Surviving cancer is a compliment that should be celebrated. Many patients believe after medical treatments they can move on with their normal habits. Most patients leave their doctor without understanding the associated risk of side effects of surgeries, radiation, and cancer. One condition called Lymphedema is a life long risk that requires therapy.
The lymphatic system includes the spleen, tonsils, adenoids, lymph nodes, lymphatic vessels, thymus, and the bone marrow that produces lymphocytes. A healthy lymphatic system pumps lymphatic fluid from the right lymphatic duct and through the thoracic duct into the subclavian vain. Then the lymphatic fluid is filtered and eliminated through the bladder.
The lymphatic vessels have a natural pathway which is laid out according to
the anastomoses. The anastomese, also known as a water shed, acts like a mountainous region that directs of the fluid. The water shed divides the body from left to right and above or below the umbilici. The axilla and the inguinal are locations with clusters of lymph nodes. The lymphatic fluid from the arm will travel to the nearest axilla to connect with the lymph nodes and process the fluid.
Lymph nodes are small structures that perform several different functions. They increase or decrease in size from an immune response caused by viruses, fungi, and bacteria. Lymph nodes are the location where interstitial fluid is filtered, foreign objects are stored, and some of the white blood cells communicate. It is common to find macrophages cleaning foreign products that are found in the lymphatic system. Particles from cancer that are metastatic are often found in the lymph nodes. During breast cancer surgery, the lymph nodes with cancer cells are removed from the patient. After the lymph nodes are removed; interstitial fluid starts to accumulate in arm.
Diagnosing lymphedema includes a bilateral circumference volume measurement of the upper extremities. A circumference greater than three centimeters that last longer than three months in a specific location is called Lymphedema. To diagnose a secondary lymphedema, medical history of the patient should be discussed. Secondary lymphedema is a multifactoral condition caused by surgeries, injuries, medical treatment, life style habits, body mass index greater than 25 and in conjunction with the destruction of lymph nodes or lymphatic vessels. Other signs of lymphedema include skin changes such as color change or tissue texture change, swelling, pitting edema, or hardening of the skin.
Treatment option for lymphedema includes two different forms of therapy that have been agreed upon by a consensus panel of experts which includes complete decongestive lymphatic therapy and manual lymphatic drainage. Manual lymphatic therapy is provided by a trained medical expert that provides a light pumping massage to stimulate the lymphatic vessels and contraction of lymph nodes. The therapy will flush excess fluid from a limb by pushing the fluid cross the water shed. Decongestive therapy is a special wrapping technique that uses a series of short stretch bandages to create a gradient pressure and causes the fluid to move out of the limb.
There is no cure for lymphedema, only a control method. After therapy the patient needs to maintain their limb by doing self massage and applying compression bandages every night. If a patient is unable to do their own massage, there are medical devises that can help. A FlexiTouch machine can be purchased through a patients insurance with their duramedical supply benefits. Patients need to be diligent in their self care to benefit from any form of therapy. After the initial treatment, the patient should consider being re-evaulated every 6 months to measure the limb. The patient will return for therapy if the limb increases in size.
Davey S.ORT-LANA- Healing Hands of Lymphat- ic’s. 110 N. Federal Hwy. suite 201 Hallandale, Fl. Phone interview on April 3, 2009
Haines T.P., Sinnamon P. Early arm swelling after breast surgery: changes on both sides. 2006. Springer Science and Business Media. 101:105-112
Lymphomation.org. Lymphatic system. Last up- dated 2008. Accessed March 2009. http://www. lymphomation.org/lymphatic.htm