Help For Lymphatic Swelling
October 26, 2011
By Cheri Teranishi-Hashimoto
Cheri Teranishi-Hashimoto, Dpt
Physical therapist at Rehabilitation Hospital of the Pacific
Where did you receive your schooling and training?
I received my bachelor’s degree as a double major in movement in sports science and exercise and fitness, and my master’s degree in exercise physiology at Purdue University. I received my master’s and doctorate degree in physical therapy from Des Moines University Osteopathic Medical Center.
I received my board certification in Women’s Health from the American Physical Therapy Association, my Lymphedema Specialist certification from the Lymphology Association of North America and my Cancer Exercise Trainer certification from the American College of Sports Medicine.
How long have you been practicing?
I have been a physical therapist for nine years.
What is lymphedema?
Lymphedema is excess accumulation of proteinrich fluid in the body. Primary lymphedema occurs when someone is born with malformation of their lymphatic system. Secondary lymphedema occurs as the result of trauma or damage to the lymphatic system, including surgery, radiation or an infection.
There are four stages of lymphedema. Stage 0 occurs after lymph nodes or the lymphatic system have been damaged or removed due to trauma or surgery. At this stage there is no excess swelling, but the transport capacity of the lymphatic system has been reduced. In Stage 1, observable swelling and “pitting” may be noticeable along with feelings of tightness or heaviness in the affected region. Pitting is when you are able to touch the affected area and leave an indentation that refills after a period of time. Stage 1 is also called “spontaneously reversible” in the case of a breast cancer patient, swelling may be present but they elevate their arm, perform their drainage techniques and exercises and the swelling may resolve. However, once their transport capacity has been reduced, they are always at increased risk for swelling to recur. Stage 2 is when the fluid has stayed in the tissues for a longer period of time. It is unable to be removed readily by the lymphatic system and the protein-rich fluid begins to harden or become fibrotic. Tissue changes are more noticeable and pitting may not be present. Stage 3 is the most severe stage commonly referred to as elephantiasis, where tissue changes and skin changes are very observable. Stage 3 is rarely seen in breast cancer patients and more commonly seen in the lower extremities.
What are the responsiblities of the lymphatic system?
Our lymphatic system helps with immune function and circulation, carrying lymphatic fluid waste products to the lymph nodes to be broken down and sent out of the body (usually through urine output), while the rest of the protein-rich fluid is sent back into our circulatory system.
Our lymphatic system covers our entire body alongside our circulatory system. The lymph nodes lay in chains along the lymphatic vessels throughout our body. The main areas include the neck, armpits and groin region. We’re not born with a set number of lymph nodes, so you can have 25 under one armpit and just five under the other. When our lymph nodes are removed or damaged, they don’t regrow and they don’t repair themselves. When the transport capacity of the lymphatic system is not functioning at 100 percent, the body will do as much as it can to maintain balance and keep things as normal as possible until it cannot. That’s when the fluid starts to back up in the body, particularly in the quadrant where the lymphatic system is not functioning efficiently. In the case of a post-surgical breast cancer patient, we may see swelling not only in the arm or hand, but in the body in the chest or trunk area as well.
What does treatment involve?
Treatment involves two phases of complete decongestive therapy. Phase I, the “decongestion” stage, occurs under the guidance of your therapist while Phase II, the “preserve and improve” stage, is the lifelong routine care which is performed on your own once therapy is finished.
Complete decongestive therapy is comprised of four main components. 1) Manual lymphatic drainage is a hands-on technique that helps to guide the fluid from the congested area of the body to other areas for removal. These techniques are taught to the patient to be performed on their own at home. Our skin is very elastic and will continue to stretch as much as it can to accommodate the fluid buildup. 2) Compression bandaging is used to decrease the size of the affected area to as small as possible before someone is fitted for a compression garment. Compression garments not only contain the swelling but also help to provide pressure against our muscles and skin as we move, which assists with fluid removal as well. 3) Decongestive exercises are specific movements that help to promote fluid movement. After breast cancer surgery, tightness in the surrounding tissues and muscles are common, so stretching exercises are included as part of a home exercise program. 4) Skin and nail care are important for anyone with a compromised lymphatic system as any opening in the skin increases the risk for infection. Each component of complete decongestive therapy is maintained in Phase II of treatment by each patient independently.
Is lymphedema curable?
Lymphedema is not “curable.” Once our lymphatic system has been compromised we are always at increased risk for lymphedema to develop. Some patients never develop lymphedema, some develop it right after surgery and others may develop it 20 years after surgery. For those who develop lymphedema, we recommend that they continue Phase II of treatment for life to decrease their risk from symptoms recurring or worsening.
Anything else you want to mention?
Many of my patients mention that there is a need for community education about lymphedema and more resources for those undergoing treatment or who have finished treatment for breast cancer. The most important thing for your health and well-being is that you ask about it. You should be able to obtain information from your primary care physician, medical oncologist, radiation oncologist, surgeon or other health care team provider. It is recommended that you find a certified lymphedema therapist for treatment.