Reducing Your Risk of Lymphedema
A recently published study showed
that
accurate
patient education is a critical
dimension of lymphedema risk-reduction. Knowledge of lymphedema and
its risk reductions is essential to all breast cancer patients, and
makes a difference in their long-term quality of life.
In this study only fifty-seven percent
of the participants reported that they received lymphedema
information.
-
"Cancer-Related Lymphedema: Information, Symptoms, and
Risk-Reduction Behaviors," Authors: Fu, Mei R.;
Axelrod, Deborah; Haber, Judith, Source: Journal of Nursing
Scholarship, Volume 40, Number 4, December 2008 , pp. 341-348(8)
If
you've been treated for breast cancer, you are at risk
for lymphedema of the hand, arm, back, and chest or
breast on the affected side. If your surgery was
bilateral, then both sides are at risk. The risk remains
for the rest of your life. The good news is that you can
reduce that risk by understanding a few important
principles and the safe practices that follow from
them.
Promote and Protect.
Two
words summarize all the risk reduction practices and make them easy
to remember: "Promote"
and "Protect."
That means you will
promote
the lymph flow in your affected arm/chest or other affected area,
and
protect
the area from injury or infection. This can be done in a few
simple ways:
- Drink plenty
of fluids -- staying well hydrated helps dilute lymph fluid and
keep it moving freely;
- Elevate the at
risk arm or hand as much as possible during the day and on
pillows at night; support the arm well so that it doesn't tire;
- Several times
a day (or whenever you think of it) pause and do some
deep breathing -- this helps stimulate the largest lymph
vessels in your body and promotes lymph flow; Repeat the
breathing exercise 10 to 20 times;
- Several times
a day (or whenever you think of it) pause and raise your hands
over your head as high as is comfortable for you, and "pump"
your fists open and closed 10 to 20 times. This can be
done with or without a "stress ball."
I had a conversation
with a masseuse yesterday. He mentioned how most of his clients
have compromised lymphatic movement, and the first thing he
teaches them is therapeutic breathing. So I asked him about
breathing, specifically We know about breathing in through the
nose, out through the mouth, getting a good tummy breath, right?
What he added was the importance of a full abdominal
tightening/crunch which includes the butt and a kegel squeeze at
the end of the exhale. Then the inhale is started by abdominal
relaxation, then filling the lungs. I found it to be helpful. -
kcshreve
Prevent infection
-
Keep the
skin clean (Please see the article written by Dr. Mei Fu and
published in the Wounds International
Preventing skin breakdown in lymphoedema ›
Practice development › Wounds International, Vol 1; Issue 4 ›
Wounds International
regarding skin care, or see or print a copy of the article in
pdf format here.)
-
Keep your
arm pits and the area under your breasts dry to avoid fungal
infection
-
Keep your
skin intact
-
Moisturize
your skin daily to prevent microscopic cracks
-
Keep nails
clean and avoid cutting cuticles
-
Use
sunscreen or protective clothing to prevent sunburn
-
Use an
insect repellent on any exposed skin
-
Avoid razor
nicks and burns--see
Shaving Under Our Arms
-
Wear gloves
when handling household cleaners and other chemicals
-
Wear rubber
gloves when washing dishes
-
Wear sturdy
work gloves when gardening or using tools
-
Wear a
thimble when sewing to avoid needle and pin pricks to your
fingers
-
Use extra
caution to prevent burns
-
Avoid skin
punctures from IV's, injections, blood tests
-
Discuss with
your doctor the use of prophylactic oral antibiotics with any
medical procedures that involve the affected parts of your body
In case of nicks, scratches, burns, insect bites,
abrasions or any skin break, wash the area well and
apply a topical antibiotic. Watch for redness, itching,
sudden swelling, warmth to the touch, rash, or fever,
which may indicate an infection, and
get medical help
promptly.
Stay active, but be watchful
-
Exercise is good for both prevention and control of
lymphedema.
-
Build up gradually to your former activity level.
-
With any new activity, start slowly and increase
gradually.
-
Take frequent rests, or switch activities to avoid
overuse or constant repetition.
-
Stay well hydrated (avoid caffeine).
-
Use your legs, not your back, to lift things (or
kids!) off the floor.
-
Use both arms rather than one to carry heavy
objects, such as milk bottles.
-
Keep your arms close to your body when hefting
loads.
Stop at once if you experience heaviness, aching,
firmness, or swelling. Rest and elevate your arm. You
may want to try the activity again the next day, but
stop earlier and plan to proceed more slowly.
Your certified personal trainer can ask for
a copy of the PAL Protocol. The Univ of Pennsylvania does not give
it out to us mere mortals, but they will give it to a qualified
trainer. Here's the link to fill out the form to ask for it:
http://www.penncancer.org/physical-activity-and-lymphedema/receive-pal-intervention-materials/
The PAL Protocol is a very detailed
explanation of the exercises used during the PAL trial, and your
trainer will know just how to interpret the information in the
document. As a general description, for upper body work, the idea
is to start with very low weight (1 lb..feels silly but that's the
research-based way to minimize LE risk), add in very small
increments, gradually, lifting 2x per week. If you miss more than a
session, back off the weight to the prior increment.
Avoid body-weight exercises that have you
bearing weight on the upper body (i.e. push up, plank), because it's
not feasible to know how much weight you are bearing, nor to build
in small, measured increments. Bodyweight exercises are possible
after you have built up through the slow weight progression over
time.
If you have an LE diagnosis: wear a sleeve
and gauntlet or glove. If you do not have an LE diagnosis: it's a
judgment call. Any tingly feeling, or heavy feeling in your affected
arm? If so, try to see an LE therapist now for an evaluation,
because you may have subclinical (net yet visible) LE, and in that
case, were it me, I would be wearing the sleeve/gauntlet when
lifting weights.
(And if you have the tingly/heavy feeling,
get that eval even if you're not going to lift weights, because
research suggests that if you treat it while it's subclinical, you
may be able to reverse it.)
Your instinct to start working with a
trainer to lift weights is spot on. Think about this: if we can
condition our arms/trunk to lift heavier weights, the fact of
lifting heavier weight will be less likely to get the lymphatic
system all excited and trigger LE. The trick is to avoid triggering
LE while you lift gym weights to build up your ability to lift
daily-life weights--hence the slow (annoyingly slow) pace of adding
weights to your program.
For lower body: Have at it, except of
course, watch for lifts that also require help from the upper body,
like dead lifts and weighted squats. The PAL Protocol helps your
trainer interpret this.
I don't think you're being silly at all,
and activity like raking is highly repetitive against resistance, so
I think you do want to stop and rest pretty often. I hope someone
else will drop in here and suggest strategies for doing that kind of
work while taking some LE precautions.
Good luck with all of the above! I have LE
in my upper arm and on the side of my trunk, and I am now about 8
weeks into weight training, following the PAL Protocol, with a
certified trainer. The weights I'm lifting are humorously light
compared to before my bmx last summer. But I also take great
pleasure in reporting that I can tell I'm regaining my prior
strength, and so far (knock on wood), I have not had a single
experience of my LE flaring during or after a training session.
(Wish I could say that about flying, sigh. I need a research-based
FLY protocol!) I wear a men's short-sleeved Under Armour
compression shirt to support my LE side, in addition to wearing the
sleeve and gauntlet while training. Carol
Avoid constriction
-
Do not allow blood pressure
to be taken on an at-risk arm.
-
Make sure bracelets, rings, watches and clothing are
not tight.
-
Bras should fit comfortably, with wide straps that
do not cut into the shoulders.
-
Avoid under-wire bras that can limit lymph drainage
below the breast.
-
Keep bags and purses light so they don't dig into
your shoulders or fingers.
Avoid temperature extremes
-
Extreme cold may cause rebound swelling that can
overwhelm the lymph system.
-
If an ice pack is needed, pad it with a towel and
use it for no longer than 10 minutes at a time.
-
Heat can draw lymph fluid to the affected areas and
overwhelm the lymph system.
-
Avoid water temperatures of more than 102 degrees in
hot tubs, saunas, baths or showers.
-
If moist heat is needed, moderate the temperature
and use it for no longer than 10 minutes at a time.
-
In warm climates, limit outdoor activities to the
cooler morning hours.
Control your weight
Studies have
shown that maintaining your ideal weight, or losing weight if
you are overweight, can make a significant difference in
controlling lymphedema.
Weight loss may curb cancer-related arm swelling.
-
If you are overweight, weight loss can significantly
reduce your lymphedema risk.
-
Try to avoid weight gain following your cancer
surgery.
-
Get help from a dietician if necessary.
Use
compression garments
-
Always "promote" your lymph flow with manual lymph drainage
massage before donning your compression garments.
-
Garments
should fit
well
and be checked for fit by a knowledgeable
professional.
-
Always wear a glove or gauntlet with a compression
sleeve to avoid trapping any excess fluid in your
hand. Please see this important and informative
article by
Dr. Andrea Cheville, Associate Professor of Physical Medicine at
the Mayo Clinic,
Importance of Compression Sleeve and Gauntlet Combination:
USE OF GAUNTLETS AND COMPRESSION SLEEVES IN LYMPHEDEMA
MANAGEMENT AND PREVENTION
-
If you have had bilateral surgeries, wear garments
on both arms.
-
Wear your garments when you exercise or for any
strenuous or unusual activities, or if your arm
feels achy or heavy after exercise.
-
Wear your garments for air travel, and for an hour
or two after you land while your arm recovers from
the pressure changes. (Please
click here to learn more about wearing compression garments while flying.)
-
If you choose to travel without wearing compression
garments, take a well-fitted sleeve and glove with
you in your carry-on luggage in case you develop
heaviness or swelling. (Please
click here to learn more about controversial
studies done on wearing compression garments while flying.)
In addition to all
of the above risk reduction recommendations, we
suggest each and every patient with lymphedema, or at
risk for lymphedema, wear a
medical alert bracelet (free from
Peninsula Medical, Inc.
) as well as a
g-sleeve
when going to doctor's appointments or being admitted
into the hospital, for additional protection of their at
risk limb.
In addition, there
are many places on the web that sell lovely medical
alert bracelets that look like jewelry. Here are
some examples of places we have found lovely bracelets
in all price categories. There are many available,
but these are some of our favorites available at the
sites below and others: The beautiful selection of
this medical alert jewelry is huge!
And yes, they can
easily be worn over your sleeve/glove!
Laurenshope
Creative Medical ID
ECrator
HAH Originals
