Lymphedema

Removing Your Lymph Nodes

You may hear the term "lymphedema" when your surgeon first discusses your operation for breast cancer. Whether you have a lumpectomy or mastectomy, your surgeon will usually remove some of the lymph nodes under your armpit. This procedure (an axillary node dissection) is most often done at the same time as the breast surgery. If cancer is found in the lymph nodes, your doctor will talk to you about additional treatments. These additional therapies are designed to control and kill cancer cells that could be in other parts of your body. The advantage to this is finding out the "stage" of your cancer. However, possible problems include stiffness of the arm, numbness under your arms, and swelling of the arm.

Definition of Lymphedema

Lymphedema is an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arm(s). The lymph nodes in your armpit filter lymph fluid from the breast and your arm. Both radiation therapy and surgery can change the normal drainage pattern. This can result in a swelling of the arm called lymphedema. The problem can develop right after surgery or months to years later. About 5% to 20% of women develop this problem.

Symptoms of Lymphedema

Signs or symptoms of lymphedema to watch out for include: a full sensation in the limb(s), skin feeling tight, decreased flexibility in the hand, wrist or ankle, difficulty fitting into clothing in one specific area, or ring/wristwatch/bracelet tightness. If you notice persistent swelling, it is very important that you seek immediate medical advice from a medical doctor who is familiar with lymphedema. Early diagnosis and treatment improves both the prognosis and the condition.

Treatment of Lymphedema

Treatment of lymphedema will depend on how serious the problem is. Options include an elastic sleeve, an arm pump, arm massage, and bandaging of the arm. Exercise and diet also are important. Should this problem develop, talk to your doctor and see a physical therapist trained in manual lymphatic drainage as soon as possible. The sooner you receive treatment the better your chances of reducing the swelling. I encourage you to once again do what is best for you! Treatment experts presenting at a New York City American Cancer Society workshop, from the U.S. and abroad, often disagreed demonstrating different schools of thought on the use of drugs and surgery, fitted sleeves and drainage pumps, massage and wrapping techniques and the most effective methods for complex decongestive physiotherapy. (My personal experience with both the pump and then manual lymphatic drainage is told in "My Story." However, I had a great deal of trouble with the manufacturer, Barton-Carey, on my fitted sleeves for both arms. It appears they not only could not follow the measurements from my physical therapist but lied to all of us as to time lines, pairs sent, costs, etc. After four attempts to use their sleeves, I would recommend someone else!)

Protecting Your Arm

To protect your arm(s):

• Avoid sunburns and burns to the arm or hand.

• Have shots (including chemotherapy) and blood pressure tests done on the other arm. If you have bilateral lymphedema, you will need to discuss your personal situation with your physician. I have blood pressure taken on my legs and blood draws are done by my surgeon in my pelvic area.

• Use an electric razor for shaving underarms.

• Carry heavy packages or handbags on the other arm or shoulder.

• Wash cuts promptly, apply antibacterial medication, cover with a bandage, and call your doctor if you think you have an infection.

• Wear gloves to protect your hands when gardening and when using strong detergents.

• Avoid wearing tight jewelry on your affected arm or elastic cuffs on blouses and nightgowns.

You may want to consider wearing a Medic Alert bracelet stating no blood pressure or blood draws on your affected arm(s). The National Lymphedema Network also promotes wearing a bracelet to protect breast cancer survivors from receiving treatment to their affected arms(s) that could trigger the onset of lymphedema or worsen an existing case.

Some of this information is from A Woman's Guide to Breast Cancer Diagnosis and Treatment from the Medical Board of California; National Lymphedema Network; and an article in the April 1998 issues of NABCO News.

National Lymphedema Network

The National Lymphedema Network is an internationally recognized non-profit organization founded to provide education and guidance to lymphedema patients, health care professionals and the general public by disseminating information on the prevention and management of lymphedema. A toll-free support hotline is: 1-800-541-3259