WHAT IS LYMPHEDEMA?
Lymphedema is the accumulation of a particular kind of fluid, typically in one part of the body. Lymph is the protein-rich body fluid that accumulates when the lymphatic system for fluid transport is damaged. Lymphatic fluid is exchanged by tranference between the blood circulatory system and the lymphatic system.
WHY IS THE LYMPHATIC SYSTEM IMPORTANT?
Fluid transport is one very important component, but many do not realize that the lymphatic system is part of the immune system. It fulfills the function of ‘immune trafficking,’ the process whereby infection-fighting cells can be mobilized to the tissues that require assistance. When the lymphatic system is compromised by surgery, trauma, or improper development, the affected part of the body is prone to recurrent infection because of the faulty surveillance mechanism. Increasing the rate of exchange of lymphatic fluid by increasing the velocity of blood flow in the circulatory system has been shown in clincial results to reduce the amount of excees lymphatic fluid in the lymphatic system.
WHY IS IT THAT I WAS NOT WARNED ABOUT THE RISK OF LYMPHEDEM PRIOR TO MY SURGERY?
Regrettably, many doctors are still very under-educated about the lymphatic system in general and, specifically, about the problem of lymphedema. We’re trying to increase awareness about lymphedema and its relationship to the circulatory system. Patients can also help their doctors to learn. Physicians must learn from their patients about their lymphedema experiences so that they will be better prepared to deal with their future patients.
HOW DOES SURGERY AFFECT MY RISK OF LYMPHEDEMA?
The risk is chiefly aligned with lymph node removal. Individuals that have just lumpectomy, or other surgical interventions, are at such low risk that it is impossible to estimate. Sentinel node techniques, alone, are used in about 40% of current breast cancer patients. The sentinel node technique is defined as the removal of no more than four lymph nodes, where the risk is about 6%. If you have more than four lymph nodes removed, the risk rises to 15% to 25%.
DOES RADIATION INCREASE THE RISK OF LYMPHEDEMA?
Yes, radiation can traumatize the lymphatic system equivalently to surgery, even if surgery is not done. However, just as all surgery is not alike, not all radiation therapy is the same. In general, radiation therapy confers risk that is roughly equivalent to axillary lymph node dissection and increases the risk associated with surgery if both treatments are performed.
IF I HAVE HAD LYMPH NODES REMOVED UNDER ONE ARM, DO I HAVE TO WORRY ABOUT THE LYMPH NODES IN OTHER ARES OF MY BODY?
No. The lymphatic system is present throughout the body, but lymphedema is a regional disease that affects only the part of the body that is subjected to surgery or radiation.
DO I HAVE TO WORRY ABOUT THIS FOR MY WHOLE LIFE?
The proper term to use is ‘vigilance.' Stated positively, the primary risk for lymphedema development is in the first year following surgery and radiation therapy, when 90% of the cases occur. By the end of 3 years, 95% of the cases will have appeared. If you don’t have lymphedema after 3 years of vigilance, the risk remains, but it is quite small. If you take the proper precautions and use the proper surveillance, the risk can be maintained as small as possible.
WHAT ABOUT EXERCISE AFTER CANCER SURGERY?
While, in the long run, exercise is very beneficial, it is very important to give your body adequate time for healing and to not push the exercise early on. Do not push strenuous physical activity until the body is ready to do it. We believe that focusing on movement following surgery rather than strenuous exercise is the best and fastest pathway to return to strenuos exercise following surgury. We are especially focused on movement that increases the velocity of blood flow in the circulatory system that requires minimal effort just after surgery. For the first three to four weeks, it is important to avoid stressful exercise and, thereafter, to try to become progressively more active. The Treadwell® System is designed specifically to meet the needs of low exertion movement that significantly increases the velocity of healing blood flow.
AND WHAT ABOUT EXERCISE DURING RADIATION THERAPY?
There are similar concerns. One can expect a certain amount of inflammation related to the radiation, and it would be important to avoid over-taxing the lymphatic system. Accordingly, it is reasonable to ‘take it easy’ during radiation therapy.
SHOULD I BE USING MY ARM (OR LEG) FOR EVERYDAY ACTIVITIES?
Yes, absolutely. Bear in mind, however, that stressful physical activity increases the formation of lymph in the arm or leg at risk. You don’t want to push the lymphatic system ‘over the edge’. Engaging low stress activity that increases blood flow, i.e. the Treadwell® System, will relieve rather than push the lymphatic system. Once you recognize your threshold for activity, you can gently extend your limits over time, while continuing to include the Treadwell® System for the increased blood flow benefits before and after exercise.
PRIOR TO MY CANCER DIAGNOSIS, I LEAD A VERY ACTIVE LIFESTYLE. NOW I AM NERVOUSE THAT MY FORMER ACTIVITES COULD CAUSE LYPHEDEMA TO EMERGE. WHAT DO YOU ADVISE?
My earnest advice is that once you are a cancer survivor, you must enjoy the gift of life. This means not placing boundaries on your definition of being alive. It is true that there is a small, finite risk of lymphedema appearing for the first time in somebody at risk, or becoming worse in someone who already has it. However, with the appropriate precautions, those risks are quite small. It is very important, activity by activity, to weigh the risk-to-benefit ratio.
There is some finite risk of lymphedema with activities like surfing or rock climbing, to choose two random examples. But you have to weigh the importance to your life of those continuing experiences. With or without ‘risky’ activities appropriate treatment for lymphedema is essential when the lymphedema appears. It is very important to maintain surveillance for changes in the limb-at-risk. Take precautions against infection when there are breaks in the skin and seek medical attention early if any changes are observed. When you go outside, put on a sun block, because sunburn can aggravate lymphedema. When you are working in the kitchen, be careful. When you’re in the garden, be careful, and wear gloves if there is the possibility of skin trauma. But what you want to lift, lift. What you want to do, do. And where you want to go, go. Just be careful.