What is Lymphedema?
I have been told that I have "a bit" of lymphedema and that is why I am getting heaviness in my arm, what does that mean?
When lymph nodes are removed or the lymphatic circulation is interrupted for whatever reason, the extracellular (outside of the cells) fluids that transport some of the cells waste products cannot flow freely back into the circulation. This back-up of fluids will cause a swelling in the affected area that can be chronic. This swelling has a different consistency than the kind of swelling that we get with varicose veins or heart failure.
Lymphedema is called primary if it occurs because of a congenital problem (something that had an origin at birth), and secondary, if it occurs due to an identifiable cause (if it is unidentifiable and secondary we call it idiopathic). The most common reason for lymphedema today is an interruption of lymphatic channels by combination of surgery and radiation for breast cancer.
Generally, a single surgery itself does not alter the lymphatic system sufficiently to cause lymphedema. The body repairs the damage done by the surgery itself. But when we have to go back again and remove the nodes, we damage the self-repairing capacity of the body. If radiation is needed after the surgery, the self-repairing capacity can be further impaired.
Women (they have more such surgeries than men, who will have the same symptoms) may note heaviness of the arm, shoulder, and breast or back on the side that has been treated. Because of a relatively high incidence of this complication after lymph node "sampling" surgery, we have moved away from this technique and are now minimizing the exploration by something called "sentinel node" surgery to determine if the cancer has spread. I am not a cancer specialist, but I am often asked to evaluate women who complain of "heaviness" in the arm that turns out to be related to the breast problem rather than a cardiovascular disease.
Often, if the problem is seen very early after surgery, time will improve and dissipate many of the symptoms. If you are told that you have lymphedema, you may want to discuss some of the following important questions with you health care provider:
- Do I need to go for physical therapy or lymphatic drainage massage?
- Would I obtain relief of my symptoms by a compressive sleeve and gauntlet?
- What can I do to keep this from getting worse, or to alleviate symptoms?
- Are there activities that I should avoid? Should we be taking blood pressures and drawing bloods only on the non-affected side?
- How will this affect my lifestyle? Is there anything that I am currently doing, or may do that can make things worse?
- Do I need to carry antibiotics in case of infection or insect bite?
- Would you prefer me to see someone who has specialized in this field?
Fortunately, rather simple physical techniques and appropriate forms of physical therapy can medically treat this annoying condition. More information and discussion of this relatively common problem is available from the American Lymphedema Society. If you are unable to find someone in your area who is comfortable prescribing for this condition, the American Cancer Society can also be of help.
Larry Weinrauch is a cardiologist in Watertown, Massachusetts and is affiliated with Mount Auburn Hospital. He wrote for HealthCentral as a health professional for Heart Health, High Blood Pressure, and High Cholesterol.