Preventing and Managing Lymphedema

Updated: Mar 1

Under usual circumstances, the axillary lymphatic system (which is part of your immune system) helps to remove interstitial fluid from your hands and arms. Lymph nodes along the pathway also serve as a source of infection control. Drainage from the arms is dumped into the thoracic duct, which drains into the bloodstream. Lymphedema occurs when there is a blockage of the lymphatic system such as when few to all axillary lymph nodes are removed during breast cancer surgery. It is a condition in which localized fluid accumulation exceeds the body's ability to drain the limb and the limb swells. This swelling can be demoralizing, painful, and debilitating. Most studies show that the risk of lymphedema is less than a 5% risk for survivors who have had a sentinel node biopsy and up to a 20% risk in those who have had an axillary dissection.

Lymphedema is sometimes triggered by an event such as an injury or overuse of the arm. If your lymphatic system is already having difficulty with draining, a small event can set off lymphedema. Some such events include taking hot showers, wearing tight-fitting clothes or jewelry, a small cut or insect bite, lifting heavy items, push-ups, weight gain, and sun burns.

Let me pause here for a moment about push-ups. They are problematic and many specialists believe they should be avoided altogether. I agree. The only thing that incites my lympheda is push-ups.

It is important to wear sunscreen and protective clothing while gardening. I'm sure that you have already been told a number of times to avoid blood pressure cuffs and lab draws from the surgical side but I'll just reiterate that again.

Signs of lymphedema include pain in the affected limb, heaviness or tightness of the limb, reduced flexibility near a joint such as the wrist, hand, or shoulder. Also look for ring and watch tightness, bra tightness, or difficulty fitting into the arm of shirts or jackets. If any of these signs occurs, contact your doctor and wear your compression garment immediately if you have already been fitted for one. I also believe it's prudent to treat the source of inflammation immediately.

Other ways to reduce swelling include continuing to use your arm normally, putting it above your heart 2-3 times daily for 45 minutes at a time if possible (opening and closing your hands and fingers helps, too). It also helps to exercise your limb as instructed by your physical therapist. They can provide a number of useful exercises and provide very beneficial massage therapy. Do not perform deep massage on the affected limb.

Please also visit the American Cancer Organization website and the website of the National Cancer Institute for additional tips such as weight loss and laser therapy. Surgical options have improved for lymphedema as well! Some doctors now provide even more sophisticated treatments than liposuction alone. Doctors Russell Ashinoff, MD, FACS and Lisa Schneider, MD, FACS at The Institute for Advanced Reconstruction perform procedures such as Lymphaticovenous Anastomosis (LVA) and Vascularized Lymph Node Transfer (ULVTx). Surgeons at Johns Hopkins and several other institutions are performing these procedures as well. This is very exciting for patients who suffer from lymphedema and are told that there are no options beyond controlling symptoms. Currently, surgery is not commonly recommended. That may change as interventions improve.

#VascularizedLymphNodeTransfer #compressiongarment #lymphedemarisk #LymphaticovenousAnastomosis

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