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

• r 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

• ff 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

• 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

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