Lymphoedema: Dealing with your swollen arm or preventing it!This article is contributed by Amanita Breast Care Specialists and is meant for women who have received surgery on the lymph glands under the arm for breast cancer. What is the lymph and lymphoedema?
Lymph is the colourless fluid which forms in the body and drains into the blood through a network of vessels and lymph nodes. Lymph nodes filter the fluid trapping bacteria, cancer cells and any other particles not welcome in the blood stream. When the lymph nodes are removed, the body compensates by “re-routing” the lymph through other lymph vessels in the area. However, this system is less efficient. If these vessels are overloaded, lymph fluid may accumulate in the tissues, causing the swelling known as lymphoedema. Why is lymphoedema associated with breast cancer?
If cancer cells have begun to spread from the breast they may be found in the lymph nodes under the arm. Lymph nodes which contain cancer cells must be removed but, at the moment, the only way to find out whether they are affected is to remove them (a procedure known as axillary dissection) so they can be looked at under a microscope. Unfortunately this places women at increased risk of lymphoedema. It is hoped that a relatively new procedure called Sentinel Node Biopsy will reduce this risk. A sentinel node biopsy will enable surgeons to identify the node or nodes likely to be affected first. If these are clear, other nodes are unlikely to be affected and therefore do not need to be removed. Sentinel Node Biopsy may not be appropriate for all women and may not be readily available in all parts of the country. Radiotherapy to the armpit also interferes with the natural flow of lymph, making this another risk factor in the development of lymphoedema. Swelling and “odd sensations” soon after surgery are not lymphoedema.
After surgery, it is normal for there to be some numbness of the armpit, upper arm and the breast or chest wall and there is often some swelling. As the nerves begin to repair, it is also normal to experience a number of odd and uncomfortable sensations, often described as tingling, or the feeling that the skin has been sun burnt or grazed. These sensations can occur in the breast or chest wall, armpit, upper arm and upper back. The swelling and odd sensations usually settle down during the weeks or months after surgery. Discuss the symptoms with your surgeon or nurse at each visit, especially if swelling or discomfort persists or increases. How do you know if you have lymphoedema?
Lymphoedema can occur at any time after surgery-even many years later. It is important to know the signs and symptoms. If lymphoedema should start to develop, the sooner you seek advice and start treatment, the better it can be managed. Early symptoms of lymphoedema are: - Swelling of the arm or breast (you may notice that your rings, sleeves or wristbands feel tight.)
- Feelings of discomfort, heaviness and tightness in the arm or breast.
- Aching in the arm or shoulder
What can trigger lymphoedema?
The most commonly recognised triggers for lymphoedema are: - Infections in your arm, on the same side as your surgery. Infections can start from cuts, scratches, injections, insect bites, burns or sunburn – anything that causes the skin to break.
To reduce the risk of infection: - Keep your skin moist and supple
- Protect your skin from the sun with clothing and sunscreen
- Use insect repellant and, if bitten, use a product to reduce the itchiness of the bite
- Avoid injections or intravenous drips in the arm or hand on the side of your surgery.
- Treat breaks to the skin with antiseptic
- If a cut, bite or break to the skin becomes inflamed, or your arm becomes red or swollen, see your doctor as soon as possible. Antibiotics may be needed.
- Being overweight
- Too little or too much exercise: gentle muscle movement increases lymph flow and reduces the risk of fluid accumulating. Gentle, regular exercise is better than occasional bursts of intense activity. If you want to exercise vigorously, work up to it gradually and, if concerned, seek advice.
- Overheating your arm: Avoid sun, hot baths/showers, spas, saunas and excessive exercise.
- Injuries to the arm
- Carrying or holding heavy parcels: Work up slowly to carrying heavy items and check for swelling.
- Restricting circulation to your upper body or arm: Blood pressure cuffs, tourniquets, bras with narrow straps, clothes which are tight around your chest or arm, tight jewellery or watches may reduce lymph flow.
- Travelling: Sitting still during long flights, car or bus trips and pressure variations in aeroplanes may reduce lymph flow. Consider wearing compression garments. There are specific cautions you can take.
Remember · Not all women who have had breast cancer develop lymphoedema · Early diagnosis and treatment make it easier to manage, reduce the amount of swelling and improve arm function · Be aware of possible problems · Take precautions · Observe your arm for any changes · Seek prompt medical advice Use your arm for daily activities
Arm & Shoulder exercises will help you regain normal movement and maintain normal circulation. It is important to use your arm normally both to assist the return to full movement and to lessen problems such as shoulder stiffness, muscle weakness, skin and muscle tightening. Suggestions given below may prevent the occurrence of Lymphoedema 1. Use your arm and shoulder in as normal movements as possible. 2. Use both arms during activities, just as you did before surgery 3. Avoid over using your arm. 4. While your arm is regaining strength avoid carrying heavy objects. 5. Get into the habit of carrying your handbag on your non operated side 6. Be careful cutting fingernails 7. Moisturise your skin to prevent cracks and splits. 8. The arm on your operated side should not be used for measuring blood pressure, taking blood, giving injections or inserting drips. 9. Seek medical advice if your arm or hand feels very uncomfortable, or of there is swelling, redness or any signs of infection. | 
