Each of the four seasons impacts on our lives differently. The way we behave and feel changes with the seasons. Spring is the season of new beginnings and rebirth, the grass take on a different hue and tiny buds appear on the rose bushes that were nothing more than gnarled bored stems. The twittering of birds can be heard as they busy themselves building nests in the morning as the sun begins to rise.
Spring takes on a vibrancy that we had all but forgotten during the winter months. The diagnosis and treatment of breast cancer is similar in many ways to the changing of the seasons. With diagnosis, come dark feelings, lifeless and grey, reminiscent to me of winter months. As treatment ends and we regain an energy and healthy glow, I am reminded of the rebirth that is spring.
So many of my patients ask me why no one informed them about Lymphoedema when they were first diagnosed. As I explain to them what Lymphoedema is and I begin to treat them, so they too experience a rebirth, what they physically and emotionally feel as their treatment commences behaves like a rebirth to them.
Lymphoedema refers to the accumulation of an excessive amount of fluid in cells, tissues or organs and is clinically characterised by swelling. Lymphoedema is a progressive condition that occurs when the lymphatic transport system removing the fluid from the tissue is compromised.
Lymphoedema can develop anywhere in the body, but is most commonly found in the extremities and just under the skin. In breast cancer we usually find the oedema in the arm on the affected side, the operated breast, or if you have had a mastectomy it can be on the chest wall, below the breast and around the side of the chest wall towards the back to your shoulder blade.
The lymph drainage system is made up of lymph fluid, lymph vessels and lymph nodes.
The red blood capillaries just below the skin leak fluid into the tissues and this becomes the protein rich lymph fluid. Just below the skin, anchored to it, we find the initial lymphatic vessels. They absorb this fluid and transport it via larger collecting vessels to the lymph nodes.
The lymph nodes for the arm and the breast are found in the armpit and below the collarbone. The lymph nodes act as “alarm systems” for the spread of cancer and infection. From the lymph nodes larger lymph collecting vessels return the lymph fluid back into the blood circulation at the level of the collarbone. And so the cycle of lymph fluids continues.
Usually a homeostasis exists between the amount of fluid produced just beneath the skin and the amount of fluid absorbed. If there is any dysfunction in this system, Lymphoedema occurs. The function of the lymph system is therefore to circulate fluid in the body, to remove waste products from the tissues and to act as an alarm system for infection and spread of cancer.
Lymphoedema can develop immediately after surgery. It is usually mild and resolves in a couple of weeks. If it develops 6-8 weeks following surgery or radiation therapy it will commonly resolve following manual lymph drainage. The most common form of Lymphoedema develops slowly over time and can develop years (up to 20) later.
There are varying degrees of Lymphoedema, ranging from a sub clinical to extreme stage. In my opinion as soon as you have merely had your sentinel node removed or have had surgery or radiation, you are at a risk of developing oedema.
How do you know that you have Lymphoedema?
The main symptom is swelling.
The area might feel boggy, woody, heavy or thick. You might find that your clothes, bra, jewellery and watch might begin to feel tight. The swelling might come and go, worsening as the day progresses or depending on your activity. Other symptoms could be an aching feeling, difficulty with movement, repeated skin infections (cellulitis) thickening and hardening of the skin. You might find that the skin colour changes, as you lose the normal wrinkles in your skin (like finger prints). You might find that the healing capacity following a cut or bruise is retarded.
The greatest risk factors for developing lymphoedema secondary to breast cancer
- Radiation Therapy.
- Seroma Presence.
- An elevated BMI (normal BMI=18,5-24,99).
- Increased heat – no hot baths, showers, steam showers, saunas-stay cool!
- Injury or trauma to the area. Avoid injections, drips, or blood to be taken from the arm of the affected side. If you are having chemotherapy prior to your breast surgery they must always administer the chemotherapy on the opposite side if you do not have port.
- If you are gardening wear gloves.
- Avoid spider bites and mosquito bites.
- If you are cooking, do not cut yourself or burn yourself.
- If you are sewing use a thimble.
- Infection – should you hurt yourself, clean the area with an alcohol swab and apply Bactroban until it is completely healed.
- Use your own apparatus if you have manicures
- Diet – drink 6-8 glasses of water a day. Enjoy a low salt and low fat diet. Avoid too many diuretics (tea, coffee, alcohol and fizzy drinks).
- Travel – wear a compression garment, do diaphragmatic breathing and move!
- Compression – do not use a blood pressure cuff on the affected side. Do not wear tight jewellery or clothing.
The goals of treatment are:
- Control swelling and other associated symptoms.
- Promote the lymphatic flow and prevent secondary complications.
- Help patients better cope with the psychological aspects of Lymphoedema.
- Enable patients to lead a normal life, brim-full quality of life.
This is achieved by means of complex decongestive therapy – this includes:
- Meticulous skin and nail care
- Manual lymph drainage – gentle massage
- Multi-layer compression bandaging and/or a compression sleeve
- Exercise therapy – specific decongestive exercises
- Exercising the do’s and don’ts
- Lifestyle modifications
- Scar massage and mobilisation
Lymphoedema is not life threatening and can be easily managed. That is why it is so important to contact a certified manual lymph drainage therapist that you can be educated and thus prevent the development of swelling. Regardless of the extent of the swelling, Lymphoedema must be treated as soon as possible in order to prevent further complications and to, most importantly, look and feel better. Treatment is more effective when initiated at an early stage.
5 ways to jumpstart your lymphatic system
- Dry bruhing
Written by Sue Serebro.