New breast cancer procedure helps prevent lymphedema

By Petrina J. Johnson

Axillary reverse mapping, a breast cancer procedure involving the removal of cancerous lymph nodes, is helping prevent lymphedema in patients.

Dr. Leonidas Miranda of North Houston Specialty Physicians, said the procedure is relatively new but very important. ARM was developed by Dr. V. Suzanne Klimberg, a breast surgeon. Miranda, a general surgeon, said he begin using the procedure about a year ago. Miranda said ARM is a major improvement because it decreased the risk of lymphedema down to 4 to 7 percent.

“In the old days we use to take the lymph nodes from the arms and breasts,” said Miranda. “This is why there was such a high rate of lymphedema, 20 to 25 percent.”

The previous procedure was a great experience but the high risk for patients developing lymphedema made it what Miranda described as a “sad situation.” It was something he said the patients should not have to endure.

“On top of the fact that they (the patients) had to go through all these treatments they had developed swollen of the arm,” said Miranda.

The new procedure, Miranda explained, helps to identify the lymph nodes coming from the arm. He said ARM involves injection of a special blue dye under the skin in the arm. The blue dye travels through the lymphatic (channels) in the arm. Miranda said the lymph nodes that are blue help the surgeons know which ones are coming from the arm.

“When you open the arm pit you see them (lymph nodes) and then you don’t take them, this is what axillary reverse mapping is,” said Miranda. “When you see those lymph nodes you only take the ones that are not blue.”

Miranda said because the surgeons do not have to remove the lymph nodes from the arm, it helps preserve the return circulation coming from the arm. This helps to prevent lymphedema.

“It does add a few more minutes to the procedure (the operating time) but it is well worth it,” said Miranda.

Certain surgeries may lead to limbs swelling

Stephanie Turner, Aiken Standard

For some people, they will never be fully healed. An illness has crept inside them, swelling their limbs to abnormal sizes.

This swelling can be a sign of lymphedema, according to Holly Shurtleff, Hitchcock Healthcare occupational therapist.  "You can eat perfectly healthy and be the ideal weight, and, yet, you can still get lymphedema," she said.

March is deemed Lymphedema Awareness Month.

"This illness can be really scary," Shurtleff said.
Lymphedema stems from your body's lymphatic system, which helps protect our bodies from germs and bacteria, as well as help us release waste, Shurtleff said.

"It is part of the circulatory system of veins and arteries," says the National Lymphedema Network.

Shurleff explained that the "controlling center" of the lymphatic system are called the lymph nodes, which are located in the lymph vessels.

When lymph fluid passes through these nodes, they rid the fluid of harmful bacteria and viruses.

"Networks of the lymphatic system comprising these vessels ... and nodes are situated in several areas of the body," the National Lymphedema Network stated.

These networks reach places like the neck, the armpits, the pelvic area and the groin.

Surgery that results in the lymph nodes being removed are one way a person can get lymphedema. These surgeries are often used as treatment methods for cancer patients, Shurtleff said.

"Surgical removal of a tumor and adjacent lymph nodes and vessels may block lymph fluid from flowing naturally through its system," the National Lymphedema Network says.

Having radiation therapy can also leave its effects by causing scar tissue to form. This will also disturb the flow of lymph fluid.

Some are born with lymphedema, Shurtleff said.  "The whole baby's body can swell," she said.

If the swelling goes untreated, your skin can harden and/or you can get infections, the National Lymphedema Network stated.

Treatment methods include exercising, using compression garments and bandages and taking antibiotics. Methods are determined based on the cause and severity of the illness, the National Lymphedema Network stated.

Your affected limb can return to its normal size but only if it swelled up to less than 5 percent of its normal size, Shurtleff said.

"The further it is, the greater the possibility it won't get back to your normal size," she said.

One treatment method she uses is massaging. That and exercise can "get the fluid moving throughout the whole area," she said.  Lymphedema cannot be cured, she added.

The swelling can reoccur; therefore, those with this ailment must take precautions.

Besides keeping your weight to a healthy level, avoid wearing tight jewelry and doing stressful movements with the affected limb. Avoid injuries by wearing protection as you work around the house or at your job. Keep the limb away from heat, and keep it elevated as much as possible.

Those with affected limbs should not to get blood drawn or shots put into them.

Those who need to have their lymph nodes removed can work to prevent themselves from catching lymphedema, Shurtleff said.

After surgery, be sure to drink plenty of fluids, protect the limb and exercise.

If you are experiencing unusual swelling and discomfort, tell an oncologist or your regular physician.

For more information on lymphedema, visit www.lymphnet.org.

Top Tips for Air Travel With Lymphedema

With the holiday season in tow, an increase in travelers will invade airports all over the country.  we've put together a few tips for those with lymphedema and are planning to travel by air this season.

Cabin pressure during a flight in a plane is less than the atmospheric pressure while on the ground. The decreased pressure in the cabin can cause increased swelling of the limb. If you have had a mastectomy, lumpectomy or radiation therapy you should wear compression garments while traveling by air to reduce risk of swelling.

Air travel is sedentary in nature, normally causing blood and lymphatic circulation to slow.  When you have been properly fitted for a sleeve and glove/gauntlet, it should be tight at the wrist and sit one finger width from the arm pit.

A hand piece or glove should be worn with the sleeve in order NOT to push the fluid into your hand. It is recommended to wear your sleeve 2 hours prior to flight and 2 hours after you have landed. Wearing garments applies to other types of long distance travel such as a car, train, or bus.

Travelers Tips:

-Wear comfortable clothing
-Avoid lifting and carrying heavy baggage
-Take a short walk every 2 hours
-Raise your arm and turn in circles several times
-Wear compression garments while on the trip will help prevent symptoms and swelling
-Drink plenty of liquids, avoid dehydration
-Take sunscreen, insect repellent, and extra non-scented lotion such as Eucerin

If you are in need of compression garments, call our BOC/ABC certified fitter, Kristen Knowles at 713-623-4247.  She specializes in creating customized solutions to increase mobility and decrease lymphedema swelling.

Is it OK to exercise with lymphedema?

Yes, exercise is safe and beneficial for individuals with lymphedema, as long as a few standard guidelines are followed.

1. Always wear your compression bandages or garments when exercising – Compression garments help to move your lymph fluid from your limbs, trunk or face.  Without the garments, lymph fluid will collect in the affected area and increase swelling.
   
2. Get clearance from your doctor – As always, it’s a good idea to discuss your exercise goals with your physician and to make sure that you are in good overall health before starting an exercise program.
   
3. Start slowly – Your exercise program should include stretching, strengthening and endurance.  Some good examples of exercise programs are: Yoga, walking, swimming or cycling.  It is NOT advised to engage in high-speed activities like tennis, water skiing or football.
   
4. Hydrate – Hydration is super important to maintaining a healthy body, and even more important for people with lymphedema, as it aids in your body’s ability to expel lymph fluid.
   
5. Pay attention to your body – It is important that you feel good after exercising!  If you notice increased swelling, then you will want to choose a different activity for that day (i.e. swim instead of walk).

We want to assist you in reaching your exercise goals.  With our dedicated staff on your team, we can ensure that your custom compression garments will support you in your exercise program.

Let us know if you have any questions or concerns about your treatment options.  Our certified lymphedema specialists will be happy to answer your questions about how we can help you or someone you know who have lymphedema.  Call today at 713-623-4247, or email us at Kristen@hairandwellness.com

Top 10 Lymphedema Tips for the Summer

1.  Increase fluid intake, mostly H2O
By increasing your daily water intake, you are telling your body that it has plenty of reserves and as a result it will release fluid out of your body.  If you are not a fan of drinking water, try flavored waters.  Crystal lite offers on-the-go packets, available in delicious flavors such as kiwi-strawberry, cherry pomegranate and raspberry peach.

2.  Try and stay as cool as possible
At times staying cool may seem impossible in 90+ degree weather.  Use fans to help circulate air conditioning while indoors.  Also store plastic bottles of water in the freezer for easy access to cold water when you travel outside.

3.  Avoid tight restrictive clothing
Opt for lightweight, loose-fitting cotton clothing.  Cotton clothing will keep you cooler than those made out of synthetic materials.

4.  Avoid severe sunburns

I like sunscreen products that good for sensitive skin, affordable, waterproof and offer UVA and UVB protection.  Banana Boat Baby Tear-Free Sunblock  SPF 50 is $10 for 8 ounces, Bull Frog Water Armor Sport 50+ is $9.99 for 6 ounces,  Beach Defense Water + Sun Barrier Lotion SPF 30 & 70 is $10.99 for 6.7, or Hydrosport Sunblock Spray SPF 30 by Aveeno is $8.99 for  5 ounces are all great options.

5.  Always use insect repellent
Protecting your skin from insect bites is another top priority during the warm summer months.  Avon carries a strong defense against mosquitos, gnats, ticks, sand flies and other biting insects.  Skin So Soft Bug Guard Plus Picaridin Aerosol Spray is $7.99 for 4 ounces of protection.  Another good option is Deep Woods Off! Deep Woods Insect Repellent V, 25% DEET, 6 oz for $7.49.  This insect repellant is a reduced DEET product that works well.  It sprays upside down too!   Be sure that you apply insect repellent over your garment.

6.  Try and avoid high sodium foods
Restrict your daily salt intake to between 1,500 – 2,300 mg per day.  Also avoid processed foods as they typically contain a lot of sodium and preservatives.

7.  Protect your handsWhen working in the yard or gardening try and wear glove to protect your hand with upper body edema.  Choose a work glove with a suede leather palm for heavy-duty protection.

8.  Exercise Smart
When exercising outdoors try and do this not in the middle of the day, instead opt for early morning or after sunsets.  Exercise for shorter periods of time, take breaks at regular intervals and always wear compression on the affected limb, unless you are swimming, as water resistance acts as natural compression.

9.  Protect Your Feet
With lower body edema it is a good idea while at the beach wear water shoes as to avoid cuts and scrapes.

10.  Travel Prepared
If possible, talk to your doctor and get a prescription for antibiotics in case of infections.  Also, remember if you are flying, drink plenty of water and make sure you wear your day time compression garments, as the decreased air pressure in the airplane’s cabin may increase your swelling.

For more tips, contact Kristen, our BOC, ABC Certified compression garment fitter at kristen@hairandwellness.com.