preventable condition that may affect people who have undergone certain kinds of cancer treatment.  Lymphedema can be a serious side effect after breast cancer surgery (lymph node biopsy or removal) and radiation therapy. It is thought that as many as one out of four women who have been treated for breast cancer will have this problem.  Lymphedema occurs when fluid collects under the arm, in the arm or hand.  Since the fluid does not drain, swelling can occur.  This can become painful and can limit arm movement and daily activities.  Lymphedema may occur right after treatment or months or years later.

Prevention and Treatment
Prevention and early diagnosis are critical for those who are at risk.  Lymphedema can occur very rapidly, and it responds best to treatment in the earliest stages.  The treatment for mild to moderate (Stage 1 and 2) lymphedema usually consists of bandaging, exercises, gentle massage, nutritional counseling, training in preventive behaviors, and strict hygiene practices for proper infection control.  In the later stages, the condition may require corrective surgery.

Factors that may increase your risk:

  • Surgery to remove breast cancer or lymph nodes.
  • Radiation treatment to the breast or underarm.
  • Being overweight.
  • Being inactive.
  • Eating a poor diet.
  • Having diabetes.
  • Having any condition that affects the flow of blood or lymph in or near the arm.
  • Having had other surgery in the arm or armpit in the past.

What brings on Lymphedema?

  • Injury to the skin or muscle in the arm.  This could include insect bites, cuts, scratches, bruises, burns, and allergic reactions (poison oak or ivy).
  • Gaining a lot of weight.
  • Heat.  Hot tubs and very hot weather.
  • Long flights.  It is not common for flying to bring on the first bout of lymphedema.  Women who have had a problem with lymphedema may notice that flying makes it worse.

What you can do to prevent Lymphedema:

  • Use sunscreen (spf 15 -30) and insect repellant (with no alcohol in it).
  • Keep your hand and arm clean.  Avoid harsh soaps.  Dove is good.
  • Keep your skin moist and free of cuts and cracks.
  • Avoid too much heat, sauna, sunburns, tans on the affected side (surgery side).
  • Use an electric razor to avoid cutting the skin under the arm.
  • Wear gloves to protect your hands while doing housework and yard work.
  • Do not get manicures that cut the skin around the nails.
  • If you get a cut or scrape, clean the area and apply antibiotic ointment.
  • Keep your ideal body weight.
  • Avoid getting cut or having blood drawn on the affected side.
  • Do not allow your blood pressure to be checked on that arm.
  • Avoid lifting heavy objects such as heavy grocery bags and suitcases on the affected side.  This includes purses.
  • Don’t smoke.
  • Do not wear clothes that are tight on your arm.
  • Avoid wearing any jewelry that is tight.  You may need to get rings sized so that they are larger.
  • Do rest your arm in an elevated position with support.
  • Wear compression bandage/sleeve when flying.
  • Do not ignore any swelling of your affected arm or hand.  Call the doctor right away!
  • Do not ignore small or minor injuries to your arm or hand.
  • Report any signs of infection such as redness, warmth, red streaks, or pain and soreness in your affected arm that starts suddenly.
  • Report any changes in the size of your arm or hand.  You might notice that clothes or rings are tight.  Also report any new numbness or pain in your affected side.
  • Examine your arm regularly.  Run the tips of your fingers over the back part of your upper arm.  Try to notice if there is a change in fullness of the tissue.  Stand in front of a mirror and look at both arms from the front and side.  Look for differences in them.
  • Know what your arm looks like when there is no swelling.  Then you will be able to notice any new changes.
  • The arm feels full or heavy.
  • Tight feeling skin.
  • Clothes or jewelry fit tighter than usual.
  • Not being able to move the hand or arm like usual.

Dealing with Lymphedema:

  • Elevate the arm as often as you can with support.  Lie down and place your arm on a pillow so that the hand is higher than the elbow and the elbow is higher than the shoulder.  Do this 2 to3 times a day for 45 minutes.  If you use a compression garment, put it on after the swelling has gone down.
  • Try arm and shoulder exercises such as arm swings, front raises, side raises, and shoulder shrugs for loosening up exercises.
  • Gentle stretching exercises may also help keep the arm and shoulder movable and prevent pain.
  • See a physical therapist or other health team member who knows how to treat and check lymphedema.
  • See a massage therapist trained in manual lymph drainage.
  • Wear a compression bandage or sleeve during the day.  A compression bandage or sleeve can either be ready made or custom fitted.  You will need a prescription from your doctor to get one. Be sure to have a professional measure your arm when you are getting a sleeve. There should be no areas that are pinched or creased when you put your sleeve on. Many times the American Cancer Society can direct you to a place in your area where you can have this done.
  • Gently massage your affected arm using manual lymph drainage.  You can be taught to do this by a physical therapist or massage therapist certified in lymph drainage.
  • Prevent further injury to the arm or hand.
  • Prevent infection and keep the skin soft and free of cracks and cuts.

Wear a “Medical Alert” Bracelet.

Dealing with Severe Lymphedema:

  • If severe Lymphedema pain occurs, discuss how to manage your pain with your doctor or nurse.  They can talk with you about which medicines may be used, how to position and support your arm and help you with other measures to reduce pain.

When Do You Need to Seek Help?
As soon as you notice swelling, call your doctor or nurse.  It is very important to get lymphedema treated early.  It will not go away on its own. Seeing a specialist may be well worth the trip.  Remember, preventing lymphedema is the key.

For more information:
You may wish to get a copy of the book Lymphedema: Understanding and Managing Lymphedema after Cancer Treatment.   This book is published by the American Cancer Society and may be purchased in a bookstore or by calling the American Cancer Society

National Lymphedema Network (800-541-3259)

Useful websites:
National Cancer Institute: Lymphedema
American Cancer Society: Lymphedema: What every woman with breast cancer should know
Breast cancer: Side effects of treatment: Lymphedema
National Lymphedema Network

Examples of sleeves and other devices:
www.makemeheal.com
www.lymphedivas.com

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