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Lymphedema: A Breast Cancer Patients Guide to Prevention and - - PowerPoint PPT Presentation
Lymphedema: A Breast Cancer Patients Guide to Prevention and - - PowerPoint PPT Presentation
Lymphedema: A Breast Cancer Patients Guide to Prevention and Management Lindsay Davey, MScPT, MSc, CDT Registered Physiotherapist, Certified in Combined Decongestive Therapy, Owner/Clinic Director of Toronto Physiotherapy The Lymphatic
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What is Lymphedema?
The swelling of a body part due to the
accumulation of lymphatic fluid
Caused by an insufficiency of the lymphatic
system to ‘drain’ fluid from the limb (or torso)
Reasons for impaired drainage:
- Surgical removal of lymph nodes from the armpit
- Radiation to the lymph nodes in the armpit/chest
Lymphedema can take weeks, months, or
years to appear following cancer treatment
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Who Gets Lymphedema?
Incidence rate of lymphedema in breast
cancer population: 6% - 30%
Increased Risk*:
- Full mastectomy
- Higher number of nodes removed
- Radiation to armpit
- Tumour positive nodes
- Post-op complications
- Axillary Web Syndrome (Cording)
- Increased Body Mass
- Genetic predisposition?
*Miaskowski C et al, PLoS One 2013: Apr 16; 8(4).
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Symptoms of Lymphedema: Early Stage
May not see swelling Sensation of heaviness, fullness, tightness,
bursting sensation, aching pain, tingling
May see swelling or puffiness after exercise
- r more vigorous use of the arm
Elevating the arm may decrease swelling Swelling may be ‘pitting’ when pressure is
applied
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Symptoms of Lymphedema: Later Stage
Swelling of the upper arm, forearm, hand,
fingers and/or trunk
Non-pitting Elevation has no effect Areas of ‘hardening’ of the tissue Skin changes Chronic condition (but can be well managed!)
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How is Lymphedema Treated?
Gold Standard Treatment Approach: Combined Decongestive Therapy (CDT)
- 1. Manual Lymphatic Drainage Massage
- 2. Compression
- 3. Infection Prevention / Skin Care
- 4. Exercise
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Manual Lymphatic Drainage Massage
NOT the same as a typical massage Specific pressure Specific strokes Specific sequence Re-routes fluid to bypass deficient
pathways where nodes have been removed
- r exposed to radiation
Self-massage is a KEY component in
- management. *VIDEO*
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Compression
TWO Phases:
- 1. Arm Volume Reduction Phase
Short-stretch bandages (like tensor
bandages)
Usually takes 3 – 6 weeks
- 2. Maintenance Phase
Compression garment, custom fit or
- ff the shelf
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Are These Garments Covered Under OHIP?
The Assistive Devices Program (ADP) will pay
for 75% of the cost of garments
They cover 2 garments, 3 X per year ADP form must be signed by a Physician
(the first time it must be a specialist), a CDT-Authorizor (like myself), and a Fitter
Some patients may also have coverage
through extended health benefit plans
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Infection Prevention & Skin Care
The arm is at higher risk for infection Keep the skin well moisturized (glycerin-free
products are best to prevent drying/cracking)
Caution with things that could break the skin:
- Insect bites
- Animal scratches
- Cuticle trimming/manicures
- Paper cuts or larger cuts
- Shaving the armpit
- Minor burns
Use antibiotic cream on all cuts/scrapes
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Signs of Infection and What To Do
Signs of Infection:
Redness (Cellulitis) Streaking or Rash appearance (Lymphangitis) Heat Fever Generally feeling unwell
What To Do:
STOP heavy use of the arm STOP self-massage and compression Seek medical attention immediately
(antibiotics)
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Exercise: How Does It Help?
For Breast Cancer Rehabilitation In General:
Aerobic exercise (ex- walking) can decrease
fatigue, stress, depression, body mass, and improve immune responses
Strength exercises help battle
deconditioning and generalized weakness
Patients’ Quality of Life scores are
significantly higher among those who exercise!
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Exercise: How Does It Help?
For Lymphedema Prevention & Management:
Promotes fluid flow via pumping action
- f contracting muscles
Strengthening makes limb less susceptible
to repetitive strain or other injuries (which can cause inflammation)
Stretching maintains tissue flexibility to
promote flow through lymphatic channels
Decreases risk of lymphedema*
*Schmitz K et al, JAMA 2010: 304, 2699-2705
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Exercise Principles for Lymphedema Patients:
Wear compression during exercise Avoid wearing tight jewelry Pre- and Post-exercise self-massage promotes
lymphatic flow
Keep cool Include aerobic and resistance training Progress exercises for the arm at slower rate;
delay pectoral exercises?
Evidence supports lifting ‘heavy’ weights*
*Cormie P et al, J Cancer Surviv 2013 Apr 20, epub
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Scar, Radiation Damage, and Cording
YES WE CAN HELP! Mastectomy, lumpectomy and/or node
dissection scars
Adherent/tight tissue in radiation zone Rope-like cord in armpit/arm Specialized massage techniques* Specific home exercises Improves range of motion, improves
lymphatic flow, decreases pain
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Do’s and Don’ts !
Avoid injections and IV’s on the affected side Avoid blood pressure cuffs on this side Avoid hot tubs and saunas Diuretics do not help lymphedema
* * *
Do wear some form of compression on flights Do learn self-massage of the arm, and neck! Do learn diaphragmatic breathing!
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Summary: Lymphedema and CDT
Incidence as high as 30% in breast cancer
patients
Chronic condition, but can be well
managed!
CDT effectively treats lymphedema CDT can help prevent lymphedema CDT therapists a great resource on topic of
lymphedema, scar and radiation field tissue adhesions, cancer rehabilitation
We’re here to help!
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Resources
Lists of CDT Therapists:
- Lymphovenous Association of Ontario
www.lymphontario.ca
- Toronto Lymphocare Centre
www.torontolymphocare.com
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Resources
Toronto Physiotherapy
www.TorontoPhysiotherapy.ca
On-line Resources:
- A copy of this talk
- Lymphedema educational material
- Self-Massage Video
- Lymphedema Blog: hot topics and
latest research
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