Lymphedema
Lymphedema Symptoms and Causes
Have you noticed unusual swelling in your body? Do you have swelling in an arm or a leg or even in your torso? You might be suffering from lymphedema, a buildup of lymph fluid. The swelling indicates that your body's lymph system cannot handle the amount of fluid. Do not ignore these symptoms because complications from infection can occur. Contact your therapist or physician.
Symptoms of Lymphedema
- A limb or body part is swollen
- Swelling worsens over time
- Repeated episode of infection
- Sensation of heaviness and limited motion
- Clothes, jewelry or shoes no longer fit
Possible Causes of Lymphedema
- Treatment of cancer
- Birth defects
- Infections
- Trauma (injury or surgery)
- Circulatory disorders
General Recommendations
- Protect the area below the surgery from injury, even many years after surgery.
- If you have had lymph nodes removed from under your arm
- Do not have blood drawn from the arm on the side of the lymph node surgery.
- Do not allow a blood pressure cuff to be placed on that arm. If you are in the hospital, make sure you notify your nurse and other hospital staff of your condition.
- Avoid razors, use an electric shaver for underarms.
- Wear gloves when gardening or doing other activities that may lead to cuts on your fingers or hands.
- Wear strong sunscreen to avoid sunburn.
- Practice good skin care to reduce the risk of infection
- It is important to keep your weight within normal limits as much as possible.
For more information, check out these helpful websites:
National Lymphedema Network, http://www.lymphnet.org
StepUp-SpeakOut www.stepup-speakout.org
Lymph Notes www.lymphnotes.org
Lymphovenous Canada www.lymphovenous-canada.ca
Lymphedema Support Network www.lymphoedema.org/Isn (Britain)
Lymphoedema Network Australia www.lymphoedema.org.au
Lymphedema
What is lymphedema?
Lymphedema is a collection of fluid that causes swelling (edema) in the arms and legs.
What causes lymphedema?
One of the causes of lymphedema is surgery to remove lymph nodes , usually during cancer treatment. Normally, lymph nodes filter fluid as it flows through them, trapping bacteria, viruses, and other foreign substances, which are then destroyed by special white blood cells called lymphocytes. Without normal lymph drainage, fluid can build up in the affected arm or leg, and lymphedema can develop. Medicines such as tamoxifen (Nolvadex), radiation therapy , and injury to the lymph nodes can also cause lymphedema. This type is called secondary lymphedema.
Primary lymphedema can be present at birth or develop during puberty or adulthood. The cause of primary lymphedema is not known.
What are the symptoms?
Symptoms of lymphedema include feeling as though your clothes, rings, wristwatches, or bracelets are too tight; a feeling of fullness in your arms or legs; and less flexibility in your wrists, hands, and ankles.
How is it treated?
Treatment for lymphedema depends on its cause and includes wearing compression garments such as stockings or sleeves, proper diet and skin care, and fluid drainage.
Elevating an arm or leg that has swelling can help ease the drainage of lymph fluid from the affected limb. Whenever possible, rest a swollen arm or leg on a comfortable surface, above the level of your heart. Don't put pressure on your armpit or groin area, and don't hold a limb up without support for very long since this can increase swelling.
Gentle exercise can help reduce swelling. The use of muscles during exercise naturally helps lymph fluid to circulate, which can reduce swelling. But exercise also increases blood flow to the muscles being used, which can increase the amount of lymph fluid present. If you have swelling, it is important to properly bandage an affected limb before exercising. Ask your doctor how to use a bandage for this purpose and what exercises are appropriate for your condition.
After surgery or radiation treatment
If you have had surgery to remove some lymph nodes, use your affected arm or leg as normally as possible. Most people are healed about 4 to 6 weeks after surgery, and able to go back to their normal activities.
If you have had lymph nodes removed or have had radiation therapy as part of cancer treatment, you may be able to avoid lymphedema or keep it under control by following the tips below.
Contact your doctor promptly if symptoms of an infection—such as redness, pain, or increased swelling—develop in your arm, hand, leg, or foot.
Protect the area below the surgery from injury, even many years after surgery.
If you have had lymph nodes removed from under your arm:
- Do not have blood drawn from the arm on the side of the lymph node surgery.
- Do not allow a blood pressure cuff to be placed on that arm. If you are in the hospital, make sure you notify your nurse and other hospital staff of your condition.
- Use an electric shaver for underarms.
- Wear gloves when gardening or doing other activities that may lead to cuts on your fingers or hands.
If you have had lymph nodes removed from your groin:
- Bathe your feet daily in lukewarm, not hot, water. Use a mild soap, preferably one that has moisturizers, or use a moisturizer separately.
- Wear comfortable and supportive shoes that fit properly.
- Wear the correct size panty hose and stockings. Avoid wearing constricting garters or knee-high or thigh-high stockings.
- Ask your doctor how to handle any cuts, scratches, insect bites, or other injuries that may occur.
- Use sunscreen and insect repellent when outdoors to protect your skin from sunburn and insect bites.
- Do not ignore a feeling of tightness or swelling in or around your arm, hand, leg, or foot. Let your doctor know about it immediately.
- Ask your doctor to refer you to a physical therapist who specializes in lymphedema. Many insurance companies will not pay for physical therapy evaluations and treatments without a doctor's referral.
- If you have lymphedema, you may want to wear a lymphedema alert bracelet. These bracelets, available through the National Lymphedema Network, are worn to protect those who have lymphedema from receiving treatment such as blood pressure readings, injections, or blood draws to their affected limbs that could make their condition worse.
LYMPHEDEMA OVERVIEW
Lymphedema is swelling caused by a build-up of fluid, usually in the arm in women who have been treated for breast cancer. Lymphedema is one of the most troubling complications that can develop after breast cancer surgery. Many women find that lymphedema worsens the physical and emotional strain of dealing with breast cancer.
The risk of developing lymphedema depends upon the type of surgery you had, the time since surgery, and if radiation therapy was used. Generally, women who undergo more extensive surgery, have many lymph nodes removed, or have radiation therapy to the axilla (arm pit) after surgery are more likely to develop lymphedema
WHAT IS LYMPHEDEMA?
Lymph is a clear fluid that contains mostly protein and white blood cells (the blood cells that fight infection). Lymph vessels drain lymph from the body's tissues and organs. The fluid is filtered through lymph nodes (also called glands) and eventually drains into the bloodstream.
Lymphedema can develop if surgery or radiation treatment affects the lymph vessels.
Women who have multiple lymph nodes removed (a full axillary node dissection) are more likely to develop lymphedema than those who have only sentinel lymph node biopsy. Women who have both surgery and radiation treatment are at even higher risk.
LYMPHEDEMA SYMPTOMS
The initial symptoms of lymphedema may include:
- A heavy sensation or an aching discomfort in the arm
- Swelling of the affected arm or upper chest
- Difficulty moving the arm
- Stiffness, weakness, or numbness
PREVENTING WORSENING OF LYMPHEDEMA
Women with lymphedema can do several things to prevent it from getting worse over time. Expert groups recommend the following:
- Avoid trauma and injury to the affected arm. Blood draws, IV lines, injections, and acupuncture should be avoided in the affected arm, if at all possible. Avoid tight fitting clothing, prolonged blood pressure monitoring, or any activity that could interfere with lymph flow in the affected arm.
- Try to prevent infection. Practice careful skin and nail hygiene. Use skin moisturizers to prevent dry, cracked skin. Use an antibiotic cream or ointment on small skin cuts, such as paper cuts. Use protective gloves for household work and gardening. Use an electric razor rather than a razor blade to remove hair in the arm pit.
- Avoid heavy exercise and lifting heavy objects with the affected arm immediately after surgery. These activities may increase blood flow, which can worsen edema. Gentle stretching and range of motion exercises, provided by a healthcare professional, may be used immediately after surgery. Check with your doctor before resuming an exercise program after breast cancer treatment.
- Avoid extreme temperature changes during bathing or washing dishes. Hot tubs, steam baths, and spending time in hot climates may worsen lymphedema.
- Keep your weight under control. Obesity can worsen lymphedema and may limit the effectiveness of compression pumps or sleeves.
- Avoid resting your arm below your heart or sleeping on your arm for prolonged periods.
Contact your doctor or nurse if the affected arm develops a rash, becomes red, blistered, or warm, or if you get a fever (temperature greater than 100.4ºF or 38ºC). These symptoms could signal the beginning or worsening of lymphedema.
If you develop lymphedema many years after surgery or have worsening lymphedema, contact your doctor or nurse immediately.
IMPACT OF LYMPHEDEMA
While lymphedema is not a life-threatening condition, it can have a major impact on your quality of life. A change in how your arm looks can be distressing.
- After breast cancer surgery, many women are worry about how they look; having a swollen or misshapen arm can make this worse.
- If lymphedema affects the ability to use your arm, this can affect your quality of life, particularly if it is your dominant arm (eg, right arm if you are right-handed).
- Lymphedema can reduce tissue healing and occasionally causes chronic pain. For these reasons, prevention and early treatment of lymphedema are recommended
The following organizations also provide reliable health information.