In June’s Survivor Newsletter* we offered survivors the opportunity to ask questions regarding lymphedema to certified lymphedema therapists Emily Naderer and Lauren Carity from Mount Carmel.
Below are some questions we received and their responses.
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Q1: What is lymphedema? What causes it?
A1: The best way to explain lymphedema is to first understand the anatomy and physiology of it all. In your body, fluid and nutrients are transported to the tissues by the arteries. Most of the fluid is returned to the heart by the veins, but a small portion of the fluid (about 10%) returns to circulation in the lymphatic vessels. This fluid, along with large molecules that are basically the waste products of the skin and muscles (we call them proteins) make up “lymph.” Normally your lymph vessels carry the lymph and proteins to the lymph nodes, and the lymph nodes break down those proteins. If there is damage to the lymphatic system, say by removal of lymph nodes, radiation, etc, the lymph starts to build up in the tissues because it is not being removed properly. The lymph build up will eventually cause a firm swelling in the affected area as the fluid and protein continues to collect. This is lymphedema.
Q2: Almost a 5 year survivor, sometimes I feel the heaviness in my arm which I believe to be lymphedema and a ring on my finger gets tight as well. Are these true symptoms of lymphedema?
A2: Yes, both heaviness and tightness of rings and watches are possible signs of lymphedema. Lymphedema typically develops in stages and in the early stages, there might actually not be a lot of visible swelling. Heaviness and minor changes in swelling can be early signs that the proteins are starting to build up in the tissues. If the lymphatic vessels are just barely keeping up with the demand of the body, we’ll often see swelling or other symptoms that tend to come and go at first. Usually over time these symptoms will get worse and become persistent if not addressed.
One other thing to keep in mind, is that often after breast surgery, being cautious with the affected arm will cause prolonged weakness on that side. The arm might feel “heavy” because the muscles on that side are weaker or faster to fatigue. This is why slowly building back up to normal strength is recommended. Going slow is important though, because overdoing it can actually cause some swelling by irritating the
muscles. As you can see, it’s not always cut and dry. I would recommend a physical therapy evaluation to take a closer look at what’s going on with your arm specifically.
Q3: What should I do if I think I’m having symptoms?
A3: The first step is to always talk to your doctor. If you are still undergoing treatment you can talk to your oncologist or surgeon. If you aren’t still seeing them anymore, talk to your family doctor. They can write a prescription for a physical therapy evaluation. The PT will take measurements, discuss your symptoms and come up with a plan to address anything discovered during the assessment.
Q4: Is there anything I can do to prevent it or treat it?
A4: The biggest key to prevention is skin care. You want to avoid infection. This means trying to avoid even the littlest cuts, scratches, burns etc. If you do have an injury, be diligent about keeping the area clean and protected as it heals.
Lymphedema cannot be cured, but the symptoms can definitely be managed with treatment. Treatment typically involves massage to move the proteins out of the tissues, compression to move the fluid and prevent further swelling, and continued skin care. Exercise may also be a part of the treatment for some, if weakness or scar tissue is playing a role.
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