Thursday, June 07, 2007
Lymphedema: Could You Be at Risk?

By Sheila Brant, OTR/L, CML DT

Gina is a 63 year-old woman who is a breast cancer survivor. She underwent a mastectomy and radiotherapy five years ago. She is happy to have beaten cancer, but lately she has noticed some puffiness in her arm and tightness of the rings on her fingers. Ray is a 35 year-old male who has had swelling in his legs since he was an adolescent. It did not bother him too much in the past, and doctors told him not to worry about it. But over the past seven years, his legs have swelled to an unusual size and walking has become difficult. George is a 70 year-old male who has had circulatory problems in his legs for some time. He has developed wounds and swelling in his legs that do not go away. His socks and shoes leave indentations on his feet. One leg appears more swollen than the other. What do all of the above individuals have in common? Along with 400,000 other individuals in the United States, they are suffering from a condition called Lymphedema.

What is lymphedema

Lymphedema is a chronic swelling, usually in the arms or legs, that occurs as a result of an impaired lymphatic system. Lymphedema can occur in anyone—men, women, and children. The lymphatic system is part of the circulatory system along with veins and arteries. It has several important functions: It collects excess fluid from tissues in all parts of the body, and returns the fluid to the heart. It removes impurities including bacteria, proteins, and waste cells from the circulatory system. It aids in creating disease fighting cells, or antibodies, called lymphocytes for the immune system. If the lymphatic system has been impaired, the fluid can become backed up. Swelling occurs when the amount of fluid in an area is greater than the capacity of the lymphatic system to carry it away.

What are the causes and types of lymphedema?
There are two types of lymphedema - Primary and Secondary.
Primary Lymphedema is caused by an abnormality of the lymphatic system that can be present at birth, develop at or around the onset of puberty (lymphedema praecox), or develop after the age of thirty-five (lymphedema tarda). Secondary Lymphedema, the most common type, has many causes including:
Surgery, in particular when lymph nodes are removed after treatment of cancer: breast, prostate, gynecological, head or neck, or melanoma. Lymphedema may develop soon after surgery or many years later. Radiotherapy which kills cancer cells but can also damage the normal flow of the lymphatic system.
Trauma that damages the nearest area of lymph nodes.
Infections, lymphangitis.
Paralysis or immobility.
Chronic venous insufficiency.

Why should lymphedema be treated?
Lymphedema is a serious condition. If left untreated, lymphedema creates an environment of stagnant, protein-rich fluid which increases the potential for bacteria to cause recurrent infection. Lymphedema may increase limb girth size. Lymphedema often interferes with wound healing and may cause skin changes and tissue thickening (fibrosis). There are less common life threatening complications as well, such as the development of lymphangiosarcoma (a rare type of cancer). Lymphedema may worsen with time if left untreated. It may result in loss of range of motion and strength. It may cause fatigue due to heavy limb size, weight, and pain. Due to the possible cosmetic deformities, lymphedema can also have large psychological, social, and emotional effects on the person who develops it.

What treatments are available for lymphedema?
Unfortunately, there is no cure. However, with early intervention and proper treatment, the condition can be controlled and minimized, allowing the individual to lead a full and normal life. Treatment begins with a physician's referral to a specially trained Occupational or Physical Therapist. The therapist performs a thorough evaluation to determine a baseline of the individual's sensation, pain, range of motion, strength, skin integrity, and extent of swelling. A treatment plan to decrease the swelling and improve the individual's ability to function may include: Lymphatic manual drainage, a specialized lymphatic "massage", to move the extra lymph fluid through intact lymphatics and create new pathways for the lymph fluid to flow. Compression bandaging to reduce swelling. Exercise to improve functioning of the lymphatic system, range of motion, and strength. Establishment of a good skin care program to decrease the chances of infection. Recommendation of a compression garment and instruction for wear and care. Thorough patient education regarding all of the above to promote independence with self-management of lymphedema. Not all therapists have received special training to treat lymphedema, so it is important to select an occupational or physical therapist that is qualified to treat individuals suffering with the condition. Nanticoke Memorial Hosptital Outpatient Therapy Services employs two qualified therapists, Joan Burditt and Sheila Brant who have been trained and certified by the Academy of Lymphatic Studies. For more information, call 629-6224.

Cancer Survivor Day was held at NMH
The rain did not keep many people away from the Cancer Care Center at Nanticoke Memorial Hospital on Sunday, June 3. Many Cancer survivors and their families gathered to celebrate their successes and share their stories. Bruce Williamson, a survivor, thanked the hospital for their support and dedication. "You should treat others better than yourselves and that is what you have done," Williamson said of the Cancer Care Center staff. Survivor Yvonne Comfort wanted to thank a higher power for her success. "I want to say thank you God, because that's where my blessings come from," Comfort said. Betty Evans had been a cancer survivor for the longest period of time. Diagnosed in 1978 with lymphoma, when the survival rate was only 20% (the survival rate now is 80%), Bevans has been a survivor for 29 years. The Mayor was supposed to read a proclamation at the event, but did not make it. Dr. Anthony Policastro instead delivered the proclamation and also a few words of his own. Being a pediatrician, Policastro was happy to announce that Leukemia now has an over 90% survival rate. Executive Chef at the hospital, Shawn West, demonstrated some healthy cooking techniques and handed out recipe cards, as well as some delicious samples, to the survivors and their families. The room at the Cancer Care Center was filled with many smiling faces. There was a mix of tears and laughter as survivors shared their triumphs as well as their tribulations.