Lymphedema - another side effect of surgery

Over the last few weeks I've had a number of visitors with lots of other questions.  Besides the scars another side effect of having all your lymph nodes removed is the risk of Lymphedema (I've lucked out not to have it yet...).  I didn't even know this existed before finding out I'd have to have all my lymph nodes removed under my right arm!  I know while getting my pre-surgery talk I was told the risks but at that point I was just shaking my head saying - ok do what you need to do!

Anyway, Lymphedema refers to swelling that generally occurs in one of your arms or legs. Although lymphedema tends to affect just one arm or leg, sometimes both arms or both legs may be swollen.

Lymphedema is caused by a blockage in your lymphatic system, an important part of your immune and circulatory systems. The blockage prevents lymph fluid from draining well, and as the fluid builds up, the swelling continues. There's no cure for lymphedema, but it can be controlled. Controlling lymphedema involves diligent care of your affected limb

So before I was discharged from UNC I had a physical therapist give me a list of things I should avoid for the rest of my life!  Like - hot tubs and cat scratches!  ha!

I. Skin Care - Avoid trauma / injury to reduce infection risk
• Keep extremity clean and dry
• Apply moisturizer daily to prevent chapping/chafing of skin
• Attention to nail care; do not cut cuticles
• Protect exposed skin with sunscreen and insect repellent
• Use care with razors to avoid nicks and skin irritation
• If possible, avoid punctures such as injections and blood draws
• Wear gloves while doing activities that may cause skin injury (i.e., washing
dishes, gardening, working with tools, using chemicals such as detergent)
• If scratches/punctures to skin occur, wash with soap and water, apply antibiotics,
and observe for signs of infection (i.e. redness) One write-up even says to avoid cat scratches…
• If a rash, itching, redness, pain, increased skin temperature, fever or flu-like
symptoms occur, contact your physician immediately for early treatment of
possible infection
 II. Activity / Lifestyle
• Gradually build up the duration and intensity of any activity or exercise
• Take frequent rest periods during activity to allow for limb recovery
• Monitor the extremity during and after activity for any change in size, shape,
tissue, texture, soreness, heaviness or firmness
• Maintain optimal weight
 III. Avoid Limb Constriction
• If possible, avoid having blood pressure taken on the at-risk extremity
• Wear loose fitting jewelry and clothing
IV. Compression Garments
• Should be well-fitting
• Support the at-risk limb with a compression garment for strenuous activity (i.e.
weight lifting, prolonged standing, running) except in patients with open wounds
or with poor circulation in the at-risk limb
• Consider wearing a well-fitting compression garment for air travel
NLN Position Paper: Lymphedema Risk Reduction Practices
 V. Extremes of Temperature
• Avoid exposure to extreme cold, which can be associated with rebound swelling,
or chapping of skin
• Avoid prolonged (greater than 15 minutes) exposure to heat, particularly hot tubs
and saunas
• Avoid placing limb in water temperatures above 102°Fahrenheit (38.9°Celsius)
VI. Additional Practices Specific to Lower Extremity Lymphedema
• Avoid prolonged standing, sitting or crossing legs
• Wear proper, well-fitting footwear and hosiery
• Support the at-risk limb with a compression garment for strenuous activity except
in patients with open wounds or with poor circulation in the at-risk limb

NOTE: Given that there is little evidence-based literature regarding many of these
practices, the majority of the recommendations must at this time be based on the
knowledge of pathophysiology and decades of clinical experience by experts in the field.
© 2008 National Lymphedema Network (NLN).

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