lymphedema: getting the facts · massage not the same as a typical massage specific pressure (the...
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Lymphedema:
Getting the Facts A Cancer Patient’s Guide to Prevention
and Management
Lindsay Davey, MScPT, MSc, CDT
Registered Physiotherapist,
Certified in Combined Decongestive Therapy,
Owner/Clinic Director of Toronto Physiotherapy
The Lymphatic System:
What Does It Do?
Maintains a normal balance of fluid in our
tissues and blood stream
20% of all tissue fluid returns to the heart via
the lymphatic system (80% returns via veins)
Monitors for foreign material and bacteria in
the body
Circulates immune cells for fighting infection
What is Lymphedema?
The swelling of a body part due to the accumulation of lymphatic fluid
Caused by an insufficiency of the lymphatic system to ‘drain’ fluid from the limb (or torso)
Reasons for impaired drainage: ◦ Surgical removal of lymph nodes
◦ Radiation to an area where lymph nodes reside
Lymphedema can take weeks, months, or years to appear following cancer treatment
Who Gets Lymphedema? Most research has been done on breast
cancer patients, where incidence rate of lymphedema is between 6% - 30%
Increased Risk: ◦ More extensive surgery to remove primary
tumour
◦ Higher numbers of lymph nodes removed
◦ Radiation to remaining lymph nodes
◦ Tumour positive lymph nodes
◦ Post-operative complications
◦ Web Syndrome (Cording)
◦ Increased body weight
Symptoms of Lymphedema:
Early Stage
May not see swelling
Sensation of heaviness, fullness, tightness,
bursting sensation, aching pain, tingling
May see swelling or puffiness after exercise
or more vigorous use of the limb
Elevating the limb may decrease swelling
Swelling may be ‘pitting’ when pressure is
applied
Symptoms of Lymphedema:
Later Stage
Swelling of any section of the limb,
hand/foot, fingers/toes, pelvis/trunk
Non-pitting
Elevation has no effect
Areas of ‘hardening’ of the tissue
Skin changes
Chronic condition (but can be well managed!)
How is Lymphedema Treated?
Gold Standard Treatment Approach:
Combined Decongestive Therapy (CDT)
1. Manual Lymphatic Drainage Massage
2. Compression
3. Infection Prevention / Skin Care
4. Exercise
Manual Lymphatic Drainage
Massage
NOT the same as a typical massage Specific pressure (the lymphatic channels are
delicate!) Specific strokes Specific sequence of strokes Re-routes fluid to bypass deficient pathways
where lymph nodes have been removed or exposed to radiation
Self-massage is a KEY component in management. *VIDEO*
Compression
TWO Phases:
1. Limb Volume Reduction Phase
Short-stretch bandages (like tensor bandages) ◦ Usually takes 3 – 6 weeks
2. Maintenance Phase
Compression garment, custom fit or off the shelf
Are These Garments Covered
Under OHIP?
The Assistive Devices Program (ADP) will pay for 75% of the cost of garments
They cover 2 garments, 3 X per year
ADP form must be signed by a Physician (the first time it must be a specialist), a CDT-Authorizor (like myself), and a Fitter
Some patients may also have coverage through extended health benefit plans
Infection Prevention & Skin Care The limb is at higher risk for infection
Keep the skin well moisturized (glycerin-free products are best to prevent drying/cracking)
Caution with things that could break the skin: ◦ Insect bites
◦ Animal scratches
◦ Cuticle trimming/manicures
◦ Paper cuts or larger cuts
◦ Shaving
◦ Minor burns
Use antibiotic cream on all cuts/scrapes
Signs of Infection and
What To Do Signs of Infection: Redness (Cellulitis) Streaking or Rash appearance (Lymphangitis) Heat Fever Generally feeling unwell
What To Do: STOP heavy use of the limb STOP self-massage and compression Seek medical attention immediately
(antibiotics)
Exercise: How Does It Help?
For Cancer Rehabilitation In General:
Aerobic exercise (ex- walking) can decrease fatigue, stress, depression, body mass, and improve immune responses
Strength exercises help battle deconditioning and generalized weakness
Patients’ Quality of Life scores are significantly higher among those who exercise!
Exercise: How Does It Help?
For Lymphedema Prevention & Management:
Promotes fluid flow via pumping action
of contracting muscles
Strengthening makes limb less susceptible
to repetitive strain or other injuries
(which can cause inflammation)
Stretching maintains tissue flexibility to
promote flow through lymphatic channels
Tips for Exercise:
Wear compression during exercise
Avoid gripping tightly on equipment or weights
Avoid wearing tight jewelry
Pre- and Post-exercise self-massage promotes
lymphatic flow
Don’t exercise in overly hot environments
Bike or workout gloves are great for hand
compression; bike shorts for pelvis compression
Progress exercises at slower rate
Do’s and Don’ts !
Avoid injections and IV’s on the affected side
Avoid blood pressure cuffs on this side
Avoid hot tubs and saunas
Diuretics do not help lymphedema
* * *
Do wear some form of compression on flights
Do learn self-massage of the limb, and neck!
Summary
Lymphedema incidence as high as 30% in breast cancer survivors
Lymphedema is a chronic condition, but can be well managed!
Combined Decongestive Therapy (CDT) is the gold standard treatment approach and is highly effective
CDT can also help prevent lymphedema
We’re here to help!
Resources
Lists of CDT Therapists:
◦ Lymphovenous Association of Ontario www.lymphontario.ca
◦ Toronto Lymphocare Centre
www.torontolymphocare.com
Resources
Toronto Physiotherapy
www.TorontoPhysiotherapy.ca
On-line Resources:
◦ A copy of this talk
◦ Lymphedema educational material
◦ Self-Massage Video
◦ Lymphedema Blog: hot topics and latest research
Thank you!
Lindsay Davey, MScPT, MSc, CDT
www.TorontoPhysiotherapy.ca