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Watching Out for Lymphedema
Article written by Jenny Bradt, P.T., D.P.T., C.L.T.-LANA
I am a physical therapist who has treated lymphedema for nearly three decades. Lymphedema refers to tissue swelling caused by the accumulation of fluid usually drained through the body’s lymphatic system. Lymph nodes are an important part of the lymphatic system that helps drain this fluid. Lymphedema can be caused by cancer treatments that remove or damage your lymph nodes. A major advancement in lymphedema prevention occurred when the sentinel node biopsy replaced a full axillary dissection for most people undergoing surgery for breast cancer. An axillary dissection (ALND) is more extensive and still necessary for some, removes one or more of the three groups of lymph nodes in the arm pit (axilla). A sentinel lymph node biopsy (SLNB) only samples nodes that are most likely to have cancer cells in them. This prevents the need for more nodes to be sampled, thus a SLNB reduces the risk of developing swelling. Back in 1995, we told people to avoid repetitive movements, including some upper body exercise. We advised against using that arm for any procedure including injections and blood pressure readings. Some patients would even order medical alert bracelets in case they were in an auto accident and unable to ask emergency workers to be cautions of their at-risk arm. We issued sleeves to anyone who was going to travel by air.
So, what about those precautions? Are they theoretical or based on observation? Multiple studies have looked at large groups of women who had injections, blood draws and blood pressure readings in the arm at risk. None of these activities was associated with increased swelling. Other studies have shown no association with flying and the time spent in the air. The most encouraging studies show exercise using the arms such as strength training and rowing, did not increase arm swelling. In fact, people who engaged in regular exercised showed many improvements in mental and physical health. People who were the most at risk of increasing arm size were women who had an ALND, whose body mass index was higher than twenty-five, who had regional node radiation, or suffered at least one episode of cellulitis. Cellulitis is a skin infection often caused by injury to the skin. It causes the skin to become red and hot and needs immediate medical attention. People are more at risk for cellulitis if they have lymphedema.
In 2017, the American Society of Breast Surgeons published recommendations for surveillance and management of lymphedema. The recommendations recognize that surgery involving the lymph nodes increases the risk of lymphedema and emphasize personalized education based on individual risk. They conclude that using the at-risk arm for IVs and blood pressures is fine but everyone with node surgery should know the symptoms of lymphedema so that they can access prompt treatment.
People wonder, do I need to be worried about lymphedema? We know that most people who develop swelling will do so in the first 30 months after axillary surgery. Prompt treatment reduces the risk of progressive lymphedema. Be familiar with your arm and the way it looks and feels, so that if you do notice any changes in size or feeling, you can tell your medical team right away. If you notice any signs or symptoms of cellulitis, have it checked the same day you notice it. Reduce risk when you can. If you have anxiety about developing swelling and it is getting in the way of you doing the things you enjoy, please ask your oncology team for an appointment with a therapist at Mayo Clinic Physical Medicine and Rehabilitation.
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In 1968 I had 14 lynph nodes removed, and luckily did not have any swelling of my arm. But, recently the arm has swollen. In addition, I broke my left shoulder, and I notice the upper arm swells, but no pain, just difficulty with clothing, sleeve too small. The swelling comes and goes, and seems to be related to how much I use the arms. I am now 92, so the swelling may have some relationship to the medications I take. I had an aortic Valve replacement approximately 1 year ago. I find your article very informative. Thank you
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2 ReactionsI am glad you found the article helpful! It seems like there might be some recent events that might be causing your arm to swell. Have you talked to your doctor about the swelling in your arm?
I have not spoken to my doctor since it comes and goes. At my age, and the number of medications I already take I r eally hate to add any more. I am familiar with the fact Pregabolin can cause weight gain and we are watching that very carefullly. I really cannot afford to go off this med since it is so helpful with the Trigeminal Neuralgia.
Gina5009
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1 ReactionHi. Maybe you have seen my question about lymphedema in the breast cancer section. I developed lymphedema 2 years ago and at that time, I had lymph nodes involved after breast cancer diagnosis but no surgery. As of today, I had a unilateral mastectomy but still no lymph nodes were removed. My question is can I get in a wet sauna? I have read so much research and it seems to be split down the middle but everyone seems to say, be cautious. This sauna will cost me over $5000 and that's not a chance I want to take if it will cause lymphedema to he worse. What's your thoughts? Thanks
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1 ReactionDidn’t know any of these even though I’ve been seeing a PT to help with reducing arm swelling for months. I also have the need to fly 18 hours long leg. What kind of sleeves need to wear? Thought to use steam room after chemo so that can sweat a lot to detoxify the body. Can’t do it anymore?
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1 ReactionResearch that has been published included people who had lymph nodes resected, so your situation sounds different from what was specifically observed in those studies. You could trial a sauna before purchasing one for yourself, to see if that causes any swelling. Keep in mind that anytime you try something to see how the arm reacts, make sure to be ready to use any lymphedema management techniques you have used in the past to return the arm/body part to its usual size.
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1 ReactionSleeves come in different sizes and different levels of compression. Most of the time we use a sleeve 20-30mmHg for arm lymphedema. If your hand swells you need to wear either a glove or a gauntlet which is a glove without fingers. A variety of brands exist, and the shape of your body would determine which one might be the most comfortable. For example, the Juzo brand comes in a short length and has a “max” size that allows for a wider upper arm. The LympheDIVA brand works well on longer and leaner arms. The Medi brand has a bit of pressure relief at the inner elbow. It can be quite helpful to visit a durable medical equipment store that sells these items so you can see and feel the differences between brands.
In regard to the steam room, if you have been using this with no adverse effects to your arm swelling, then you could continue to use. But be observant to conditions or activities that tend to increase arm swelling. Then take note and either avoid those situations or wear compression to avoid increased swelling in the arm.
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1 ReactionI use Juzo arm compression. My PT told me the size to get. I do like the one's with silicone just below armpit
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2 ReactionsThank you so much for such detailed response!