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Lymphedema
A breast cancer patient who has had lymph nodes removed from her armpit is at risk for lymphedema, the excessive accumulation of lymphatic fluid as a result of the absence of the nodes that help control its drainage. A woman has 35 to 40 nodes in each armpit; the greater the number of nodes surgically removed (especially if the number is more than seven), the more difficult it may be for lymphatic fluid to drain adequately.
The swelling that signals lymphedema is likely to start slowly. A slight puffiness is a sign that you should drink lots of water and pay close attention to the swelling. If it worsens, or if there is a sign of infection--the arm is red or warm to the touch and you are running a fever--contact your doctor. A physical therapist certified in lymphedema management may be able to reverse the swelling. A cancer doctor or breast cancer support group or breast cancer center may be able to recommend names.
Some steps a patient can take to reduce the likelihood of lymphedema:
- Avoid having your doctor check blood pressure or draw blood from the arm at risk. If you've had lymph nodes removed from both arms, you can offer your foot for blood draws and leg for blood pressure, or at least alternate arms.
- Good muscle tone helps the normal flow of the lymphatic system, so follow the exercise program prescribed by your healthcare provider. It's OK to lift weights. Just start at a low weight and work your way up to heavier weights.
- Make as much use as possible of the affected arm for ordinary purposes such as brushing the hair, washing the face, and the like.
- Drink six to eight glasses of water a day.
- Make every effort to prevent the arm and hand from becoming infected. This requires careful attention to cleanliness, scrupulous care of any cuts or bruises, daily use of skin creams to prevent dryness or chapping, and use of garments such as gloves and long sleeves to protect against injuries while gardening or doing chores.
- Guard against burning the skin, whether from kitchen injuries, hot showers or baths, or the sun. Use sunblock providing a sun protection factor (SPF) of at least 15.
- Wear loose-fitting garments and jewelry, especially when traveling by air.
- Avoid lifting objects heavier than you're used to.
- Don't carry a shoulder bag or grocery bag with the at-risk arm.
- When flying, walk about the cabin at least hourly to aid circulation.
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