LYMPHEDEMA

by Cheryl Badura, OTR/L CLT and Jill Gaulke Harlan, OTR/L CLT Lymphedema is a chronic condition that involves the swelling of a body part (arm(s), leg(s), trunk, face) due to trauma of the lymphatic system. When lymph channels become blocked and lymph fluid cannot drain properly, protein-rich fluid tends to accumulate in the affected body part. Primary lymphedema can be present at birth or develop from unknown causes later in life. Secondary lymphedema develops because of lymph node removal or damage. Damage or removal of the lymph vessels can occur as a result of surgery (i.e. mastectomy, lumpectomy), radiation, infection or other trauma.

Secondary lymphedema is a risk for a lifetime for anyone who has undergone surgery or radiation for breast cancer. In fact, the average onset of lymphedema for someone who has had breast cancer is 1½ years after surgery. Most often lymphedema will develop in the arm of the affected side, but will also occur in the trunk or breast. I t is important to be aware of signs and symptoms of lymphedema so treatment can be started right away. Lymphedema will not go away on its own; it will worsen over time if not properly treated. Signs and symptoms of lymphedema include the following: • Increase in limb size • Feeling of heat in limb • Puffiness • Pitting of skin if pressed • Aching limb • Inability to pick up fold of kin on a finger • Decreased sensation of a limb or "pins and needles" • Redness (although this could also indicate infection) It is important to see a physician right away if any of these signs or symptoms appears. A certified lymphedema therapist will provide treatment that includes a specialized massage technique called manual lymph therapy (MLT) or manual lymph drainage (MLD). The gentle massaging action stimulates the lymphatic system and promotes drainage of lymph fluid, toxins, proteins and debris out of the affected areas. The lymph fluid is absorbed back into the system, and the remaining components are exerted from the body through urination or sweating. A second key component of treatment involves application of low stretch compression bandages (never ace wraps) which allow a pumping effect when muscles contract, stimulating lymphedema reduction. Another component to treatment and a key to lymphedema prevention and management is meticulous skin care. Some examples are a daily skin check, including examining your limb for cuts, burns or bites as these are potential sources for infection. Treat any skin opening with antibiotic cream and protect hangnails or cracked, torn cuticles. Also note the signs of infection (redness, warmth, tenderness, red streaks, or swelling) and contact your doctor if any are present. It is also important to protect your skin from the sun and overheating. Wear sunscreen and avoid saunas or hot tubs. Avoid skin constriction by wearing loose fitting clothing and jewelry. Finally, insist that your affected arm(s) NEVER be used for injections, blood tests or blood pressure measurements.