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C o m p r e h e n s i v e

Lymphedema

TreaTmenT CenTer

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1000 Trancas st. napa, Ca 94558707.252.4411 TTD (Deaf Use only) 707.226.2901

www.thequeen.org

For a free physician referral:Call 1.877.QUeen Line (1.877.783.3654) or visit www.thequeen.org

Factors contributing to Lymphedema• surgery or radiation therapy (high risk)• surgery and post-operative infection• Being overweight• infections• sedentary lifestyle• Constricting clothing or jewelry• Dependent limb position• recurrent tumor• heavy breast prosthesis• Trauma to the lymphatic system• parasite (specific regions of the world)

symptoms oF Lymphedema• swelling of limb or body part

(skin feels more firm)• Condition worsens over time• heaviness and limitation of movement• ache/pain in limb• repeated infections (cellulitis)• skin thickening, lymph leakage through

clothes (advanced stages)• Cosmetic problem

(difficulty fitting into clothing)• altered lifestyle

early diagnosis and treatment improves both the prognosis and the condition. Do not ignore even the slightest swelling. seek medical treatment immediately.

how does Lymphedema encourage inFection?Lymph fluid is rich in protein. When the flow of the lymphatic system is obstructed, fluid accumulates and becomes stagnant in the limb. This createsa very favorable environment for bacteria to feed and thrive. it is recommended that persons with lymphedema have contact with a physician so that any cuts or signs of infection can be treated immediately.

generaL precautions• excellent nutrition: low salt, low fat, lots of fresh

fruits and vegetables (consult physician if special medical conditions exist)

• minimize alcohol and nicotine• avoid being overweight• meticulous cleanliness• meticulous skin and nail care• sleep with limb wrapped or elevated if possible• exercise, swim, walk and special exercises

– Do not overtire yourself• Use hypo-allergenic soaps and fragrances• seek treatment for even the slightest

lymphedema/swelling• Treat infections vigorously• avoid high-heeled shoes• Travel with limb elevated• Wear compression sleeves/bandage when flying• Wear gloves while doing housework or gardening• Use precaution with the use of diuretics (this

may remove fluid but not the protein in the channels and your lymphedema may worsen with your body trying to increase fluid to the area to remove the protein)

warning!if you notice a rash, blistering, redness, increase of temperature or fever, see your physician immediately. This could trigger the onset of lymphedema or a worsening of lymphedema.

FoLLow-up/maintenance• skin care, mLD, bandaging, compression

garment, nutrition and exercise are learned during the course of treatment.

• Follow-up reviews are frequently recommended within six months.

• Continue with your involvement with the Lymphedema support Group and keep up-to-date with new advances in bandaging and compression garments.

For more information:• Comprehensive Lymphedema Treatment Center,

call 707.257.4089• Lymphedema support Group, call the Breast

Center 707.257.4047

Treatmenttreatment oF LymphedemaLymphedema is a serious condition. it indicates that the lymph system is unable to handle the lymph load. it is important to keep in mind thatlymphedema can occur even if all precautions are observed. it is not necessarily “your fault,” but treatment should be started as soon as possible. at present, the most effective and least invasive approach is referred to as Comprehensive/Complex/Complete Decongestive physical Therapy. The length of treatment is variable and depends upon the severity and duration of the lymphedema. Treatment centers are limited, and you may be on a waiting list to begin treatment. Get involved with the Lymphedema support Group (Bosom Buddies) and take advantage of educational offerings.

the Lymph systemThe lymph system consists of lymph vessels, nodes and tissues. it is a part of the circulatory system. The role of the lymph system is to filter impurities from the circulatory system and to produce lymphocytes for the immune system. Lymph vessels are channels that transport colorless fluid called lymph. Lymph fluid consists of white blood cells and waste products from the lymph tissue, and originates in the tissue spaces throughout the body. Lymph nodes purify the lymph fluid of bacteria, toxins and dead cells, and produce lymphocytes to enhance the immune capabilities of the body. Lymph is propelled through the various lymph vessels by muscular activity, contraction of the lymph vessels, and by the movement of the diaphragm during breathing.

what is Lymphedema?Lymphedema is a swelling of a body part (face, neck, stomach, lungs, arms, legs) caused by the abnormal accumulation of lymph fluid. it is a chronic and progressive disease that continues to worsen over time when not treated. Lymphedema can usually be brought under control by good care and attention to some lifestyle changes.Lymphedema is usually compatible with a normal and active lifestyle. The condition most often causes a feeling of heaviness, slight discomfort and cosmetic deformity. repeated episodes of infectionmay also occur. although much of the medical community believes lymphedema to be a rare condition, in fact, it affects 2.5 to 4 million people in the United states.

primary Versus secondary Lymphedemaprimary lymphedema occurs without any obvious cause, and can occur at birth or later in life. it is generally more common in women, and usually appears in the legs. There is often a familial connection and multiple members of a family may develop lymphedema at some stage in their lifetimes. secondary lymphedema is caused by injury, scarring, excision of lymph nodes, or radiation in combination with surgery. Common treatments of cancer of the breast, uterus, bladder, ovary, prostate, testicles, hernias, and malignant melanomas and lymphomas are components for the development of lymphedema. it is estimated that there are 2.5 million cases of secondary lymphedema in the United states. most of these cases are caused by breast cancer therapy.

how do i reduce the chances oF deVeLoping Lymphedema?if lymph nodes are surgically removed and/or radiation therapy is received, the risk of developing lymphedema is greater. axillary resection significantly increases occurrence of lymphedema because lymph channels are destroyed. Lymphedema may occur within a few short weeks after surgery or radiation, or 15 to 20 years after treatment.

avoid temperature extremes• hot baths, hot tubs, hot showers• Turkish baths, saunas• Burns (cooking, smoking, sunburn)

– Wear oven mitts, use opposite arm, use sunscreen• Climates (hot or cold) that are extreme

changes from your normal climate

avoid infections• insect bites – Wear protective clothing, gloves,

long sleeves, insect repellent• manicures, pedicures – Do not cut cuticles• injections, blood draws or acupuncture• pet scratches• skin punctures and cuts – Use electric razor

avoid blunt trauma• Lifting heavy objects

– Carrying heavy handbags or over-the-shoulder straps

– Luggage– Restrict weight lifting to 15 pounds or less• repetitive motions against resistance– Moving furniture– Washing/scrubbing floors or windows• Constricting clothing that interferes

with circulation– Blood pressure cuffs– Tight clothing, especially bra straps– Heavy breast prostheses (wear bra strap

relief pads, consider lightweight prosthesis)– Rings, watches, bracelets

Four steps oF decongestiVe physicaL therapy

1 hygiene and topical skin products• eliminate bacterial and fungal growth– Daily bathing– Careful and thorough drying between skin folds,

toes and fingers– Use of low pH skin lotion twice daily

2 manual Lymph drainage (mLd)• specific manual movements along lymphatic

pathways that empty and decompress obstructed lymph vessels

• Up to one hour once or twice daily as needed• Facilitates flow of lymph fluid into the venous

circulation and allows the limb to return to near normal size

3 bandaging and compression• Frequently used in combination with mLD• “Low” stretch elastic bandages compensate for

diminished tissue pressure• prevents affected limb from refilling• Bandages are worn frequently at first, less often

as treatment progresses• at the end of the course of treatment, a ready-

made or made-to-measure garment is ordered

4 remedial exercises and evaluation• exercises help to improve flow of lymphedema

and improve muscle tone• patients frequently sleep with bandages on• Bandaging skills are taught to patient/caregiver

during course of treatment

Lymphedema can usually be brought under control by good care and attention to some

lifestyle changes.