Lymphedema: What You Should Know About Your Risk, Treatment Options

Resistive exercises, surgery may help manage symptoms

Lymphedema: What You Should Know About Your Risk, Treatment Options

If you are at risk for or already have lymphedema, you can watch for signs and take steps to avoid or control the condition.

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Lymphedema is swelling of a body part – most commonly an arm or leg – caused by excess lymph fluid collecting in body tissues. The condition results when lymph vessels or nodes are missing, damaged or removed.

This disrupts the lymphatic system. It undermines its ability to properly drain fluid as part of the immune system.

The swelling most commonly affects one arm or leg, but occasionally affects both arms or legs. Certain people may even experience swelling in the chest, head or genitalia.

Who is at risk?

Lymphedema most commonly occurs after surgery to remove lymph nodes in the armpit in breast cancer patients or lymph nodes in the groin to treat other types of cancer.

Radiation therapy to treat breast and other cancers also sometimes damages the lymphatic system and limits normal fluid drainage.

Patients who have damaged or missing lymph nodes and who are overweight also are more at risk for the condition.

“While breast cancer patients represent the population segment at highest risk for developing lymphedema, it can also occur due to injuries, or a congenital issue with the formation of lymphatic circulation,” says plastic surgeon Graham Schwarz, MD.

An infectious parasite can cause the condition in people living in certain areas of the world. This is very rare in developed countries, however.

How to cope with lymphedema

Functional limitations — decreased mobility and a bulky limb — can affect your work and your ability to participate in favorite activities.

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“Patients may experience frustration because they’re not able to utilize their arm or leg the way they used to and the limb can feel heavy and painful,” says Dr. Schwarz.

Effects of lymphedema include:

  • Sleeves, rings, bracelets or wristwatches feel too tight
  • A feeling of “fullness” in your arm or leg
  • Diminished flexibility in the joints of the affected limb
  • Greater risk for developing infections
  • More difficult for your body to fight infection

Steps for lymphedema patients include:

  • Diligently protect yourself against things like bug bites and cuts to avoid infection.
  • Make sure you don’t have blood drawn from the affected arm.
  • Don’t allow medical staff to place a blood pressure cuff on an affected arm.
  • For leg swelling, wear comfortable, supportive shoes and wash your feet daily in warm – not hot – water.
  • Some patients may need to wear a long sleeve to lightly compress the affected arm, especially when traveling by airplane. This encourages the lymph fluid to flow out of the arm. Depending on how severe your condition is, your doctor may ask you to wear the garment all the time, even when swelling subsides.

Get ahead of your symptoms

There is no cure for lymphedema, but treatments can relieve symptoms and help control the condition.

The best approach for cancer patients is to take steps ahead of time to anticipate and possibly head off symptoms.

“Clinicians specially trained in this condition take arm measurements soon after surgery and then every three months thereafter,” says physical therapist Diane Galvin, who specializes in breast cancer rehabilitation.

“Studies have shown that you can minimize the effect of lymphedema by treating it early. If we can detect subclinical changes in size before it reaches a certain percentage — meaning before you see it or maybe even feel it yet — we can manage it before it becomes a clinical issue,” Ms. Galvin says.

She says it’s important for people who have had lymph nodes removed to see their practitioner early to measure their arms and detect any difference between them.

Why exercise can help

“One of the relatively new ways we treat lymphedema, and that many people aren’t aware of, is through active and resistive exercise,” says Ms. Galvin.

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Recent studies show that muscular contraction against resistance helps reduce symptoms for those living with the condition.

According to Ms. Galvin, this research also shows that resistive exercise can help prevent lymphedema for women who are at risk, but don’t yet have it.

For patients who want to try exercise, it’s important that a physical or occupational therapist supervises any weightlifting or other resistive exercise, she says.

“We still use manual lymphatic drainage – what people call lymphatic massage,” she says. “It’s effective, but in my opinion, it’s not as effective as having people perform active, resistive exercise.”

Surgery for early-stage lymphedema

Doctors are using a relatively new surgical procedure – vascularized lymph node transfer – to treat some lymphedema patients.

“For this procedure, we take lymph nodes from the groin or shoulder area and transfer them, along with their blood supply, into an area where lymphedema occurs,” says Dr. Schwarz. People with Stage 1 or Stage 2 lymphedema are the best candidates for the surgery, he says.

This procedure is not a cure. Instead, it’s something with potential to help patients reduce swelling in the affected limb and decrease infections, he says.

Larger medical centers across the U.S., including Cleveland Clinic, use a multidisciplinary approach to provide a full array of surgical and non-surgical treatments and support for those living with lymphedema.

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