If you’ve had treatment for breast cancer, you probably have questions about lymphedema. How can you prevent it? How do you manage it?
Lymphedema care is as individual as the person seeking care. To give us prevention tips, answer general questions about managing lymphedema and to offer guidance on finding therapy and a therapist, I’ve invited Karen to join us on this blog.
Karen is physiotherapist who has been working in lymphedema management since 1989. She started in the public healthcare system in Alberta and has moved into private health care. She’s seen hundreds of clients and has a wealth of experience; of which she has generously offered to share with us here.
*Reminder: Karen cannot provide medical advice nor respond to individual medical queries, but rather she can offer quality information so that you can better understand your health and better communicate with your health care team.
I know our members will have many great questions, but I’d like to get things started with talking about therapist certification.
You are Vodder trained and LANA certified. Can you briefly explain what these credentials mean? What advice would give women looking for a therapist?
For a therapist to be certified you must first be a Physiotherapist, Occupational Therapist, Physiotherapist or Occupational therapist assistant, Registered Nurse, Registered Massage Therapist or Physician. Certification is given after full completion of the course which is normally 150–160 hours of teaching, hands on training and examination. Most times this certification is good for two years and then recertification is needed. LANA (Lymphology Association of North America) also offers recertification through written testing.
Women looking for a therapist should be looking to insure the therapist did the initial full lymphatic training, are they re-certified and are they experienced. It is a specialty treatment and although many do the training, not everyone uses it regularly.
With mild lymphedema, I visited a Vodder trained physiotherapist a couple of times and she recommended a most useful book. I feel quite welcome to ask to see her again, but don’t want to take up her time unnecessarily.
Since then, I try to remember to follow what seem to be the standard suggestions: do the self massage each day (that I remember), wear the sleeve when I am going to do something like gardening or carrying a (beautiful granddaughter) baby, use lotion each day, try not to carry things in the le arm and put my purse across the opposite shoulder and suchlike.
So far, so good.
What else should I be doing? and what signs are there that would tell me to go back to the nice LE woman?
Well number one I am a firm believer in having regular check ups on your arm every 6 – 12 months. Even for a quick check up. There are things we may pick up that you haven’t.
You should be keeping active with regular exercise such as walking most days, light weights (2lb) are great for the arms with one on one education to start, healthy diet, healthy weight, keep stress down, wear your garments whenever you are active such as household chores, exercise, gardening and travel. I am assuming you do not have measurable or visible lymphedema. Otherwise watch for signs of heaviness and achiness in the arm, lose of boney contours or puffiness in the limb and lose of visible veins and tendons as the swelling will mask them. Make a habit of comparing your limbs on a daily basis. Hope that helps.
Q 1. Will I automatically get lymphedema or is there something like special exercises I can do to prevent it?
No, you will not automatically get lymphedema with nodal dissection in the armpit. But you have a 30 to 40% chance of developing some swelling. If you get a cut or wound on your arm that is healing or gets infected, or if you have radiation and/or chemotherapy treatments, your chances of getting lymphedema are higher.
- Keep that arm moving after surgery and do the shoulder exercises recommended by your cancer care team. Alternatively, go see a physiotherapist who specializes in breast cancer patients.
- Wear a light-weight arm sleeve (class I or 20-30mmHg) during all exercise and cleaning duties.
- Avoid repetitive activities such as vacuuming, lugging groceries and heavy cleaning for a good 6 weeks after surgery.
- Add activities slowly and keep an eye on your arm.
- Attend a lymphedema information session offered in your community.
Getting a baseline set of measurements of your arm is a great idea. This means measuring your arm at different places before you get lymphedema. That way you and your cancer care team can tell if there have been any changes.
Q 2. If I don’t get lymphedema right away, is it possible that it can start later, for example a year after my operation?
Yes, it is possible to develop lymphedema years after surgery. I see this most often when women over use their arm during a heavy lift or spring cleaning activities. Always avoid over straining your arm as a rule. Lymphedema will most often show itself in the first year if you are going to develop it. Be proactive: follow the prevention tips above, and if you do develop lymphedema, see a specialist right away.
Q 3. If I do get lymphedema, can it be healed or will I have this problem for the rest of my life.
Lymphedema is a chronic medical condition. Identifying it as early as possible and receiving proper treatment will almost always reduce its severity. Lymphedema is manageable. Most important is that you learn to self manage as much as possible. Get treatment when needed and follow the recommendations of your treating specialist.