Lymphedema

Lymph is fluid that oozes out of your tiniest blood vessels. The fluid goes between your cells and brings nourishment and carries away damaged cells, cancer cells, and germs. Lymph then travels through tiny tubes called lymphatic vessels. The vessels carry lymph from your tissues to collection points called lymph nodes. The word edema means “swelling;” lymphedema is then the swelling of an arm or leg because the lymphatic flow is blocked.

• Lymphedema usually results from having lymphatic vessels or lymph nodes removed or damaged (such as during surgery or radiation for cancer)
• It can rarely result from a birth defect.
• Lymphedema has no cure, but special massages along with pressure stockings and bandages can help with swelling.
• Doctors and nurses avoid drawing blood, taking blood pressure, or starting an IV in an arm or leg with lymphedema.

Lymphedema results when part of your lymphatic system is blocked. Then, lymph builds up in your tissues, causing swelling. There are two types of causes.

Usually, your lymph vessels are normal, but something happens that blocks them, such as:

• Surgery, such as when doctors remove lymph nodes from the armpit of women having surgery for breast cancer.
• Radiation therapy
• Severe injury to an arm or leg
• In developing countries, a certain kind of worm infection called lymphatic filariasis causes lymphedema. Rarely, cancer blocks your lymphatic vessels.

Lymphedema has no cure. The following may help lessen your swelling:

• Elevating the swollen limb to help the fluid drain (for example, keeping your foot up on a stool)
• Special massages to help drain fluid.
• Arm or leg movements from your doctor to help move the fluid.
• Pressure bandages or stockings to wear on the swollen arm or leg.
• Rarely, surgery to remove the swollen tissues under the skin and to help lymph drain.

It is important to avoid injuring an arm or leg with lymphedema. Also, if you have an arm with lymphedema, do not have your blood pressure taken on that arm or have blood drawn or an IV started as that could make your lymphedema worse.

Your providers may send you to a lymphedema therapist. These trained specialists can get you started on the best ways to keep swelling under control. The most common treatments include:

• Compression garments: Compression sleeves and stockings for the arms and legs relieve swelling. Compression pushes the fluid back into circulation by increasing the rate that the lymphatic fluid is filtered out of the soft tissue. Compression also gives you external containment that prevents and helps control swelling. Other compression garments are designed for different areas of the body where swelling occurs. These can be fit to your needs.
• Multi-layer compression bandaging: Short stretch bandages help reduce swelling to soft tissue. They’re applied with levels of pressure to help re-route fluid from the swollen areas. Once the lymph fluid is moved out of a swollen limb, it is a good time to wear compression garments to prevent swelling from returning.
• Compression devices: A pneumatic compression pump connects to a sleeve which is wrapped around the arm, leg, chest, genitals, head and neck. The sleeve is inflated and deflated on a cycle. This on-and-off pressure gets fluid moving through lymph vessels and veins and keeps it from building up in the arm or leg. Compression pumps have also been shown to reduce risk of infection.
• Manual lymphatic drainage (MLD): A very light form of massage involves gentle skin stretch on soft tissues completed by a therapist. Lymph from the swollen area is gently transferred into an area with working lymph vessels. Patients can be taught to perform MLD on themselves.
• Exercise: Physical exercise as well as decongestive exercise are important to stimulate lymphatic drainage. The muscle pump contraction filters out lymphatic fluid, and the decongestive exercises help to stimulate the lymphatic system to take up the fluid.
• Complete decongestive therapy (CDT): CDT combines compression, manual lymphatic drainage, meticulous skin care and exercise. Depending on the severity, this type of lymphedema treatment can last from two weeks to several months.
• Surgery is considered if other nonsurgical treatments aren’t working. Not everyone is a candidate for surgery, but for some people symptoms can be eased with a surgical procedure.

Generally, compression sleeves and stockings for lymphedema aren’t covered by Medicare. A home compression pump will be covered if compression garments aren’t working well. If you have a secondary insurance to Medicare, they may cover compression garments and pumps as well. Talk to your provider about all your payment options with lymphedema therapy.

While there’s no cure for lymphedema, lifestyle changes can help control your discomfort and reduce swelling. Exercising, practicing good hygiene, wearing the right clothing, and eating healthily can all help you feel better and more in control of your condition.

• Exercise is one of the best ways to keep fluid moving within your body. Always check with your provider before starting a new exercise program. Your therapist may have special exercises for you depending on the stage of your condition.
• Avoid strenuous exercises involving the affected limb unless you have been given clearance. You’ll get specific instructions about the activities that are safe for you.
• To improve cardiovascular fitness, try aerobic activities, like walking, swimming, low-impact aerobics or specially prescribed exercises. Aim for 20 to 30 minutes most days of the week. Include a five-minute warm-up, including stretching exercises, before any aerobic activity and include a 5- to 10-minute cool down after the activity.
• If your normal exercise routine includes weightlifting with your arms or even strength training with your legs, check with your doctor or therapist about the best time to resume this activity and ask if there are any weight or movement restrictions.
• Stop exercise if it’s causing pain and discuss this with your provider. If your affected arm or leg becomes tired during the exercise, cool down, rest and elevate it. As you resume exercise you want to make sure you slowly increase frequency and duration to allow your body time to adjust.

• Keep your skin meticulously clean. Dry your skin thoroughly (including creases and between fingers and toes). Apply lotion to surrounding skin, but not in between your toes.
• Frequently wash your hands with soap and warm water, especially before preparing food, and after using the bathroom or after touching soiled linens or clothes.
• Wear gloves while doing housework or gardening.
• Avoid cutting your cuticles when manicuring your nails. Use care when cutting your toenails. Treat athlete’s foot with antifungal powder.
• Protect your skin from scratches, sores, burns and other irritations that might lead to infection.
• Use insect repellents to prevent bug bites.
• Always wear sun protection (SPF 30 or higher) when going outside.
• Immediately report any signs of infection to your provider.
• Treat minor injuries immediately: Wash the area with soap and water, then apply antibiotic ointment. Once cleaned, cover the area with a bandage and call your healthcare provider.

• Wear loose clothing that won’t restrict movement of your arms and legs. Wear comfortable, closed-toe shoes and avoid tight hosiery and socks. If you must wear watches or jewelry, be sure they’re worn loosely on the affected arm.
• Sit properly. To keep fluid flowing in your legs, try practicing a good posture by keeping your feet flat on the floor and avoid crossing your legs. Try not to sit for longer than 30 minutes.
• Consider wearing compression garments if traveling by plane. If you plan to fly soon, ask your provider if you should wear a compression garment on your affected arm or leg to minimize swelling. For long flights, you may need to bring additional bandages.
• Be careful at medical checkups and blood draws. Ask to have your blood pressure checked on the unaffected arm. Avoid injections, IV lines or blood draws on the affected side when possible.

• Swelling is better controlled with good nutritional habits. Your lymph systems work more effectively with better nutrients taken from minimally processed, natural foods (fruits, veggies, whole grains). Healthy eating keeps you closer to your ideal weight, an important factor in reducing symptoms and it makes you feel better overall.
• Reduce foods high in salt and fat.
• Include at least 2 to 4 servings of fruit and 3 to 5 servings of vegetables in your daily meal plan.
• Eat a variety of foods to get all the nutrients you need.
• Use package label information to help you to make the best selections for a healthy lifestyle.
• Eat foods high in fiber such as whole-grain breads, cereals, pasta, rice, fresh fruits, and vegetables.
• Drink plenty of water — eight 8-ounce glasses of water are recommended per day.

There is no sure way to prevent all cases of lymphedema. But symptoms can be caught early and minimized. No matter the type or cause of your lymphedema, you can take steps to reduce or even prevent swelling.

If you’ve had breast cancer surgery talk to your surgeon and healthcare team about ways to head off symptoms early. For example, recent studies show resistance exercises for your arms (working with resistance bands, light weights, push-ups) may prevent symptoms. Soon after treatment, talk to your provider about having your arms measured at certain time intervals to check for changes in size. These checks can be done before you can see or feel any difference with swelling. Spotting changes early can help you get started on treatment right away.

• Keep your affected arm or leg elevated above heart level when you can.
• Move around as much as possible to keep fluid moving.
• Avoid exposing extreme hot or cold temperatures to your affected limbs. If you’ve had radiation therapy, don’t apply ice or heat to your arm or leg. This increases your risk of lymphedema.
• Protect the affected areas from sharp objects; wear protective clothes. Don’t walk barefoot outside, or garden without your gloves.
• Use electric shavers instead of scissors or razors to remove hair. Replace the shaver heads frequently.
• As always, wear loose, comfortable clothing you can move around in.
• Maintain your ideal body weight. A registered dietitian or your provider can help calculate your ideal body weight for this situation, and you can measure your BMI.
• Avoid alcoholic beverages.