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

NStyleID

Page Last Modified 09/29/2015

All medical information presented on this page is the opinion of
our Editorial Board and Experts.  See our "About us"  and "Resources" pages.