Lymphedema is a medical condition commonly caused by damage to or the removal of your lymph nodes as a part of treatment for cancer, such as radiation therapy or surgery.
Lymphedema can develop when the lymphatic system becomes blocked or damaged. Lymph fluids build up in soft tissues, causing swelling and other symptoms. Lymph is a thin, clear fluid that circulates throughout the body carrying white blood cells and removing wastes, bacteria and other substances from tissues. Edema is the buildup/back-up of excess fluid. Thus, lymphedema occurs when too much lymph collects in an area of the body.
Under normal circumstances, protein-rich lymph fluid is filtered by the lymph nodes and then it’s released into the bloodstream. When the body cannot properly carry lymph fluid because lymph nodes are obstructed, the liquid collects and tissues begin to swell. This is what occurs during a case of lymphedema — the lymph vessels are unable to sufficiently drain the lymph fluid.
Lymphedema affects 140 million people worldwide and 3 million patients suffer from this disease in the United States alone. An important sub-population is patients with breast cancer related lymphedema (BCRL), which affects over 400,000 patients in the United States. In fact, studies have shown that following treatment for breast cancer, patients have a 5-50% chance of developing lymphedema.
The following symptoms are strong signs of lymphedema:
- Swelling: Swelling due to lymphedema typically affects part or all of an arm or leg, including the fingers or toes.
- Fibrosis: Lymphedema may lead to fibrosis, which is the hardening and thickening of the skin.
- Discomfort: Often, lymphedema includes feelings of heaviness or tightness along with aching or discomfort
- Limited flexibility: Due to the swelling and feelings of heaviness, lymphedema may restrict the normal range of motion.
The most common causes of lymphedema include:
- Cancer. If cancer cells block lymph vessels, lymphedema may result. For instance, a tumor growing near a lymph node or lymph vessel could enlarge enough to block the flow of the lymph fluid.
- Radiation treatment for cancer. Radiation can cause scarring and inflammation of lymph nodes or lymph vessels.
- Surgery. In cancer surgery, lymph nodes are often removed to see if the disease has spread. However, this doesn’t always result in lymphedema.
- Parasites. In developing countries in the tropics, the most common cause of lymphedema is infection with threadlike worms that clog the lymph nodes.
There are two types of lymphedema: primary and secondary lymphedema
Primary lymphedema is caused by an inherited condition that affects the development of the lymphatic system. Primary lymphedema can develop in infancy, puberty or even later in life. This type of lymphedema is rare.
Secondary lymphedema is much more common. Secondary lymphedema is caused by trauma to the lymphatic system. In the United States, cancer treatment is the most common risk factor for lymphedema. Surgery, chemotherapy and radiation can disrupt the lymphatic system. Tumors may also block the lymphatic system, resulting in lymphedema.
Gold Standard for the Diagnosis of Lymphedema
Lymphoscintigraphy has been regarded as the gold standard for the diagnosis of lymphedema since its first introduction. Lymphoscintigraphy is a nuclear scanner that shows the dye’s movement through the lymphatic system and identifies any blockages.
Stages of Lymphedema
- Stage 0: The flow of lymph in the body is not moving as it should. You may or may not have symptoms.
- Stage I: The affected area is swollen and feels heavy. Pressing on the swollen area leaves a pit (dent) in the skin. Resting and elevating the limb can help reduce swelling at this stage.
- Stage II: The affected area is more swollen and may feel firmer than the area around it. Pressing on the swollen area does not leave a pit. Resting and elevating the limb no longer reduces swelling.
- Stage III: The affected area is extremely swollen and the skin feels hard and thick.
Conventional treatment of lymphedema often includes:
Pressure garments
Exercise
Skin care
Bandages
Compression devices
Weight loss
Laser therapy
Drug therapy
Surgery
Massage therapy
What to Avoid to Prevent Aggravating Lymphedema
- Avoiding hot showers, sun beds, steam rooms, and saunas may help prevent symptoms of lymphedema.
- Do not take very hot baths or showers.
- Do not wear tight-fitting clothes.
- Do not wear tight-fitting jewelry.
- Don’t go barefoot outdoors.
- Look for changes or breaks in the skin.
- Keep your skin supple by moisturizing it every day.
- Make sure footwear fits properly.
- To prevent developing athlete’s foot, use an anti-fungal foot powder.
- Use gloves when gardening.
- Keep nails short.
- When going outside in an area where there may be insects, use insect repellent.
- When out in the sun, use a high factor sun block.
- When you have a cut, treat it immediately with an antiseptic cream. And keep the area clean.
- Raise the affected limb above the level of the heart whenever possible.
- Avoid blood pressure checks, blood draws, or injections in the affected limb.
Complementary and Alternative Treatments
In addition to conventional medical treatments for lymphedema, the condition can also be managed with various complementary and alternative treatments.
Optimal Diet recommendations for lymphedema are:
Primarily whole foods, mostly consisting of a wide variety of rainbow-colored fruits and vegetables. Whole fruits and vegetables are great to add to your diet. Options may include apples, oranges, berries, grapes, carrots, beans, broccoli, peppers, and green leafy vegetables like spinach and kale.
Gluten free grains such as brown rice, oats, quinoa, buckwheat, farro and millet and wild rice are among the foods one should consume primarily.
Almond and hemp milk are included in the primary list while sweetened dairy milk should be avoided.
Fermented foods such as kefir, yogurt, pickles, and kimchi provide good bacteria for gut health.
Monosaturated and polysaturated fats are known as “healthy fats.” These types of foods can help with weight loss, reduction of inflammation, and help the body function normally. You can find these fats in foods such as olive oil, nuts, avocado, and wild fatty fish like salmon.
Foods to be eaten in limited quantities include:
- Dairy
- Eggs
- Poultry
- Meat
- Oils and condiments
- Dried fruit, sugar, and real maple syrup are only to be eaten occasionally as well.
- Wine, specifically red, is only to be drank occasionally, with no more than 3 servings a week.
Some foods should rarely or never be eaten including:
Grains with gluten. These are in most breads, cakes, cookies, breakfast cereals, crackers, pasta, pies, etc.
Processed meat, meats preserved with salt, nitrates, or nitrites or meat substitutes with gluten or highly processed soy are also to be avoided or rarely eaten.
Drinks to avoid include the following: sweet drinks (sugar and artificially sweetened), soft drinks, teas, coffee based beverages, fruit drinks, beer, liquor and mixed drinks.
Blood Sugar and Lymphedema
Another factor to consider when dealing with lymphedema is maintaining a steady and normal blood sugar. It is important to choose foods with a low glycemic index to maintain stable blood sugar levels. Stable blood sugar levels are important for the integrity of our lymphatic vessels. When our vessels are weak, they leak more fluid into the tissues. This not only causes more swelling, but also increases the chances of developing infections and wounds.
Importance of Hydration
Hydration is also very important when you have lymphedema. It is best to avoid sugary and caffeinated drinks because they cause dehydration, blood sugar changes, and weight gain. Alcohol is not a great option because it has the opposite affect and causes dehydration. Even diet drinks are not good because of dehydration. Water is the best source of hydration. And drinking plenty of it is important to help your lymphatic system function better. Green tea is also a great option due to the antioxidants. The liquid you may get from different foods will also help with hydration. A great rule of thumb is to consume 64 ounces or 8 cups of fluid a day.
Avoid Diuretics
You should avoid diuretics unless directed by your physician. These cause the body to get rid of extra fluid, which seems like what you would want with lymphedema, but this can actually be harmful and worsen lymphedema. Diuretics remove the water from the swollen areas but leave behind the protein molecules in the tissues.
Watch Your Weight: A healthy weight is also a must for those with lymphedema.
Reduce Your Salt Intake: Consuming a large amount of sodium often causes water retention within the body. This means that the more salt you eat, the more fluid your body holds onto, which can make pre-existing lymphedema symptoms worse.
Compression therapy: By applying pressure from the outside, compression therapy can help move and filter fluid through the lymphatic system, alleviating lymphedema symptoms.
Exercise
Most experts recommend moderate exercise regularly for people struggling with lymphedema. Aerobic exercise such as walking or swimming can really help to move lymph fluid out of your problem areas and lower the swelling.
According to the National Cancer Institute, “Breast cancer survivors should begin with light upper-body exercise and increase it slowly. Some studies with breast cancer survivors show that upper-body exercise is safe in women who have or are at risk for lymphedema. Weight-lifting that is slowly increased may keep swelling from getting worse.” The Institute advises that exercise should begin at a very low level, increased gradually over time, and be conducted under the care of a lymphedema therapist. If you stop exercising for a week or longer, you should again start off at a low level and increase activity gradually.
Experts believe that the muscles act as a pump during exercise, pumping the lymph to areas where it is needed.
Yoga for Lymphedema
According to Joachim Zuther, lymphedema specialist and founder of the Academy of Lymphatic Studies, yoga is a great form of exercise for those experiencing lymphedema because it can be easily adapted to fit the abilities and limitations of the individual who is exercising. When diaphragmatic breathing is taught, it can increase venous and lymphatic circulation. Yoga has also been shown to improve all aspects of quality of life for cancer survivors.
According to Living Beyond Breast Cancer, “slow moving, rhythmic movements may help prevent lymphedema because they encourage lymph flow.”
In April 2020, a systematic review of the effects of yoga on breast-cancer-related lymphedema concluded that “yoga under the direction of an expert in yoga practice is safe and is not associated with any increase in limb volume or other adverse effects.”
Yoga for Lymphedema” by Joachim Zuther provides an in-depth look at the benefits of yoga, as well as an explanation of the various styles and poses that are most beneficial for the prevention and management of lymphedema.
Watch this video of a short yoga practice that includes gentle breathing, mindfulness, and movements to support the lymphatic system:
https://www.youtube.com/watch?v=FZPhRdcY4_w
Massage therapy: Similar to compression therapy, massage therapy can help manually push fluid through the lymphatic system and reduce swelling.
Acupuncture is another approach to consider; research confirms it helps with swelling and improves quality of life related to lymphedema. Of note, when getting acupuncture for lymphedema, no needles should be placed in the affected side.
Elevate your limb: Whenever you can, try to elevate the affected arm or leg above the level of your heart. When sleeping, place a pillow under your arm or leg (whichever limb is affected).
Avoid extreme temperatures: Try not to expose the affected limb to extreme cold or heat. This means you should not apply ice or a heating pad to the swollen arm or leg nor should you go into a sauna.
Additional Considerations for the Management of Lymphedema
Mind-body approaches
Mind-body approaches, including self-awareness, relaxation, and meditation, are widely used as complementary, alternative or integrative approaches to healthcare. Some approaches that may be helpful for lymphedema include acupuncture, moxibustion, yoga, tai chi, and relaxation techniques.
Hydrotherapy involves activities performed in the water, such as swimming and aquatic movements. These activities can gently strengthen the body, and the hydrostatic pressure can improve lymphatic congestion.
Hyperbaric oxygen therapy (HBOT) involves breathing in pure oxygen in a sealed chamber that is pressurized at 1.5 to 3 times normal atmospheric pressure. HBOT may promote the growth of new lymph vessels and heal scar tissue that may be blocking lymphatic channels.
Take Deep Breaths
According to Memorial Sloan Kettering Cancer Center, deep breathing helps to stimulate the movement of lymph fluid in the body. They advise not taking more than three deep breaths at a time to avoid light-headedness.
Low Level Laser Therapy (LLT) may be a good option. This therapy is defined as low intensity light therapy. The effect is photochemical, not thermal.” The light works by triggering biochemical changes within cells, similar to the process of photosynthesis in plants. This type of therapy may reduce pain, soften scar tissue, and unblock the lymphatic system. The treatment has shown good results.
HydroMassage, can reduce swelling and improve range of motion for some people with lymphedema even many years after the difficulties begin.
Nutritional Nutraceuticals You May Want to Consider for Lymphedema
The herbs Astragalus (Astragalus membranaceus) when administered orally, has been put to the test in clinical trials and has shown positive results.
Bioflavonoids like quercetin and hesperidin may prove useful as they help stabilize capillary membranes. Selenium has also been shown to reduce the risk of developing lymphedema.
As I presented in this article there are a number of options to effectively manage Lymphedema. A few options mentioned which are used at ProActive Wellness have proven most beneficial for those with Lymphedema. If you want to learn more, or discuss how we might serve you, please don’t hesitate in contacting our office. The ability to enjoy “the best performance of your life” may just be a phone call away!
As always, check with your primary physician and/or oncologist before you consider some of the alternative and complementary treatments mentioned.
God bless,
DrB
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