All swollen up

September 26, 2013
The Glebe was still on lock down so I took a lady for a walk and we did some window shopping, she was so happy to get out in the sunshine. I now have an extra lady that I do knitting with, she is recuperating from being in hospital, so she should feel better and more able to knit in a few weeks.
I noticed yesterday that it felt like I had a rock under my arm, grrr lymphedema, I haven't had this in a long time. So I had to dig through my drawers and find my compression shirt. I put it on and wore it all night, my arm swells very little, its more under my arm around to my back. Its a little better today.  I wore it to the gym and everyone thought I was very colorful. I explained why. I didn't do any cardio today, I was struggling to breathe, I must have gotten some corn starch some where. So I did my weights routine today and walked home as my car is in the garage.

About Lymphedema

Lymphedema is the swelling that occurs when lymph fluid builds up in the soft tissues of the limbs. It is caused by a problem in the movement of waste products (lymph) away from a limb (arm or leg). Lymphedema usually occurs in parts of the body where larger numbers of lymph nodes have been removed, such as the armpit (axilla), groin or pelvic area.

The lymph nodes work like small filters in the body. They filter and clean body fluids, abnormal cells and cells that cause infections. This cleaned lymph is then returned to the bloodstream.

Lymphedema occurs in about 20% of people who have had lymph nodes removed.

Causes

Any blockage or interruption to the lymph system can cause lymphedema. For example, when:

• lymph nodes have been removed during surgery (lymph node dissection)
  • can occur right after surgery, months or even years later
• radiation therapy to lymph node areas causes scarring, blockage or slowing of the lymph flow
  • may develop during a course of radiation therapy or several weeks after
  • having surgery and radiation therapy can increase the risk for developing lymphedema even more
• chemotherapy temporarily overloads the lymph system
• cancer spreads to the lymph nodes, causing a blockage
• an infection or inflammation develops in a limb, causing more damage to the lymph vessels

Symptoms

Lymphedema may occur in the trunk or limb area of the body that has been treated for cancer. It can alter the size, shape and function of an affected limb and cause:

• swelling in the limb (arm or leg)
• feeling of fullness, puffiness, or heaviness in the limb
• aching in the limb
• skin to feel tight
• decreased flexibility or movement in the limb
• clothing or jewellery to feel too tight

Lymphedema can be temporary or permanent. Many people with cancer find it is a long-term problem.

Diagnosis

Report the first signs of swelling to the doctor. The doctor may make a referral to a physiotherapist. The doctor or physiotherapist will:

• ask about medical, surgical and physical activity history and when the swelling started
• check to see if there are other reasons for the swelling, such as an infection, blood clot or new cancer
• measure the distance around (circumference) the limbs at a number of places
  • a difference of 2 cm (0.8 inches) or a significant change in limb volume may require treatment
  • assess the type of swelling and classify it as mild, moderate or severe
• check for tightness and feeling of heaviness in the limbs
• check the range of motion and strength of the limb

Prevention

After lymph nodes have been removed or damaged, it is harder for the body to fight infection, especially in the affected limb. Protect the limb from injuries, such as cuts, scratches, bruises or burns that may cause infection, by doing the following:

• Wear sunscreen to avoid sunburns, especially to the affected limbs.
• Wear loose-fitting jewellery and clothing on the affected limb.
• Keep hands, feet and cuticles soft by regularly applying moisturizing lotion or cream. Avoid pulling or tearing cuticles.
• Keep the skin clean. Test bath water temperatures with the unaffected limb. The affected one may not detect temperatures as well.
• Treat cuts or burns on the limb quickly. Clean the area, cover it with an antibacterial (antibiotic) cream or ointment (such as polysporin or bacitracin), apply a clean bandage and change it as often as necessary to avoid infection.
• Check for signs of infection, such as redness, swelling and increased warmth (cellulitis). Report these to the doctor so that an infection can be treated promptly.
• Use an electric razor to shave in affected areas because of possible numbness from surgery.
• Wear protective clothing or use insect repellents to prevent insect bites. These could become a source of infection.
• Avoid using ice packs or heating pads on the affected limb.
• Use saunas, steam baths and hot tubs with care. Heat can make lymphedema worse by increasing the work of the lymph system.
• If possible, avoid having needle sticks of any type in the affected limb. This includes having a blood sample taken, an intravenous, an injection (such a flu shot or other vaccination) and acupuncture on the affected limb or in affected areas. Needle sticks and injections can increase the risk of infection.
• If possible, avoid having blood pressure measured on the affected arm. If lymph nodes were removed from under both arms, then alternate the arms used when having blood pressure measurements done. Blood pressure cuffs put pressure on the small lymph vessels.
• If diagnosed with lymphedema, it may be suggested that a compression garment be worn when travelling by air. There is no benefit to doing this if there isn't any swelling.
• Exercise increases muscle tone and may help stimulate lymph drainage. Exercises include most activities of daily living and aerobic exercises, such as swimming, biking, and walking. Check with a healthcare professional regarding vigorous, repetitive activities. Repetitive exercise against resistance may make lymphedema worse. Wearing a compression garment during exercise may be recommended.
• Maintain an ideal body weight. Being overweight is a risk factor for developing lymphedema and can make it harder to control. Restricting the use of salt (sodium) in the diet or using fluid pills (diuretics) is not usually effective. Drinking 6 to 8 glasses of water a day may improve lymph flow.
• Preventing lymphedema in the upper limbs.
  • Do not use a shoulder strap over the affected arm when carrying a purse or briefcase.
  • Wear a loose-fitting watch and clothing on the affected limb.
  • When manicuring the fingernails, gently push the cuticles back instead of cutting them.
  • Wear protective gloves when gardening, doing housework or cooking.
  • Use a thimble when sewing.
  • Avoid pet scratches.
• Preventing lymphedma in the lower limbs.
  • Wear socks to keep feet warm, but avoid socks, stockings or underclothes with tight elastic bands on affected lower limbs.
  • Avoid walking barefoot.
  • Cut toenails straight across.
  • Dry feet well, especially between toes to prevent infection.
  • Avoid crossing the legs while sitting and don't sit longer than 30 minutes without changing position.

Treatment

It is important to manage lymphedema properly to prevent changes that may become hard to reverse. The goal of treatment is to prevent further fluid build-up and reduce swelling as much as possible. Managing lymphedema may include a combination of:

Elevation

Raise (elevate) the affected limb above the level of the heart, so that gravity will move the fluid from the limb to the body. Make sure the legs are above the hips when elevating legs during sitting. Raise the foot of the bed about 2.5 to 5 cm (about 1 to 2 inches).

Exercise

Exercise can be done in moderation and is helpful in maintaining muscle tone. Good muscle tone helps improve lymph flow. Be sure to:

• use the affected limb as normally as possible
• balance rest periods with exercise
• avoid repetitive exercise against resistance
• stop before overtiring the limb

Therapy

Seek treatment by a therapist with experience in managing lymphedema. Massage and physical therapies may help to drain fluid away from the affected limb. Check with your provincial health insurance plan about coverage for some of these therapies.

Manual lymph drainage (MLD or MLT)

Manual lymph drainage is a special kind of light massage. It improves drainage from the limb by clearing out the main lymphatic pathways of the body, starting in the main part of the body and moving towards the affected limb.

Compression garments

Many treatment methods use compression garments to keep lymphedema under control. These elasticized garments put a graduated pressure on the limb and can help move lymph into the lymph vessels and prevent lymph fluid from collecting. They may need to be worn all day (during waking hours), when working, or with exercise.

Compression garments need to be fitted for each person and should only be worn on the recommendation of a doctor or physiotherapist. Specific directions will also be given on how and when to wear it.

Complex physical therapy (CPT)

This treatment routine involves a combination of manual lymph drainage, skin care, compression bandaging, exercises and use of compression garments. It is sometimes called complex decongestive therapy (CDP).

Sequential pneumatic compression pump

This device pumps air into a special pump sleeve, creating light pressure to help move lymph fluid into the lymph vessels and back into the bloodstream. These are only used if recommended by a doctor or physiotherapist. This device should not be used if there is active infection or problems with blood clots.

Pain

Lymphedema can cause pain and change sensations in the limb. In many cases, once the lymphedema is controlled, so is the pain. If the lymphedema treatment does not help, the doctor may change the treatment or order medication to relieve pain. Some people have numbness and tingling after surgery, which is not lymphedema.

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