At risk is anyone who has had either a simple mastectomy, lumpectomy, or modified radical mastectomy combination with axillary node dissection and, often, radiation therapy. Lymphedema can occur immediately postoperatively, within a few months, a couple of years, or 20 years or more after cancer therapies. With proper education and care, lymphedema can be avoided or, if it develops, kept well under control. The following instructions should be reviewed carefully pre-operatively and discussed with your physician or therapist:
- Absolutely do not ignore any slight increase of swelling in the arm, hand, fingers, or chest wall (Consult with your doctor immediately).
- Never allow an injection or a blood draw in the affected arms.
- Have blood pressure checked in the unaffected arm.
- Keep the edemic arm or “at risk” arm, spotlessly clean. Use lotion after bathing. When drying it, be gentle, but thorough. Make sure it is dry in any creases and between the fingers.
- Avoid vigorous, repetitive movements against resistance with the affected arm (Scrubbing, pushing, pulling, etc.)
- Avoid heavy lifting with the affected arm. Never carry heavy handbags or bags with over the shoulder straps.
- Do not wear tight jewelry or elastic bands around the affected fingers or arm(s).
- Avoid extreme very hot and cold temperature changes (over 90 degrees or below zero), such as hot tubs, saunas, or sunbathing. At all times, keep the limb protected from the sun. Heat increases blood flow through the tissue. Sudden temperature changes cause undue stress on the weakened system.
- Wear gloves while doing housework, gardening, or other types of work that can result in even minor injuries. A lesion in the skin will allow infectious bacteria to enter the tissue.
- Avoid cutting cuticles when manicuring hands and pedicuring feet.
- Consult your therapist about any sports activities in which you participate, because some may aggravate the condition. However, swimming, biking, walking, and specially designed ballet or yoga classes are encouraged. Physical exertion forces the damaged lymphatic system to try to do work it cannot do.
- When travelling by air, patients with lymphedema must wear a compression sleeve. Additional bandages may be required on a long flight.
- Patients with large breast should wear light breast prostheses (heavy prostheses may put too much pressure on the lymph nodes above the collar bone). Soft pads may have to be worn under the bra strap. Wear a well-fitted bra: not too tight and with no wire support.
- Use an electric razor rather than a safety razor. An electric razor will prevent puncturing the skin and subsequent infection.
- Patients who have lymphedema should wear a well fitted compression sleeve during all waking hours. At least every 4-6 months, see your therapist for follow-up. If the sleeve is too loose, most likely that arm circulation has reduced or the sleeve is worn.
- Warning: If you notice a rash, blistering, redness, increase of temperature or fever, see your physician immediately. An inflammation or infection in the affected arm could be beginning or a worsening of lymphedema.
- Maintain your ideal weight through a well-balanced, low sodium, and high fiber diet. Avoid smoking and alcoholic beverages. Lymphedema is a high protein edema, but eating too little protein will not reduce the protein element in the lymph fluid. Rather this will weaken the connective tissue and worsen the condition. The diet should contain protein that is easily digested, such as chicken, fish or tofu.
- Unfortunately, prevention is not a cure. But, as a cancer patient, you are in control of your ongoing cancer checkups and the continued maintenance of your lymphedema.