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Lymphedema occurs when there is an interruption with the circulation as a result of the lymph vessels being unable to adequately drain lymph fluid. Fluid builds up and causes the arm (or leg) to swell. Women who have undergone surgical or radiation treatment for breast cancer are particularly susceptible to the condition (although it can also occur after any type of cancer surgery involving lymph node removal).
With lymphedema, the limb becomes heavier because there is no place for the fluid to go. There may be cellulitis, fungus or open wounds because of the bacteria that has accumulated and the loss of protein. It can even result in “weeping,” which is when fluid actually comes out of the pores of the skin.
Lymphedema can’t be cured, but it can be managed with regular treatment. Unfortunately, many doctors remain unaware of the symptoms or current management of lymphedema, and so their patients suffer.
Feelings of tightness, heaviness or fullness in the arm, in addition to swelling or redness, are common early symptoms. Lymphedema can occur several weeks after treatment, or may not happen until as many as 15 years later.
Lymphedema is very “patient specific.” While it is not clear why some breast cancer survivors get lymphedema and others do not – for example, a patient who has undergone a mastectomy might not get it, while one who has had a lumpectomy may – several factors do increase the risk. These include removal of a large number of axillary lymph nodes during surgery (fortunately, surgeons now remove fewer lymph nodes, lessening the odds of getting lymphedema), radiation to the area, infections, or being overweight.
Physical therapists specially trained and certified in lymphedema treatment use a light superficial massage known as manual lymph drainage that directs the fluid from a patient’s arm away from the affected extremity, allowing the body to absorb it. Compression bandages or garments are used to help push the lymph fluid out of the arm. Patients are also taught light exercises to encourage movement of the lymph fluid out of the limb.
Lymphedema is a progressive disease. An untreated limb can continue to swell over time and lead to open wounds, skin changes and cellulitis. That’s why it’s strongly encouraged that patients continue treatments on their own, including self-massage, remedial exercise and compression, and, when necessary, return to a therapist for a checkup.