Lymphedema

The lymph system

To understand lymphedema, it helps to understand the lymphatic system, which includes an extensive network of lymph vessels and lymph nodes.

The lymphatic system helps your immune system work properly to protect your body from foreign substances.

Here’s how the lymphatic system works: Excess fluid is collected from the space between tissues in your body and moves through the lymph vessels. The fluid (now called lymph) isn’t pumped through the body like blood, but instead is "pushed" through the lymph system as the vessels are squeezed by surrounding muscles. These vessels are different from arteries and veins, which carry blood.

Harmful substances, like bacteria and debris, are removed from the lymph fluid by the lymph nodes. The fluid from most of your tissues and organs is filtered through one or more lymph nodes before it drains into your bloodstream.

What is lymphedema?

Lymphedema is an abnormal buildup of fluid that causes swelling, most often in the arms or legs. It happens when lymph vessels or lymph nodes are missing, damaged or unable to work properly.

Lymphedema can be primary and secondary.

• Primary lymphedema is a rare and often present at birth. It is the result of missing or abnormal lymph vessels.
• Secondary lymphedema is caused by another condition that causes a change in the flow of lymph through the lymphatic system. This can be the result of an infection, tumor, surgery, scar tissue, trauma, radiation or other treatment for cancer. It can take anywhere from a few days to years for lymphedema to develop after a lymphatic injury.

What are the signs and symptoms of lymphedema?

Symptoms of lymphedema include swelling in your arms, hands, fingers, shoulders or legs. The swelling can happen for the first time after a traumatic event (such as bruises, cuts, sunburn or a sports injury), after an infection or in the part of the body that was treated for cancer.

If you have any of these symptoms, talk to your healthcare provider. Early treatment can help prevent complications from the condition.

How is lymphedema diagnosed?

Your doctor will carefully review your medical history, including past surgeries and treatments and your current medications and symptoms, and will perform a complete physical exam. You may also need testing to help your doctor make a diagnosis.

What treatments are available for patients with lymphedema?

Your treatment will depend on how advanced the lymphedema is and what caused it.

If the condition is due to an infection, you may need to take antibiotics.

You may need to see a physical or occupational therapist who specializes in helping patients with lymphedema. Therapy can include exercises, special techniques to remove fluid and activity/lifestyle changes.

General guidelines for patients with lymphedema

Eat a Healthy Diet

• Avoid foods high in salt and fat.
• Eat at least 2 to 4 servings of fruits and 3 to 5 servings of vegetables every day.
• Eat a variety of foods to get all the nutrients you need.
• Read food labels to make healthy food choices.
• Eat foods high in fiber, such as fruits and vegetables and whole-grain breads, cereals, pasta and rice.
• Drink 64 ounces of water every day.
• Reach and maintain a healthy weight. Ask your doctor or other healthcare provider for a healthy weight range.
• Avoid alcoholic beverages.

Get Regular Exercise

• Talk to your doctor before you start a new exercise program to make sure the activity is safe. Avoid strenuous exercises that involve the affected limb.
• Improve cardiovascular fitness with aerobic activities, such as walking, swimming, low-impact aerobics or other exercises your doctor recommends. You should aim for 20 to 30 minutes of aerobic exercise most days of the week.
• Include a 5-minute warm-up that involves stretching before you do any aerobic activity, and do a 5- to 10-minute cool down after the activity.
• Don’t lift weights without first talking to your doctor about restrictions.
• Stop any exercise that causes unexpected pain. If your affected arm or leg gets tired while exercising, stop, cool down, then rest and elevate the limb.

Prevent Infection

• Wash your hands often with soap and warm water, especially before preparing food and after using the bathroom or touching soiled linens or clothes.
• Wear gloves while doing housework or gardening.
• Don’t cut your nail cuticles, and be careful when you cut your toenails. Use antifungal powder if you have athlete’s foot.
• Protect your skin from scratches, sores, burns and other irritations. Use an electric razor to remove hair and replace the razor head frequently.
• Use insect repellents to prevent bug bites.
• Immediately report any signs of infection to your physician. Signs of infection include:
  • Fever over 100 degrees F (38 degrees C).
  • Sweats or chills.
  • Skin rash.
  • Pain, tenderness, redness or swelling.
  • Wound or cut that won’t heal.
  • Red, warm or draining sore.

If you get a cut or scrape, immediately wash the area with soap and water, apply antibiotic ointment, cover the area with a bandage and call your doctor for medical advice.

Avoid Tight Clothing, Shoes and Jewelry

• Women should wear well-fitted bras; bra straps should not be too tight, avoid underwire styles, and wear pads under the bra straps if needed.
• Wear comfortable, closed-toe shoes.
• Avoid tight hosiery and socks.
• Wear watches or jewelry loosely, if at all, on the affected arm.

Avoid Heavy Lifting with the Affected Arm

Avoid repetitive movements of the affected arm (such as scrubbing, pushing or pulling). Do not carry a purse or bag on the affected shoulder.

Keep Your Skin Extremely Clean

• Dry your skin thoroughly (including creases and between fingers and toes).
• Apply lotion to the surrounding skin, but not in between your toes.

Important Information for Doctor Visits

• Use the unaffected arm when having your blood pressure checked and when getting injections or blood drawn.

What can I do if I already have lymphedema?

To help prevent further swelling, follow the general guidelines for patients with lymphedema and:

• Avoid extreme temperature changes. Do not use hot tubs, whirlpools, saunas or steam baths. Use only warm water when bathing or washing dishes.
• Always wear sun protection (at least SPF 15) when you are outside.
• Ask your healthcare provider if you should wear a compression sleeve or stocking when you fly. You may need additional bandages for long flights.
• See your healthcare provider for follow-up visits, as recommended.

Long-term effects of lymphedema

Lymphedema cannot be cured. But proper care and treatment can usually bring your arm or leg back to a manageable size and shape. Regular care and follow-up visits will help you manage the condition so it doesn’t get worse.

Without treatment, lymphedema can lead to increased swelling and a hardening of the tissue, which can keep you from being able to use the limb normally. It can also lead to serious health problems.

It is important to get treatment as soon as you have symptoms of lymphedema.