Breast cancer survivors unsuspectingly may face another challenge: a disorder called lymphedema. It is estimated that over three million women who currently have breast cancer will develop this disorder. But what is it and what can be done to manage this condition?

Lymphedema comes from two words: lymph, a natural body fluid, and edema, meaning swelling. Unlike swelling seen with injury, arthritis, fluid retention, or vascular problems, lymphedema is a chronic condition in which an arm or a leg swells due to interruption of the normal lymphatic circulation. This disorder may be present at birth, or occur following surgery, radiation treatment, or after an accident.

If the lymphatic vessels are damaged, they lose their effectiveness in returning the lymph to the bloodstream. Fluid and protein accumulate in the tissues, causing mild swelling. If aggressive corrective action is not taken immediately, the condition progresses, and the limb may continue to swell. The tissues are deprived of the supply of nutrients brought by the circulatory system, and cannot get rid of their metabolic waste products. The skin loses its normal elasticity and hardens. Chronic swelling occurs and the arm or leg loses its normal mobility. The immune response may be impaired due to lymph node damage, and lymph fluid may ooze through the skin, altering its acidity (pH). These factors create an environment ripe for infections and skin ulcerations. Pain may vary from a feeling of heaviness in the arm or leg to being constant and severe.

The onset of lymphedema may be sudden, occurring immediately after cancer treatment, or it may develop years later. It is not known which women who have had breast cancer will develop this disorder, but we do know that lymph node removal and radiation therapy puts these individuals at risk, whether they have had a lumpectomy or a mastectomy.

There is no cure for lymphedema. Prevention and proper management are extremely important. A lymphedema specialist is an essential part of the healthcare team.

PREVENTITIVE MEASURES FOR LYMPHEDEMA

Preventative measures are a lifelong necessity to prevent/manage lymphedema. In addition to adaptation of a healthy lifestyle, specifics for the involved arm or leg include:

1.    Modification of daily tasks to prevent even minor injury
2.    Avoidance of tight or restrictive clothing
3.    Avoidance of undue pressure or strain
4.    Aggressive treatment of any signs or symptoms of lymphedema

       or injury
5.    Moisturize the skin with a quality pH-balanced lotion, such as

       Nivea or Eucerin

MANAGEMENT MEASURES IF YOU HAVE LYMPHEDEMA

Specialized treatment by a certified lymphedema specialist is an important aspect of management. A specialized treatment program includes:

1.    Manual lymphatic drainage, a specialized massage technique. 

       CAUTION: Vigorous and deep massage is contraindicated. 

       DEEP MASSAGE MAY FRACTURE LYMPHATIC VESSELS.
2.    Consistent use of compression bandages or a properly fitting

       compression garment.
3.    Specific lymphedema exercises. 

EXERCISES FOR LYMPHEDEMA

Here are a few chair exercises that would be appropriate for upper extremity lymphedema:  

The #1 most important exercise is diaphragmatic breathing.

Remember to inhale deeply and exhale fully and slowly. The movement of the diaphragm promotes the drainage of lymphatic fluid.

1. Begin and end your exercise session with diaphragmatic breathing. (Belly Breathing).
2. Exercises should be done while wearing compression bandages or properly fitting compression garments, if prescribed.
3. Exercise: a.  Proximal muslces first (muscles closest to the center of the body, i.e., shoulder, upper arm) b.  Distal muscles last (muscles farthest from the center of the body, i.e., forearms and fingers) *The movement of muscles, contracting and relaxing, acts as a pump and facilitates lymphatic flow
4. Using arms, gently bring bent knee toward chest several times with a gentle pumping movement (as though you are bouncing the knee gently against the chest.)
5. Neck rotations. With head and neck in good alignment over shoulders, turn head side to side, right to left. Then, drop ear toward shoulder, right to left.
6. Shoulder rolls. Roll shoulders forward-up-back-down.
7. Elbow bends. Touch right shoulder with right hand. Support right arm with left hand under right elbow. Fully extend right arm in front of body at shoulder level. Bring back to starting position. Perform four repetitions then repeat with left hand to left shoulder.
8. Wrist circles and finger pumps. Make a fist and rotate wrists clockwise. Relax hand for two seconds. Open and close fingers two times. Make a fist and rotate counter clockwise.

IT'S IMPORTANT TO HAVE YOUR PHYSICIAN'S OR LYMPHEDEMA THERAPIST'S APPROVAL AND GUIDANCE FOR ANY EXERCISE PROGRAM. THIS INFORMATION IS IN NO WAY A SUBSTITUTE FOR MEDICAL CARE. 

Thanks to Marie Cole, PT, Certified Lymphedema Specialist,  for some of the above information.

RECOMMENDED SIT AND BE FIT VIDEOS FOR LYMPHEDEMA

Many people with lymphedema have benefited from the exercises on the SIT AND BE FIT television program. Most of the videos are appropriate for those with upper extremity lymphedema because they work with the neck, truck, and shoulders before they work with the elbow and fingers. Our videos were not designed specifically with lymphedema in mind, however, and individuals with upper extremity lymphedema may need to modify some to the exercises.

1. 30 Minute Workout:  VHS
2. Tone and Stretch II:  VHS
3. All-Sitting Video:  DVD  VHS
4. Tone and Stretch I:  VHS  VHS in Spanish
5. Tone and Stretch IV:  DVD  VHS
6. Tone and Stretch III:  VHS  (The massage at the end of the first workout of Tone and Stretch III should be avoided or modified for upper extremity lymphedema patients.)