Prevention Because breast cancer patients are the largest group of people with lymphedema in the United States and also the largest group of individuals at risk for lymphedema, suggestions for prevention from lymphedema experts and clinicians have focused on lymphedema in the arms. Breast cancer survivors and others should know the warning signs and the precautions to take. With any trauma or infection, immediate care is essential. Skin care is considered the first line of defense because the skin serves as a barrier to infection. Burns, cuts, dryness or cracks, cuticle injury, splinters, and insect bites are immediate risks for infection. As a massage therapist, you should be aware of tips to reduce risk and prevent onset or worsening of lymphedema. The list below is adapted from those from the National Lymphedema Network. 8 If you have clients who have had breast surgery or radiation, or who have lymphedema, encourage them to follow these prevention suggestions. Skin care ● Keep the affected or at-risk extremity clean. Be thorough but gentle in drying. ● Use moisturizer daily to prevent chapping or chaffing. ● Protect skin with sunscreen and insect repellent. ● Use care with razors to avoid nicks and skin irritation. ● When manicuring your nails, avoid cutting your cuticles and tell your manicurist this. Cuticles are especially sensitive and at risk for injury. ● Wear gloves when gardening, working with tools, or using chemicals such as detergent. ● Wear gloves while doing housework, gardening, or any type of work that could result in even a minor injury. ● If you sustain a scratch or cut, wash with soap and water, apply antibiotics, and watch for signs of infection, such as redness, heat, or swelling. ● If you have a rash, itching, redness, pain, increased skin temperature, or fever or flu-like symptoms, contact your physician immediately. Diagnosis and treatment Early diagnosis, patient education, and treatment of lymphedema are critical to reduce the morbidity and dysfunction that can accompany the condition. If no treatment is given, individuals are at risk for repeated infections, cellulitis, impaired wound healing, and increased swelling and loss of motion. Every person at risk for lymphedema should receive adequate education about prevention and control of symptoms. Health professionals do not have an objective tool or specific criteria that accurately diagnose lymphedema. Usually the clinician can diagnose the condition using the patient’s clinical history and physical examination. Sometimes imaging studies are also used, especially when the diagnosis is made more difficult because of confounding conditions such as morbid obesity or repeated infection. Edema can occur for reasons other than Complete decongestive therapy Clients with lymphedema may participate in a two-stage approach for managing chronic lymphedema that goes by several different names – complex decongestive therapy, combined decongestive therapy, complete decongestive physiotherapy, and combined physiotherapy. We will use the term complete decongestive therapy (CDT). Phase I of CDT is an intense treatment stage, which typically involves daily clinical visits for three to four weeks for arm lymphedema and four to six weeks for lymphedema of a lower extremity. Phase II of CDT is self-management. Phase I includes education about meticulous skin care and monitoring, light manual massage (manual lymph drainage), and bandaging for 23 hours a day. Bandages or devices with compression pumps should initially be applied only by a trained
● If possible, don’t allow an injection in or drawing of blood from the affected arm. Wear a “lymphedema alert bracelet,” which alerts emergency care workers to your risks. (This is available from support groups such as the National Lymphedema Network.) Activity/lifestyle ● Gradually build up the duration and intensity of any activity or exercise. ● Take frequent rest periods during activity to allow for limb recovery. ● Monitor your affected extremity during and after any activity, checking for any change in size, shape, tissue, texture, soreness, heaviness, or firmness. ● Maintain optimal weight. Limb constriction ● If possible, avoid having your blood pressure taken on the arm at risk. If both arms are at risk, have the cuff attached to the thigh. ● Wear loose-fitting jewelry and clothing. Compression garments ● Be sure any compression garment you use fits well. ● Support the affected limb with a compression garment during strenuous activity such as weight lifting, prolonged standing, or running. ● Wear a well-fitting compression garment for air travel. Extremes of temperature ● Avoid exposure to extreme cold, which can induce rebound swelling and chapping of the skin. ● Avoid prolonged (greater than 15 minutes) exposure to heat, particularly hot tubs and saunas. ● Avoid immersing the affected limb in water hotter than 102°F.
Lower extremity prevention practices ● Avoid prolonged standing or sitting.
● Avoid crossing your legs. ● Wear shoes that fit well.
lymphedema, so in diagnosing lymphedema, clinicians must consider other potential reasons for edema, such as congestive heart failure, renal insufficiency, hepatic insufficiency, or a tumor in the lymph node basin. Although lymphedema is a permanent condition without a cure, the symptoms can be reduced and managed. In many cases, with early intervention and if the patient adheres to a recommended program, the symptoms may disappear, although the underlying condition still exists. A number of interventions are used to manage lymphedema, and no single approach is considered the standard of care. Approaches may include compression bandaging or garments, manual lymphatic drainage, and patient education regarding skin care, elevation, exercise, and lifestyle. professional trained, because incorrectly applied bandages can be harmful or useless 9 . Patients are taught the accurate and safe way to apply lymphedema bandaging, so that in the self-management phase they can self-manage their condition. During Phase I, the patient also learns and uses range of motion exercises while wearing the lymphedema bandaging. These exercises are later used in Phase II, when a compression garment is worn. Manual lymphatic drainage, also called the Vodder Technique , that is used in Phase I is a specialized massage technique originally developed by a Danish practitioner named Emil Vodder. The massage methods in the Vodder Technique are specially designed to facilitate lymph flow and drainage. The techniques include very gentle stretches of the skin and superficial fascia, accompanied by effleurage. Kneading strokes
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