MD
Anderson Cancer
Center
Date: January
2011
Duration: 11:27
What is Lymphedema?
This presentation is about the lymphatic system and lymphedema management.
Hello, my name is Janet Scheetz, PT, CTL-LANA, I am an Outpatient Supervisor for
MD Anderson Cancer Center, and I am certified in lymphedema management.
The Lymphatic System
The lymph system serves as a drainage system within our body. It helps to balance fluid levels and fights against infections and illnesses.
How the Lymphatic System Works
The lymph fluid moves through the body picking up bacteria, viruses and waste products. The fluid travels through the lymph vessels which lead to the lymph nodes where it is filtered. The filtered fluid then travels into larger deeper ducts and ultimately drains into the blood system and is flushed from the body.
The axillary lymph nodes will drain the tissues within the breast and the arm.
The groin lymph nodes will drain the lower leg and the buttock area.
Ultimately, the fluid will travel through the chest cavity along the thoracic duct and right lymphatic duct rejoining the blood system behind each of our collar bones.
Lymphedema
Lymphedema is an abnormal buildup of lymph fluid which causes swelling most often in our arms and our legs. This happens when lymph nodes or vessels are not working properly.
This is most commonly due to cancer related treatments, for example….lymph nodes being removed during surgery or you may have had radiation treatment of lymph bearing tissue. The swelling will range from mild to extreme and extreme swelling could make it impossible to use the affected arm or leg.
Early Signs of Lymphedema
There are numerous signs of lymphedema, you may experience heaviness, tension or aching in the arm or leg, have a feeling of pins and needles, notice puffiness in the arm, leg or trunk. Or notice a pit or indentation when pressing the skin, have a feeling of heat in the arm or leg, or having pink or inflamed skin.
When Lymphedema is Not Treated
When lymphedema is not treated it can get worse over time. The skin and tissues under the skin can become harder and thicker. You are at greater risk for infection and you may find it hard to do your normal daily activities, your clothing may not fit, and you may have difficulty coping with these changes.
Managing Lymphedema
To manage the lymphedema we suggest you follow the physical therapists suggestions to help prevent it. Watch for signs and symptoms and check for lymphedema daily. Report any signs and symptoms to your physician immediately.
Preventing Lymphedema: Infection and Injury
There are many things you can do to prevent lymphedema. This is a list of things that help prevent infection and injury:
Raise the infected arm, leg or area on the body when possible
Avoid pressure and constriction such as having your blood pressure taken or blood drawn from your affected arm
Try not to wear tight clothing, shoes or jewelry
Try not to sleep on the affected limb
Avoid cuts and scratches
If your leg is affected, always wear supportive shoes. Do not go barefoot.
Outdoor Safety
When working outdoors, always use protective gear and wear sunscreen.
When gardening wear gloves to avoid injury to your hands.
Kitchen Safety
Use caution when using knives and when peeling or grating food.
Wear oven mitts when handling hot foods and wear rubber gloves when washing dishes.
Be cautious in heated environments such as:
Using a heating pad or an electric blanket on the affected arm or leg or sitting in whirlpools or saunas.
Diet
In regards to diet we suggest:
Maintaining your ideal body weight
Drink 64 ounces of water daily
Avoid salty food or adding salt to foods
Limit caffeine and alcohol
Eat fresh fruit and vegetables
Travel
When traveling it is important to:
Stay well hydrated
Take stretch breaks and brief walks
Perform the lymphedema exercises given to you by your therapist
Wear compression garments or bandage your arm or leg.
Lymphedema Treatment
Complete Decongestive Treatment
There are four components within the complex decongestive therapy program (CDT). These are skin care and activity precautions:
Compression – whether it be the elastic garment or the use of the non-elastic bandages
Manual lymphatic drainage
Exercises
Skin Care
It is important to perform daily skin care.
Apply low PH level lotion…such as Eucerin® or Lubriderm®.
Dry your skin well after bathing
Use corn starch or talcum powder on your feet to keep them dry during the day.
Remember to treat cuts right away. Use soap and water to clean them, and apply antibiotic cream or ointment, and watch for any signs of infection….such as redness, a feeling of heat, fever or chills. If the wound becomes infected seek medical treatment right away.
Compression
Compressing involves the use of non-elastic bandages and elastic compression garments. Compression improves the flow of lymph fluids through the vessels and it improves and maintains the shape of the limb.
Compression Bandaging
This is a non-elastic compression system. The compression encourages the flow of fluids back into the vessels. The compression bandages will be worn 23 hours a day during the treatment phase.
Compression Garments
Compression garments are elastic and intended for daily wear. You will need to have a professional fit you for the garment. The compression garment can be ready to wear off the shelf or they may need to be custom made. This depends on the shape and size of the affected limb.
Manual Lymphatic Drainage (MLD)
Manual lymphatic drainage is a gentle massage that uses a light rhythmic stroke to stimulate lymph flow and redirects fluid to the unblocked area. MLD helps lymph fluids move quickly through the lymph system. This should be performed by a professional who has been certified in manual lymphatic drainage.
Advantages of MLD
The advantages of having MLD, is that it helps to drain and clean the tissues in the body. It develops new lymph routes for the lymph drainage. It helps the body relax and provides pain relief.
We suggest not having manual lymphatic drainage performed if you have untreated cancer, have an active infection, have untreated congestive heart failure, or untreated blood clots.
Exercises
There are four types of exercises that we teach during the treatment program. These include the lymphedema, flexibility, strength and aerobic exercises. Please check with your doctor before beginning an exercise program.
Lymphedema Exercises
The lymphedema exercises are active and nonresistive exercises that are performed slowly and rhythmically. In professional articles about lymphedema, they are referred to as decongestive exercises.
Diaphragmatic Breathing
The most important decongestive exercise is the diaphragmatic breath. Do this exercise every day. Diaphragmatic breathing pushes the chest cavity which helps move the lymph fluids through the lymph ducts and back into the blood system at a quicker pace.
Flexibility Exercises
It is important to do your flexibility exercises after surgery and radiation. Scars and tightness can create a barrier for the lymph fluid causing swelling to occur. Flexibility exercises work best when done daily and done slowly. Practice these exercises at your own pace so that you do not feel sore after stretching.
Strengthening Exercises
Before recommending strength exercises, the physical therapist will measure your overall stamina, flexibility and strength, and then design an exercise program for you to follow.
Aerobic Exercises
Aerobic exercises help to stimulate the deep lymphatic vessels to work at a faster pace. We suggest those with lymphedema perform activities such as swimming and walking. There are certain types of aerobic exercises such as jogging and tennis that may make your risk for lymphedema higher or make the condition worse. Do aerobic exercises at least three times a week.
Frequently Asked Questions
There are three frequently asked questions:
Should I use the compression pump? Researchers are currently investigating the pump. Ask your physical therapist about current research to learn more.
Should I take diuretics or water pills? Chronic use of diuretics will worsen lymphedema. Over time, diuretics cause tissue beneath the skin to harden and stop lymph fluid from flowing.
Does surgery treat lymphedema? Studies are currently being conducted to determine if surgery will be beneficial in reducing lymphedema. Ask your physical therapist about current research to learn more.
Thank you for your attention.
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