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Cancer and Lymphedema
A brief introduction
There are two types of Lymphedema: Primary Lymphedema is a condition that you are born with.
In North America, secondary Lymphedema is still an unrecognized, often misdiagnosed, epidemic resulting from cancer treatment. If you have had Lymph nodes removed and radiation treatment you are at a Lifetime Risk of Lymphedema.
Lymphedema can happen to men or women and the swelling can occur in the affected quadrant of the body: the limb, back, neck, chest wall, trunk or groin.
In order to understand how the Lymphatic system works, with concise graphics, you may wish to visit: http://www.lymphnotes.com/article.php/id/151/
The entire Lymph Notes site is also outstanding.
Lymphedema education and prevention strategies are, unfortunately, rarely given at our overburdened hospitals. That is why cancer support centres and local and online Lymphedema groups exist, to inform, support and advocate for you. In Ontario we are very fortunate to have: http://www.lymphontario.org/
Lymphedema prevention strategies and management follow a five point plan of
| Complete Decongestive Therapy (CDT) |
-Education
-Read and follow the Lymphedema Risk Reduction Practices position paper on: www.lymphnet.org
The National Lymphedema Network, an American based site filled and constantly updated with excellent information.
-Skin and nail care
As you will learn in your reading, you must be careful not to overload an already compromised system. You will want to avoid extremes in temperature, punctures, needles, blood draws, insect bites and scratches as well as blood pressure cuffs and other restrictions, like tight jewellery, on the affected side.
You may want to visit: www.g-sleeve.com for some very clever “extra help”
-Manual Lymphatic Drainage (MLD)
This massage technique is very effective in reducing swelling. It differs from ordinary massage as it is very gentle and encourages movement of lymph.
The aim of the massage is to stimulate or move the excess fluid away from the swollen area so that it can drain away normally. MLD massage also encourages and improves drainage in the healthy lymphatics. As this is a specialized form of massage, it should be given only by an accredited therapist who has completed a minimum of 135 hours of training. There are many excellent schools such as Vodder, Norton, Casley-Smith, Chikly, Földi and Leduc.
-Bandaging / Wrapping and Compression
Very simply put: in order to help reduce the swelling in an arm ( for example) affected with Lymphedema, the MLD therapist will massage and then bandage the arm from the fingers all the way up, in order to assist the lymphatic system move the lymph towards the heart.
Please look at the photos from this site, to give you some idea: http://www.adventisthealthcare.com/ARHM/services/outpatient/lymphedema.aspx
Eventually, once the swelling is reduced, the patient will be fitted with a compression garment ( sleeve & gauntlet or stocking ) which should be worn every day to keep the swelling down.
Some photos from two different suppliers:
www.juzousa.com/product_list.asp?menu1=Lymphedema+Garments&menu2=Sleeves
www.lymphedivas.com/catalog/index.php?cPath=24&osCsid=337f522f9c259977b102dd2086980635
-Correct remedial Exercise, Deep Breathing / Laughter
The Lymphatic system relies on muscle expansion ( movement) and deep breathing to propel the lymph fluid towards the heart. The lymphatic system does not have an organ, like the heart, to move the lymph through the system, instead the lymphatic system works on inertia.
The thoracic duct, located behind the lungs, is the largest organ in the lymphatic system and is best stimulated by laughter which augments deep breathing and uses the stomach muscles to create the healthy pressure and release that moves the lymph fluid, thus strengthening your immune system.
Exercise, done soon after surgery, must balance the need for movement and gentle limited stretching with the caution of not overloading or fatiguing an already weakened system. It is important to follow an exercise program post surgery that has been modified or created specifically for the cancer patient at risk from Lymphedema.
Laughing Lymphercise is one such program. Www.laughing-lymphercise.com
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