Lymphedema: Getting the Facts A Cancer Patients Guide to Prevention - PowerPoint PPT Presentation

Lymphedema: Getting the Facts A Cancer Patient’s 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 System: What Does It Do?  Maintains a normal balance of fluid in our tissues and blood stream  20% of all tissue fluid returns to the heart via the lymphatic system (80% returns via veins)  Monitors for foreign material and bacteria in the body  Circulates immune cells for fighting infection

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 ◦ Radiation to an area where lymph nodes reside  Lymphedema can take weeks, months, or years to appear following cancer treatment

Who Gets Lymphedema?  Most research has been done on breast cancer patients, where incidence rate of lymphedema is between 6% - 30%  Increased Risk: ◦ More extensive surgery to remove primary tumour ◦ Higher numbers of lymph nodes removed ◦ Radiation to remaining lymph nodes ◦ Tumour positive lymph nodes ◦ Post-operative complications ◦ Web Syndrome (Cording) ◦ Increased body weight

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 or more vigorous use of the limb  Elevating the limb may decrease swelling  Swelling may be ‘pitting’ when pressure is applied

Symptoms of Lymphedema: Later Stage  Swelling of any section of the limb, hand/foot, fingers/toes, pelvis/trunk  Non-pitting  Elevation has no effect  Areas of ‘hardening’ of the tissue  Skin changes  Chronic condition (but can be well managed !)

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

Manual Lymphatic Drainage Massage  NOT the same as a typical massage  Specific pressure (the lymphatic channels are delicate!)  Specific strokes  Specific sequence of strokes  Re-routes fluid to bypass deficient pathways where lymph nodes have been removed or exposed to radiation  Self-massage is a KEY component in management. *VIDEO*

Compression TWO Phases: 1. Limb Volume Reduction Phase  Short-stretch bandages (like tensor bandages) ◦ Usually takes 3 – 6 weeks 2. Maintenance Phase  Compression garment, custom fit or off the shelf

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

Infection Prevention & Skin Care  The limb 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 ◦ Minor burns  Use antibiotic cream on all cuts/scrapes

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 limb  STOP self-massage and compression  Seek medical attention immediately (antibiotics)

Exercise: How Does It Help? For 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!

Exercise: How Does It Help? For Lymphedema Prevention & Management:  Promotes fluid flow via pumping action of 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

Tips for Exercise:  Wear compression during exercise  Avoid gripping tightly on equipment or weights  Avoid wearing tight jewelry  Pre- and Post-exercise self-massage promotes lymphatic flow  Don’t exercise in overly hot environments  Bike or workout gloves are great for hand compression; bike shorts for pelvis compression  Progress exercises at slower rate

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 limb, and neck!

Summary  Lymphedema incidence as high as 30% in breast cancer survivors  Lymphedema is a chronic condition, but can be well managed!  Combined Decongestive Therapy (CDT) is the gold standard treatment approach and is highly effective  CDT can also help prevent lymphedema  We’re here to help! 

Resources Lists of CDT Therapists: ◦ Lymphovenous Association of Ontario www.lymphontario.ca ◦ Toronto Lymphocare Centre www.torontolymphocare.com

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

Thank you! Lindsay Davey, MScPT, MSc, CDT www.TorontoPhysiotherapy.ca