Lymphoedema

Lymphoedema:  an abnormal swelling of the arms or legs – but can also occur elsewhere.

After breast cancer treatments such as radiation, surgery, axillary node dissection, reconstruction or chemotherapy you can present with lymphoedema. It can occur in the arm, the armpit, around the breast, shoulder blade or in the rib and chest area. Although there is no cure for lymphoedema, correct management can contain the effects.

It is important to know what lymphoedema is and the symptoms. Should any of the aforementioned areas look red, or feel warmer, swollen, tight, stiff or ungainly, you most probably have lymphoedema. If, when you press in that area for a few seconds, an indent appears – you definitely have lymphoedema.

Risk Factors

Extra Weight: The most significant risk factor for developing lymphoedema is being overweight or obese.

The Body Mass Index (BMI) is used to indicate normal ranges for one’s height. The formula is: Weight in Kilograms divided by (height in Meters x height in Meters). For example, a woman is 1,76m tall and weighs 85kg. The calculation would be 85 divided by (1,76 x 1,76). Do the math in the bracket first: 1,76 X 1,76 = 3,0976. Now divide 85 by 3,0976 = 27,4.

A BMI of 20 to 25 is normal, 25 to 30 is acceptable – but a weight reducing plan is required. Anything greater than 30 is obese and requires immediate attention.

Seroma

Seroma can occur during surgery.

A cavity forms and fills up with lymph fluid – it feels like a balloon filled with water. This is treated with constant compression over the seroma area.

Infection

Certain patients can get cellulites (skin inflammation) following surgery or radiation therapy. Antibiotic treatment must be administered immediately.

Taking Care

  • Avoid drips, injections, blood tests and blood pressure cuffs on the affected arm.
  • Do not allow chemotherapy or herceptin to be administrated on the affected side via a drip.
  • Avoid damaging the skin of the affected areas as this could lead to infection. 
  • Should you wound yourself, clean the area with an alcohol swab and apply an antibacterial cream e.g. Bactroban. Keep a plaster on until new skin has grown.

Skin Care

  • Keep your skin clean and dry.
  • Moisturise daily to prevent chapping or chaffing. 
  • The moisturiser should be ph 5.5. 
  • Do not cut or pull cuticles. 
  • Remove excess hair with a blunt razor or electric shaver,

Extreme temperatures

  • Extreme cold can cause rebound swelling and chapping
  • Avoid prolonged (not more than fifteen minutes) heat; especially hot baths showers or saunas. Water should not be more than 30º C 
  • Avoid placing the limb in hot water
  • Avoid prolonged periods over a hot stove

Constriction

  • Any tightness of the area disrupts lymph drainage
  • Wear loose fitting jewellery and clothing

Diet

  • Avoid salt and spices.
  • Keep fat intake to a minimum.
  • Avoid natural diuretics like alcohol, fizzy drinks, tea and coffee
  • Drink 6-8 glasses of still water a day

Travel

  • Wear a compression garment, if recommended
  • Drink lots of liquid
  • Take deep breaths, eat low fat and low salt
  • Anything longer than 4 hours by road or by aircraft requires precautions such as a compression garment.

Exercise

  • Exercise is important as it helps to keep your weight controlled; mobilises tight, healing tissue; builds up weak muscles and allows your muscles (as they contract) to act as a natural pump for lymph drainage.

Other

  • Deep breathing stimulates lymph flow
  • Avoid mosquito / spider bites – wear long sleeves and use insect repellants 
  • Wear gloves and long sleeves when playing with pets to avoid scratches 
  • Wear long gardening gloves when gardening to avoid scratches etc 
  • When cooking or baking avoid burns and cuts 
  • When sewing wear a thimble

I shall devote my next article to the treatment of lymphoedema and exercise. In the meantime work hard at maintaining an active and healthy lifestyle.

Written by Sue Serebro

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