Understanding Lymphedema

Lymphedema is a potential side effect of some surgeries and cancer treatments. It can also occur in childhood, called primary lymphedema, and in these cases is unrelated to a cancer treatment. Preventing and managing lymphedema is key to maintaining the quality oflife you desire and reducing potential infections that can arise from it if left untreated. Lymphedema can occur any time after your cancer treatment, even years later.

It is believed by many that lymphedema is largely undiagnosed and untreated the United States. European therapists have devised most of the existing therapies and many of the products used to treat the condition were developed there. The American Cancer Society reports the risk of upper arm lymphedema after breast cancer treatment is 15-20%.

Early prevention and aggressive treatment can reduce the degree of swelling and complications but Lymphedema is a chronic condition and must be managed throughout a patient's life.

What is Lymphedema?

The Lymphatic system is a network of small vessels that carry lymph fluid through a system of nodes. The nodes filter waste and store white blood cells. The lymphatic system helps fight infections and assists in fluid removal. The protein rich Lymph fluid is comprised of cellular waste. The job of the system is to carry this waste to the nodes for processing. The presence of protein is key in determining whether swelling is due to Lymphedema or another form offluid build up (edema).

The definition of Lymphedema is the "abnormal accumulation of protein rich fluid." If left untreated Lymphedema can cause chronic inflammation and reactive fibrosis of the affected tissue. The swelled limb will feel firm or "woody" to the touch and may feel heavy to the patient.

Who is at risk?

Primary Lymphedema is the imperfect development of the lymphatic system and can develop at any age.

Secondary Lymphedema is the more common form and can develop in response to: Cancer treatment, including surgical removal of lymph nodes or radiation, trauma to the lymphatic system, infection, obesity, or a parasite.

Not all patients who have lymph nodes removed develop Lymphedema. It is believed that genetics playa roles as well. There is also no time frame for developing Lymphedema. Patients may show signs of swelling months after a procedure, years later, or not at all.

Pediatric primary Lymphedema

Pediatric patients have special needs and SunMED strives to meet them. Devices geared to facilitate compliance and garments with fun, kid friendly colors and prints can help make managing primary lymphedema easier on our young patients.

Signs of Lymphedema

• When you press on your skin it leaves an indentation
• Swelling Numbness or tingling
• Clothing or jewelry feels tight or leaves indentation
• Pain, soreness, or pulling sensation
• Limb feels heavy, warm, or tight
• Skin is red

Complications

• Infections
• Reduced mobility
• Wounds

Prevention

• Excessive heat or cold (such as hot tubs), trauma to the affected area (bits, burns, cuts, etc.), or weight can trigger Lymphedema.
• Maintain a healthy weight
• Keep skin clean and moisturized
• Treat all infections immediately
• If you plan to fly ask your Therapist about wearing compression garments during flight
• Limit your exposure to extreme heat or cold
• Avoid tight jewelry, clothes, or heavy loads (bags or purses) on the affected side
• Avoid procedures such as blood draws or injections on the affected side
• Discuss your exercise program with your therapist, exercise is always beneficial but your therapist may want you to make modifications to your program, such as wearing a garment while exercising the limb.
• Measuring your ann and feeling the consistency of tbe tissue can help you monitor changes.

Treatments

Treatments are provided by Lymphedema Therapists, a Nurse, Physical, Occupational, or Massage Therapist trained in Complete Decongestive Therapy (CDT). CDT is a combination of Manual Lymph Drainage (MLD), a gentle massage technique that moves the lymph fluid in conjunction with compression bandages, garments, binders, and specialize pumps that keep the lymph fluid from accumulating.

How SunMED can help

SunMED is a national provider of all types and brands of Lymphedema products. We will bill your insurance carrier for any product your Therapist or Doctor orders, or if you do not have coverage will provide them at discounted private pay rates. The Women's Health and Cancer Rights Act of 1998 requires all group health insurance policies cover the treatment of mastectomy related Lymphedema. The Lymphedema Specialists at SunMED will ensure that you get the products you need and work on your behalf to get them covered by your insurance.

Resources:

LANA (Lymphology Association of North America) clt-lana.org
NLN (National Lymphedema Network) www.lymphnet.org
Survivors' Helpline 888-753-5222
Lymphnotes.com
Lymphaticresearch.org
Living Beyond Breast Cancer lbbc.org