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
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