LYMPHEDEMA AND THE ROLE OF PHYSICAL THERAPY
Lymphedema affects approximately two million people in the United States. Its incidence is on the rise because each year approximately 500,000 Americans will be treated for some type of cancer that will be treated for some removal or the destruction of their lymph nodes. One out of every five of those people will then develop lymphedema.
Lymphedema occurs when the normal drainage of fluid in our body is disrupted. As the fluid accumulates, the area will become red, hot, swollen and painful. Often the arm or leg will double in size. In a normal lymph system, the body utilizes a network of nodes and ducts. Those nodes and ducts maintain the balance of the body’s fluid, they filter our waste products and fight bacteria.
However, when lymph nodes have been removed or destroyed by radiation this lymphatic system loses its ability to maintain this delicate fluid balance. As a result, there is an accumulation of protein-rich fluid that becomes a breeding ground for bacteria. If this swelling in the tissue is left untreated, it can lead to permanent tissue damage, scarring and long-term disability.
Presently, it is seen most often in women who have had breast cancer surgery where lymph nodes have been removed and radiation therapy has been done. This swelling in their arms can occur weeks, months or even years later after surgery.
That is exactly what happened for Sarah Micheals. She had decided to take an airplane trip to New York City to visit her daughter. Five years earlier she had breast cancer surgery and had been doing just fine since then. However, the next morning after she woke up at her daughter’s home, something just didn’t seem right. She felt like she was getting the flu. Her body ached and her right arm had a strange red streak on it. Throughout the day the pain in her arm became worse and her arm started to swell. She got so swollen she could barely hold her coffee cup and she had to remove her rings. Finally her daughter took her to the ER, where it was discovered she was suffering from an infection in that arm resulting from lymphedema. She was given antibiotics, which cured the infection, however, the swelling in her arm remained. She then was referred to physical therapy for treatment of the swelling.
Physical therapy care for lymphedema consists of Manual Lymph Drainage Massage (MLDM), Medical Compressions Bandaging (MCB), special exercises that milk the lymph system and supplement the massage, skin care and treatment of any infections.
The physical therapy care will help decongest the swollen body part, eliminate fiber tissue and improve the immune system function. Once the body part has reduced in size a protective garment needs to be worn on that extremity to avoid re-accumulation of that lymph fluid. This protective garment helps to maintain the natural fluid balance of the affected body part.
If you are a cancer patient who has had any lymph nodes removed or radiated here are some guidelines you should follow in order to prevent this chronic, progressive disease.
• Wear a protective garment for flying of when doing any new actives you are not accustomed to.
• Wear gloves during household chores or gardening to avoid minor cuts, animal scratches, bug bites and puncture wounds. Use antibacterial ointment right away if you do get a wound and consult your physician immediately.
• Avoid injections and blood pressure monitoring on the body part.
• Exercise at a moderate pace and keep “muscle pump” active. (Swimming in 75 to 85 degree F water is one of the best forms of exercise due to the natural pressure gradient in the water).
• Avoid hot baths such as Jacuzzi tubs, whirlpools, heat from hair dryer and sun exposure.
• Avoid any deep tissue massage.
• Wear clothing that is not restrictive to allow appropriate lymph flow. Wear your rings and watch on other extremity.
• Eat a diet low in sodium and saturated fats. Discontinue use of alcohol and nicotine.
• Keep skin clean and well moisturized. Use electric razors only.
If you have further questions regarding Lymphedema or you are wondering whether you have this disease, you can go online to the National Lymphedema Network at www.lymphnet.org or call them at (800) 541-3259.
Sheree DiBiase, PT, is a licensed physical therapist and the owner of Lake City Physical Therapy in Coeur d’Alene and the Spokane Valley. She has been practicing outpatient physical therapy for more than 20 years and was an Adjunct Professor at Loma Linda University, School of Physical Therapy for seven years, she instructed in Applied Kinesiology, Biomechanics and Gait Analysis. Both of her offices provide care for cancer related fatigue, weakness and lymphedema. She can be reached at (208) 667-1988.