A critical piece of information that most cancer patients and survivors need to have is contained within this post.
I’ll talk about lymphedema, which is an accumulation of fluid in a limb, or even the head. You might have heard of edema, which is also accumulation of fluid in an area of the body. However, lymphedema is directly related to a compromise in the lymphatic system– that is, the lymph system not being able to do its normal job and draw fluid out of the limb because one or more lymph nodes is not functioning. It is extremely important for anyone who has had lymph nodes removed from their body (or damaged due to radiation or otherwise) to understand this risk, and avoid situations that can initiate lymphedema in their limb(s) or head.
Cancer and Lymph Nodes
After being diagnosed with cancer, it is common for a patient to have lymph nodes tested. The purpose is to determine whether the cancer has spread to the lymph system and possibly other areas of the body.
What is sometimes not understood, however, is that in order to test, one or more nodes must often be removed. Commonly, the sentinal or “lead” node that instructs the other nodes is the one that is removed, if only one node is tested. Also, sometimes, instead of removal, one or more nodes may be radiated. I had a client who actually had one node radiated, but not removed.
Lymphedema – a lifelong risk after lymph node removal or damage
Lymphedema in the leg
When fluid accumulates in an area of the body, we call that edema. When fluid accumulates in a limb because the lymph system was compromised (by having node(s) removed), that’s lymphedema. For example, if a node is removed in the left armpit, then the left arm is at risk of lymphedema, for the rest of the patient’s life. This means that unless you are aware that you are at risk, you will not refrain from the circumstances or situations that can bring on lymphedema. Also, there are three stages of lymphedema:
Stage 1: Any accumulated fluid can be manually drained by a lymphatic drainage massage therapist or specialist. At this stage, it can be managed using pressure techniques, but if it is ignored, Stage 2 may ensue. Tell your doctor right away if one of your arms or legs feels heavy, swollen/tight and when you press on the skin, it leaves a little indentation (pit). Treatment is extremely important.
Stage 2: The lymphedema is no longer “reversible”. The tissue has a spongy, harder texture and when you press on the tissue, no pit remains. Lymphedema can no longer be reversed.
Stage 3: This is the most dangerous stage, because the limb is swollen, pools of fluid remain stagnant, and it is now a breeding ground for bacteria and infections. This is also called “elephantitis” because the limb looks like an elephant’s limb. If an area in the limb becomes hot, it is most likely infected, and can be life-threatening even though the patient does not realize it.
Click here if you would like more information on the stages of lymphedema.
Lymphedema above the neck.
So, lymphedema does not usually just “happen”. Somehow, circulation of fluid in the limb gets altered or completely cut off, and that will trigger it. Here are some examples.
Hanging an at-risk limb over a chair or the bed. If you know that lymph nodes were removed in the lower right groin area, don’t hang your right leg off the bed at night (or any time, really). If nodes were radiated or removed in the neck, believe it or not, all the tissue above the neck is now at risk. So don’t hang your head over the side of the bed, or lay on an inversion table for periods of time.
Massage Therapy. Massage on an at-risk limb by itself is not risky. What matters most is that the person who is massaging you knows what to NOT do in order to prevent sending excess fluid to the affected area. The therapist must have had special training in order to know exactly what he/she can or cannot do for you. If you have enjoyed deep tissue massage therapy all your life, you will still be able to enjoy it, but not in the quadrant of the body where the nodes are affected. They should also massage that area for a very short time, and work on that area last, so that the lymphatic system is already pulling fluids into the other nodes, and the therapist can instruct that limb to send its fluid towards a functioning cluster, away from the closest cluster. I have had specialized training for this, so please contact me if you have any questions or are seeking massage by a qualified therapist.
Sitting on your hands, carrying a heavy bag with an affected arm, or crossing your legs. Fluid constriction is now a concern– so whenever you consider performing an action with that limb, ask yourself if you are in any way restricting the flow of fluid. I heard about a woman who was very aware of the risk of lymphedema, and had been extremely careful to prevent it, for years. One day, while attending her son’s football game, her hands got cold sitting in the bleachers. So she decided to warm them up by slipping them under her thighs on each side. Sadly, she left the game and a few hours later, she had full-blown lymphedema. “When in doubt, don’t.”
Sitting in a sauna or hot tub for more than 15 minutes at a time.
Exposure to cold where the limb must then “defrost” itself.
The best defense is KNOWLEDGE. For even more information on risk reduction, please click here.
Next Post: Patient Education – Beyond the doctor’s office