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lymphedema Education

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What do I need to know about the lymphatic system

Lymph originates from a fluid, known as interstitial fluid, that has diffused, or “leaked out” of small blood vessels called capillaries. This fluid contains many substances, including blood plasma, proteins, glucose, and oxygen. It bathes most of the body’s cells, providing them with the oxygen and nutrients they need for growth and survival. Interstitial fluid also picks up waste products from cells as well as other materials, such as bacteria and viruses, to help remove them from the body’s tissues. Interstitial fluid eventually collects in lymph vessels, where it becomes known as lymph. Lymph flows through the body’s lymph vessels to reach two large ducts at the base of the neck, where it is emptied into the bloodstream.

Lymph nodes are important parts of the body’s immune system. They contain B lymphocytes, T lymphocytes, and other types of immune system cells. These cells monitor lymph for the presence of “foreign” substances, such as bacteria and viruses. If a foreign substance is detected, some of the cells will become activated and an immune response will be triggered.

Lymph nodes are also important in helping to determine whether cancer cells have developed the ability to spread to other parts of the body. Many types of cancer spread through the lymphatic system. One of the earliest sites of spread for these cancers is nearby lymph nodes.

What is lymphedema?

Lymphedema is a chronic disorder in which lymph fluid fails to circulate properly, resulting in the accumulation of fluid in the tissues of a limb or other parts of the body. Symptoms can include pain, numbness, decreased mobility, a loss of skin elasticity, hardening of the skin, increased susceptibility to infection, chronic ulceration of the skin, and severe swelling of a limb or body part.

What causes lymphedema?

There are two general types of lymphedema: Primary and Secondary Lymphedema.

Primary Lymphedema is due to congenital malformations of the lymphatic system. It can be present at birth or develop later in life. It is more common in females and usually appears in the legs.

Secondary Lymphedema is cause by an inadequate lymphatic drainage system, generally due to constriction or obliteration resulting from surgery (specifically involving the lymph nodes), radiation, trauma or infections. Secondary Lymphedema may appear 10 to 20 years or more after surgery or radiation. The risk of developing lymphedema is always present.

Are you at risk?

Lymphedema most commonly follows a surgical procedure where there has been removal of, or damage to, the lymph nodes or vessels. If you have been exposed to any of the following procedures or situations, you may be at risk of developing lymphedema.

» Breast surgery / Prostate surgery
» Radiation treatment
» Other surgery involving lymph nodes » Broken limbs from accidents
» Hernia repair
» Chronic Venous Insufficiency
» Severe infection
» Biopsy of inguinal lymph nodes
» Other medical procedures involving the lymphatic system

Signs of lymphedema

Some signs of lymphedema may include:
» Swelling of the limb or body part
» Area feels full or heavy
» Skin changes texture, feels tight or hard, or looks red
» New aching or discomfort in the area
» Less movement or flexibility in nearby joints, such as your shoulder, hand, or wrist
» Trouble fitting your extremity into your clothes
» Bra doesn’t fit the same
» Pitting (small indentations left on the skin after pressing on the swollen area)
» Ring, watch, and/or bracelet feels tight, but you have not gained weight

Why is treatment important?

For patients with lymphedema, the risk for infection in the affected body part is increased. The fluid collected in the affected body part is protein-rich. Such an environment can encourage bacterial growth. The lymph system is not in its usual defensive mode and is not filtering out the offending bacteria and viruses.

Aesthetics and quality of life are also concerns. Left unchecked, lymphedema can cause a body part to swell to the point where clothing choices become limited. Range of motion can be affected and there may be discomfort and/or pain.

General Guidelines

DIET
A well-balanced diet with high fiber, a variety of fruits and vegetables, very low salt, and low fat (less than 20% recommended) is important to maintain ideal weight and to avoid obesity.
SKIN CARE
Meticulous skin care is needed for the lymphedema patient. Creams and lotions such as Eucerin and Curel, etc. are recommended. Lotion should be at a relatively low pH and should not contain dyes or perfumes.

UPPER EXTREMITY PRECAUTIONS

1. Do not have injections, vaccinations, flu shots, blood draws, and IV placement on the affected extremity.
2. Keep the skin clean and dry.
3. Use antibacterial and hypo-allergenic soap to wash extremities.
4. Keep cuticles moist with cream or lotion.
5. Push cuticles back; do not cut them.
6. Wear rubber gloves when working with harsh detergents, steel wool, etc.
7. Use an electric razor to remove hair from under the arm to prevent cuts from a hand razor.
8. Use a thimble when sewing by hand to avoid needle and pin pricks.
9. Be careful to avoid skin injuries when making arts and crafts (ie. burns from glue guns).
10. Avoid getting sunburn anywhere in the radiated field and on the affected limb.
11. Avoid saunas and hot tubs – an increase in temperature can increase the lymphedema.
12. Become aware of how the involved limb(s) responds to various levels of exercise: intensity and frequency.
13. Avoid any exercise which causes the limb to increase in size if it does not return to the pre-exercise level within 24 hours.
14. Do not carry handbags on the affected arm

LOWER EXTREMITY PRECAUTIONS

1. Keep the extremity clean and well moisturized.
2. Inspect the limb for areas of infection, blisters, cuts, scratches and fungal infections.
3. Be aware of activities that may increase your risk of infection.
4. Always wear proper-fitting shoes. Avoid shoes that are tight or constrict the circulation.
5. Avoid walking outside barefoot.
6. Practice good foot and toe hygiene. You may need podiatry care for cutting toe nails.
7. Do not allow the limb to be injected.
8. Take extra care of the limb in cold or hot weather. Avoid frostbite. Wear the appropriate socks for the temperature.
9. Do not allow the limb to become sunburned. Wear sunscreen.
10. Take care if you are living or visiting an area with mosquitoes. Use insect repellent when necessary. It is better not to have the limb exposed. Therefore, wear loose pants when hiking or when outdoors in summer. Do not use insect repellent directly over the limb.
11. Avoid the use of the hot tubs and saunas. Heat causes an increase in lymphatic flow.
12. Do not wear clothes that are restrictive. 13. Maintain an appropriate weight and body mass index.
14. Eat a well-balanced diet.
15. Do not cross legs while sitting.
16. Take care to dry between toes and under skin folds after bathing – look for areas of skin breakdown.
17. Make sure garments are fitting properly and that they are replaced on a regular basis as directed.
18. Do not allow varicose veins to be injected or stripped unless medically necessary (not for cosmetic reasons).
19. When swimming, wear swim shoes in and around the pool and locker rooms.

How to reduce swelling after breast surgery or radiation.

Right after surgery, the affected arm or breast area may swell. This swelling is usually short- term and slowly goes away over the next 6 – 12 weeks. These tips may ease swelling:
» Use your affected arm as you normally would when combing your hair, bathing, dressing, and eating.
» Put your affected arm above the level of your heart 2 or 3 times a day and keep it there for 45 minutes. Lie down to do this, and fully support your arm. Place your arm up on pillows so that your hand is higher than your wrist and your elbow is a little higher than your shoulder.
» Exercise your affected arm while it is supported above the level of your heart by opening and closing your hand 15 – 25 times. Repeat this 3 – 4 times a day. This exercise helps reduce swelling by pumping lymph fluid out of the arm through the undamaged lymph vessels.
» To get back your normal shoulder and arm movement, start exercising your affected arm about a week after your surgery. But talk to your doctor, nurse, or physical therapist before doing any exercises. For most people, normal range of motion returns within 4 – 6 weeks.
» Keep in mind that the arm may swell if you have radiation therapy after surgery, and the swelling may last longer than normal. Radiation may also cause some swelling in the chest and breast toward the end of the treatment. In most cases, this swelling is short-term and will slowly go away. During treatment and up to 18 months afterward, you should do simple stretching exercises each day to keep full movement in your chest, arm, and shoulder.

When to call your doctor or nurse

» If you think you have any type of infection: fungal, viral, bacterial or inflammatory.
» If any part of your affected extremity or body part feels hot, looks red, or swells suddenly. These could be signs of infection and you may need antibiotics.
» If you have a temperature of 100.5°F or higher (taken by mouth) that is not related to a cold or flu.
» If you have any new pain in the affected area with no known cause.

Take care of yourself

Taking care of your whole body is important. Eat well and get to and stay at a healthy weight. Try to eat five or more servings of vegetables and fruits each day. Choose whole grain foods instead of white flour and sugars. Try to limit animal fats and trans fats. Cut back on processed meats like hot dogs, bologna, and bacon. If you drink alcohol, limit yourself to one drink a day. And don’t forget to get some type of regular exercise. A good diet and regular exercise can help you stay at a healthy weight and give you more energy. Try to reduce the stress in your life and get enough sleep, too. You also need people you can turn to for strength and comfort. Support can come in many forms: family, friends, cancer support groups, church or spiritual groups, online support communities, or one-on-one counselors. You can't change the fact that you are at risk for lymphedema. What you can change is how you live your life. Take good care of yourself, make healthy choices, and do what you can to make your body and your mind feel as good as possible.

The Lymphedema Program offered at Arroyo Grande Community Hospital, French Hospital Medical Center, and Marian Regional Medical Center is a comprehensive approach to management of symptoms for patients with primary or secondary lymphedema. Our therapists are specially trained in the treatment of patients with compromised lymph systems. The Lymphedema Program was established as a part of the Physical Rehabilitation services available at all three Dignity Health hospitals.

What do we provide at our lymphedema clinic?

We provide the most up-to-date treatment available called Complex Decongestive Physiotherapy (CDP). It consists of:
» Patient Evaluation/Treatment performed by a Registered Physical Therapist who is certified as a Manual Lymphedema Therapist.
» Prevention Education for patients that my be at risk of developing lymphedema
. » Manual Lymph Drainage (MLD) opens the collateral pathways creating a detour around non-functioning lymph nodes.
» Compression Therapy/Bandaging is an essential component of lymphedema management.
» Skin care/self care to heal wounds and to prevent infection
» Maintenance program » Support group

What do we provide at our lymphedema clinic?

Lymphedema is a chronic disorder in which lymph fluid fails to circulate properly, resulting in the accumulation of fluid in the tissues of a limb or other parts of the body. Symptoms can include pain, numbness, decreased mobility, a loss of skin elasticity, hardening of the skin, increased susceptibility to infection, chronic ulceration of the skin, and severe swelling of a limb or body part.

Referral


Your three local Dignity Health hospitals are able to work with most insurance companies. A referral to the Lymphedema Program can be obtained by either contacting the Physical Therapy Department or by obtaining a prescription from your physician. Although most insurance companies will pay for lymphedema treatment, some do not cover the cost of compression garments and dressings. Check with your insurance company about coverage for these therapies. Seeking and getting treatment early should lead to a shorter course of treatment to get your lymphedema under control.