Massage, compression, exercise to ease lymphedema symptoms

By Linda S. Mah | Kalamazoo Gazette

November 12, 2009, 10:19AM


Fern Taylor, of Delton, wears a compression sleeve and glove on her right arm to help prevent buildup of lymph fluid after having lymph nodes removed from her breast.

Fern Taylor never knows when her lymphedema is going to flare up. She’ll notice a rash, then there’s a burning sensation and soon her arm swells up to three times its normal size.’

The first time it happened in 2003 “I had no idea what was going on,” said Taylor, who lives in Delton.

Since then, Taylor has learned that the swelling in her right arm is the result of a buildup of lymphatic fluid, which occurs because the lymph nodes in that arm were removed as part of her treatment for breast cancer.

“Basically, the fluids in my body went where they were supposed to go, but the lymph nodes were not there anymore to carry it through the body,” Taylor said. “So it got stuck.”

The lymphatic system drains fluid from bodily tissue and allows immune cells to travel throughout the body. Lymphedema occurs when the lymph nodes are unable to drain that fluid. The fluid pools in an area, causing the body part to swell and sometimes leading to discomfort from the pressure of the fluid buildup, a sense of heaviness, a decreased range of motion, chronic wounds and ulcers and skin breakdown.

“The lymphatic system is designed to carry nutrition to all of the cells in the body and to remove waste products,” said Rosalyn Cooper, an occupational therapist at Borgess Health and Fitness Center, where Taylor receives treatment. “If the fluid gets stuck in the arm or leg, all of that junk is in there. The body is going to react as if it’s a foreign material, and your likelihood of infection is increased.”

Lymphedema occurs in 10 to 15 percent of breast-cancer patients who undergo removal of breast tissue and accompanying lymph tissue. It also occurs in patients who have had other problems, such as other cancers, congenital problems with their lymphatic system or extreme weight gain.

After Taylor’s initial bout with lymphedema, it occurred sporadically until earlier this year, when the problem became more persistent. With the help of Cooper, though, she now has the condition under control.

“You have to get into therapy and take it seriously,” Taylor said. “They do a tremendous job of working with you, but if you don’t follow through, it’s not going to work.”

A chronic condition

Once a patient develops lymphedema, they must manage it for the rest of their life through exercise, support garments, massage techniques and medication.

 But all treatment begins with education and a complete patient history, said Cooper and Kathy Sullivan, Bronson Methodist Hospital’s outpatient rehabilitation supervisor.

Patients often need information on the condition and the purpose and design of the lymphatic system, Cooper said. Sullivan, who is an occupational therapist, noted that a complete history is important for the therapists working with the patient, because certain conditions such as kidney failure and heart disease can be severely affected by the fluid buildup or the stress on the body from trying to process the extra fluid.

Moving fluid around

The most unusual aspect of therapy for lymphedema is called lymphatic drainage, which is a light, systematic massage designed to move fluid away from the affected area and toward a portion of the lymph system that is still functioning properly so it can be processed.

The massage begins in areas where the lymph nodes are still functioning, such as in the opposite extremity or the abdomen, Cooper said. That stimulates the lymph nodes and prepares them to accept the extra fluid, she said.

Then, during the drainage, “we trying to work on the fluid going from the farthest point to the closest point, or from the distal to the proximal, from the farthest away from the center of the body toward the area closest to the center,” Sullivan said.

A skilled therapist can move fluid in a patient’s toes to the abdomen, where there is a large collection of lymph nodes. “There is a dump point behind the bellybutton. If you can stimulate that deep trunk area, it acts like a clothes chute, and we have a place to put the excess fluid,” Cooper said.

In addition to improving fluid drainage, therapists help patients develop a schedule of exercises to keep the affected area flexible and healthy, without overstimulating or inflaming it.

Wrapping and compression

Patients are also instructed in bandage-wrapping techniques that help apply pressure to the affected limbs. Like the massage, the wrapping squeezes the fluid away from one area and toward another, so the wrapping will often begin more tightly at the far end of the extremity and loosen as it moves toward the body’s core.

That pressure can actually cause some of the fluid to ooze through the pores of the skin. That dampness as well as the stiffness caused by the pressure of the fluid can cause problems such as ulcers, so therapists instruct patients on how to manage skin problems and instruct them on safety precautions to reduce the chance of injury to the skin. For example, injections should never be administered in the site of the lymphedema because that trauma can trigger a flare-up.

Once patients have their condition fairly well controlled, therapists will help fit them with special compression garments that maintain pressure on the area and reduce swelling. Taylor, for example, has sleeves for her arm and hand. The garments are frequently recommended for air travel, when the change in air pressure can affect the lymphedema.

Other, less-common therapies include a compression machine that replicates the movement of the drainage treatment, and electrical stimulation that can help reduce discomfort, Sullivan said.

Staying vigilant

With all of these therapies, however, the goal is for the patient to return to a stable condition and be able to manage the swelling so it does not cause pain or limit activity. That outcome requires vigilance on the part of the patient.

Taylor admits that she doesn’t like exercise, and after her early bouts of lymphedema she did not follow her prescribed therapy. Now, though, she does her exercises daily, wears her compression garments during the day and wraps her arm at night.

“I’ve given up a lot of things in my life because of the cancer,” Taylor said. “I don’t want to give up anymore. I’ve gotten this far. I’m not going to let this get me down.”

Reprinted from the Kalamazoo Gazette.

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