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LYMPHOEDEMA

What is lymphoedema?
Lymphoedema is swelling in the arm or hand caused by the build up of lymphatic fluid in the soft tissues. This condition usually occurs when the lymphatic vessels which normally carry excess fluid out of the limbs and back into the circulation, is disrupted.The lymphatic system:
This system consists of lymphatic vessels, lymph nodes, and lymph (lymphatic fluid).
Lymph is the clear fluid which contains lymphocytes (white blood cells) which fight infection and growth of tumours.

Lymphatic vessels are thin tube-like structures that form a network and helps the lymph flow through the body and return it to the bloodstream.

Lymph nodes are small bean-shaped structures that filter the lymph and store the white blood cells that fight infection and disease. These are located along the network of lymph vessels throughout the body. Groups of lymph nodes are located in the armpit, neck, abdomen, groin and pelvis.

Useful link: http://www.imaginis.com/breasthealth/lymphedema.asp

Lymphoedema
This can occur when the under-arm lymph nodes are removed during surgery for breast cancer or after damage from radiation therapy, or rarely by the cancer itself. Approximately 15 -20% of breast cancer patients develop lymphoedema after their therapy.

Lymhoedema can happen soon after treatment, months or even years after. It is different from the swelling seen in the breast, under-arm and arm just after surgery. It may be temporary or may last for a long time. If left unattended, it becomes a debilitating and chronic condition for which there is no known cure.

Signs of lymhoedema.
Some of the early signs to look out for are:
  • feeling of fullness or tightness in the arm
  • heaviness, aching or pain in the arm
  • decreased flexibility of movement of the hand, wrist or arm.
  • rings, bracelets or watches feel tight even though weight has not changed
  • difficulty fitting your arms into the sleeves of your garments
  • visible swelling of the arm
  • redness and increased warmth (may indicate infection)
What you can do.
Follow these simple steps (always) to prevent or reduce lymphoedema.
1. Avoid blocking the flow of the lymph through the lymphatic network.
  • do not use clothing with tight sleeves
  • wear loose jewellery, avoid tight bands/ elastic
  • do not carry heavy weights on the side that has had the surgery/radiation (including handbags)
  • do not use a blood pressure cuff on the affected side/arm
  • do not allow any blood to be drawn from this arm
2. Promote the flow of lymph along the vessels and prevent its pooling in the arm
  • raise the affected arm /arm on the side of lymph node removal,
  • higher than the heart when possible
  • do not “hang” the arm down
  • do gentle exercises to improve the movement and circulation of the arm starting 3-4 days after surgery (see BCWA leaflet on Exercise after Surgery)
3. Keep the skin clean and free of any potential sources of infection
  • keep the nails short and clean
  • avoid any skin cuts, scratches or burns from gardening, sewing, housework, shaving
  • avoid any insect bites
4. Lose weight –obesity and overweight tends to worsen lymphoedema
Treatment of lymphoedema
Some of methods that have been found to be useful are:
1. Exercises
  • light arm exercise, brisk walking, and aerobics
  • gentle Tai Chi, Qi Qung and other similar movement exercises
  • swimming and dragon boat paddling
2. Pressure garments
  • these are special garments called compression sleeves or lymphoedema sleeves.
  • there are made to fit snugly and give a controlled and continuous pressure to the arm thus aiding the flow of lymph towards the body.
  • these special sleeves are worn during exercise and during daytime activities but MUST be removed during rest at night.
  • these should also be worn during any air-travel as high altitude is known to worsen or even precipitate the onset of lymphoedema
3. Massage therapy
  • this is a special therapy in which the tissues of the arm are gently massaged/stroked/tapped in such a way to gently aid the flow of lymph back towards the armpit and towards the other (unaffected) side.
  • you may need to ask an experienced physiotherapist to teach you the technique
4. Combined physical therapy
  • this is when massage therapy, bandaging or compression sleeves and other devices are used to aid the removal of the accumulated lymph from the affected arm.
  • a trained therapist is essential for this therapy.
Useful links:
http://www.cancer.gov/cancertopics/pdq/supportivecare/lymphedema/Patient/page3
http://www.imaginis.com/breasthealth/lymphedema_print.asp
http://www.lymphnet.org