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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.
After surgery,
limit stretch on the axillary
area for 10-14 days post-operatively
, as
lymphatics have limited time to regenerate: NLN
Conference Lecture, 2010, Jodi Winicour PT
From Foldi Textbook of Lymphology: Lymphatic
regeneration occurs as the stumps of the
afferent or efferent collectors of a removed
node connect as the result of proliferation of
the endothelium at the terminal portion of the
damaged vessel. Regeneration of superficial
vessels in dogs takes 4 days, and deep vessels
in 8 days.
Llimit your arm movement to
shoulder height for the first 10-14 days
post-op to allow the efferent and afferent
vessels to connect during the limited time of
lymphatic regeneration.
Systematic review of early vs. delayed exercise
has shown delayed exercise decreases seroma
formation:
http://www.ncbi.nlm.nih.gov/pubmed/15830140
A study in 2008, published in Physiotherapy,
showed higher risk of development of lymphedema
in women who had axillary node dissection and
performed exercise early vs. delayed exercise:
http://www.lymphoedemaleeds.co.uk/Pages/Research.aspx
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;
- A few weeks
after surgery, 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."
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.
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
-
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 controversial
studies done on 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
TLC
HAH Originals
NStyle ID
Page Last Modified
09/29/2015
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