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Lymphedema, by Cate Mullen, RN
Nurse Coordinator, Breast Health Center
Tufts-New England Medical Center
reprinted with permission
The lymphatic system is part of our immune system. When the lymph nodes are removed as part of breast cancer surgery, the system becomes disrupted and the body’s ability to fight infection becomes impaired. When women undergo an axillary lymph node dissection, they are at increased risk for lymphedema.
Five to ten percent of women who have had lymph nodes removed will develop lymphedema. There is no cure for lymphedema.
There are 3 distinct stages to lymphedema:
- Stage 1 is considered Mild and is characterized by pitting of the skin and indentation when you press on the skin. The condition changes as the day goes on.
- Stage 2 is considered Moderate. You will see no indentation if you press on the forearm.
- Stage 3 is considered Debilitating. This stage is an irreversible swelling of the arm and includes tissue that is hard and fibrotic.
Signs and Symptoms of Lymphedema:
- heavy sensation in the arm
persistent swelling
skin feels tight
new onset of tightness around your ring and watch
decrease in flexibility
Lymphangitis is when the fluid becomes infected. Symptoms of this include fever, redness and swelling of the skin, the skin feels warm, and you may have fever and chills.
Tufts-New England Medical Center began a lymphedema clinic in 1999. Patients meet once a month to learn from nurses and physiotherapists what they need to know and can do about lymphedema.
Things to Do if you have Lymphedema:
- moisturize the skin
- keep the area clean
- wear gloves when doing dishes and gardening
- take frequent rests when cleaning
- wear oven mitts when cooking
- use an electric razor for shaving
- use sunscreen and insect repellent when outdoors
- rest your arm in an elevated position
- control your blood sugars
- wear a compression sleeve when flying
Things NOT TO Do if you have Lymphedema:
- lift heavy objects
- wear pocketbooks on the affected side
- wear clothing with tight sleeves
- wear tight rings or watches
- take unusually hot baths/showers or go in hot tubs or saunas
- smoke
- cut cuticles
- wear acrylic nails
- permit blood pressure readings on that side
- permit blood drawing or injections on that side
- drink much alcohol
Management Strategies
- Range of motion exercises; arm elevation; compression sleeves; manual lymphatic draining (self massage technique that you can learn in the clinic at the hospital); wrap with bandages
- Manual Lymphatic Drainage — It is important to learn this technique from a certified physical therapist. It is a technique of gentle massage that helps mobilize the fluid out of the arm. You need to do it every day. If you have not been properly trained, you need to go to a certified therapist who specializes in this to get treatment and/or get trained.
- Wrapped bandages can be more effective than the compression sleeve. Again, you need to see a trained therapist who can teach you how to do the wrapping. It is also a good idea to have a family member learn the technique.
- Pumps — are an old approach to lymphedema. You can rent or purchase the machine and it comes with a full-length plastic sleeve. The pump applies gradient pressure on the arm. However, you need to do this technique two hours a day.
Resources:
National Lymphedema Network: 1-800-541-3259
Greater Boston Lymphedema Network: 781-894-2309
American Cancer Society: 1-800-ACS-2345 (1-800-227-2345)
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