What It Is, How to Prevent It, and How to Treat It
A major long-term complication is swelling of the arm—lymphedema—which
can result from removal of the lymph nodes. It can be so slight that
you notice it only because your rings begin to feel too tight on your
fingers, or so severe that your arm becomes huge, even elephantine. It
can be temporary or permanent. It can set in immediately or years after
your operation.
What causes
it? Basically, lymphedema is a plumbing problem. Normally the lymph
fluid is carried through the lymph vessels, passes through the lymph
nodes, and is returned to the bloodstream near the heart. The lymph
nodes act like a strainer, removing foreign material and bacteria. So
if you have surgery in the area and it scars over, some of the holes
are blocked and the drainage is affected. The fluid doesn't drain out
as well as it needs to, and everything backs up and swells. Protein
leaks into the tissue and then scars, causing the condition to become
chronic.
[Enlarge
image]
This used to be much more common, because more extensive surgery was
done, and it has been a serious problem for many women. The current use
of sentinel node biopsy promises to decrease women's chances of getting
lymphedema. Initial studies show that women who underwent sentinel node
biopsy had lymphedema 2–6 percent of the time, compared to 17–34
percent for full axillary dissection.
It is important to try and prevent lymphedema. You should try to avoid
significant trauma to the involved arm, including having blood drawn or
having a blood pressure cuff placed on the arm. Probably the most
important prevention is avoiding heavy lifting with your arm hanging
down for a period of time, such as when you carry a suitcase,
briefcase, or computer bag. Try to get your groceries delivered instead
of carrying them yourself. If that's not feasible, get one of those
little grocery carts and wheel them home. Also, be sure to use
suitcases with wheels when you travel.
Although there is no cure for lymphedema, we can reduce the swelling
and maintain the reduction. Treatment by physical therapists and others
trained in lymphedema treatment is the best way to reduce arm swelling.
The treatment most commonly
recommended is called complete decongestive therapy. It involves four
steps: skin and nail care, manual lymph drainage, compression therapy
using bandages, and decongestive exercises.
The treatment is conducted in two phases. The first phase is an attempt
to mobilize the accumulated protein-rich fluid and to start to break up
the chronic scarring. This phase is intense and can last four weeks,
with treatments performed twice a day, five days a week. The next phase
immediately follows and includes compression garments and bandages at
night.
Other therapies include
elevating your arm to help reduce some of the swelling. Physical
therapy and exercise can help in early cases. Also, there are long
support gloves available which, while unaesthetic, can help reduce the
swelling.
The National Lymphedema Network
can help you find resources, information, and support as well as refer
you to a lymphedema treatment center or a physical therapist trained in
complete decongestive therapy.
It is best to act right away, as soon as you notice that even a small
amount of swelling has occurred. Don't wait until your arm is severely
swollen to seek help.
|
|
|
|
|
 |
|
