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Helping you through breast cancer treatment

ALERT: Lymphoedema risk

ALERT: Lymphoedema risk

This is VERY important to read if you have had any lymph nodes removed. Your surgeon and nurses will explain the risk of lymphoedema to you when you are in hospital for your surgery. But, as with a lot of information which is given to you right now, you may not take in what they say so here is my top ten list of all things lymphoedema:

1. With fewer, or no, lymph nodes in your arm you are at risk of something called lymphoedema occurring in that arm. For those people who have nodes removed from both armpits, you are at risk of lymphoedema in both arms. And we are at risk from now on. For ever. And ever. There is no cure for lymphoedema but the symptoms can be controlled.

2. Lymphoedema is a condition that causes your affected arm/hand to swell up. I am not going to try to explain why that happens (far too technically medical for me)  but if you want more information on the how’s and why’s I have listed some websites at the end of this section.

3. The swelling of the arm usually happens gradually but in some cases it can come on suddenly. You should look out for signs that indicate your arm might be about to start to swell as a result of lymphoedema. According to the NHS website :

The main symptom of lymphoedema is swelling in all or part of a limb or another part of the body. It can be difficult to fit into clothes, and jewellery and watches can feel tight.
At first, the swelling may come and go. It may get worse during the day and go down overnight. Without treatment, it will usually become more severe and persistent.
Other symptoms in an affected body part can include:
•   an aching, heavy feeling
•   difficulty with movement
•   repeated skin infections
•   hard, tight skin
•   folds developing in the skin
•   wart-like growths developing on the skin
•   fluid leaking through the skin

4. If you notice any of these signs, or your arm/hand starts to swell, you need to seek medical assistance – call your breast care nurse, your GP or even one of the nurse helplines (Macmillan or Breast Cancer Care) who can advise you what to do. Medical treatment for lymphoedema includes draining the fluid and wearing a compression garment.

5. So, from now on we need to take steps in our everyday lives to avoid lymphoedema. This means avoiding infections in that arm, not over-using it and generally taking care of it. Your breast surgeon and nurses will give you some advice and the Cancer Research UK website has a good list of ways to help prevent lymphoedema . As does Breast Cancer Care. In the meantime here are some tips I have picked up for those of us living at risk of lymphoedema (but remember these are just a few suggestions – my recommended websites provide more tips and suggestions):

a.    Don’t pull a hang nail – you risk infection.
b.    Use moisturiser every day on your affected arm.
c.    Use a hand cream regularly to prevent cracked skin.
d.    Be prepared whilst you are out and about. Pack a little bag of plasters, antiseptic wound cleanser so that if you are out an about and get a cut you can treat it immediately to help prevent an infection from developing.
e.    Have any future vaccinations done on your other arm.
f.     Avoid hot baths and showers; use warm water instead.
g.    Wear rubber gloves for kitchen and cleaning tasks and wear gardening gloves for gardening. Use oven gloves.
h.    Shaving and waxing your underarms could cut/cause an infection so I was recommended to use hair removal cream.
i.     Protect your arm from sunburn so use a high factor sunscreen and cover up.
j.     There is advice about being careful when using your arm for lifting heavy shopping bags, gardening, vacuuming, scrubbing and exercising – check out the professional advice about these types of activities
k.    Avoid exposing your arm to extreme temperatures, such as in saunas, steam rooms and hot tubs.
l.     Avoid deep tissue massages and spa massages to the area where you are at risk (usually chest, back and arm on affected side).
m.   Apply insect repellent to avoid insect bites on holiday.

6. If you have had the lymph nodes removed from your arm, then for the rest of your cancer treatment (and beyond) remember to not have blood tests, injections, IV and blood pressure on your bad arm. If you have had nodes removed from both arms then you can have blood pressure taken on your legs and your surgeon will tell you about having future injections in other parts of your body – not your arms.

7. Consider getting a medical bracelet to wear on your arm engraved with:
Your name
Risk of lymphoedema in [R/L] arm
No BP/IV/ needles in [R/L] arm

8. Get your GP to refer you to your local lymphoedema service who can give you more advice about the risks and what to do if you develop lymphoedema.

9.  DON’T PANIC if you develop lymphoedema. It can be controlled by lymphatic drainage massage and by wearing compression garments. Manual lymphatic drainage massage is where a trained practitioner uses a very light special massage technique to help move the lymph away from areas where there are no lymph nodes (such as your arm from where your lymph nodes have been removed) to other parts of your body where you have more lymph nodes (such as your back, chest, neck or stomach). It doesn’t hurt, but because toxins are moved around your body it is important to drink lots of fluids to flush them out. Otherwise you could end up feeling unwell. Depending on the amount of swelling, you will usually have the treatment for an hour every day for a number of weeks, and then this will be gradually reduced to the point where you would only need a maintenance session every month or less. More information is available on the Macmillan website.

10.  I attended a talk given by two very lovely lymphatic drainage consultant practitioners. One of their suggestions was to have lymphatic drainage massages even if you show no signs of lymphoedema. This will help to “train” the lymph fluid in your at risk areas to drain towards other lymph nodes (such as those in your back).

HELPFUL RESOURCES AND MORE INFORMATION

Do take a look at some more information which is available about lymphoedema. There is a lot online. Here are some helpful websites but there are plenty more:

1. NHS advice on lymphoedema
2. lymphoedema.org
3. Breast Cancer Care advice
4. Macmillan advice
5. Cancer Research UK advice
6. Breast Cancer Care booklet on living with lymphoedema after breast cancer surgery can be downloaded or ordered here

To find a manual lymphatic drainage practitioner in your area, you can check out the Manual Lymphatic Drainage UK website.

Personally I see two amazing ladies who are highly qualified lymphatic drainage practitioners. Their website is MLDHERTS and on it there is a wealth of information about lymphoedema, lymphatic drainage and contact details should you wish to get in touch with them.

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