Lymph Lessons: How to Manage and Treat Post-Cancer Lymphedema

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November 20, 2012


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Fifteen years after breast cancer surgery, Gilda Torregroza noticed swelling in her right hand and arm. Four months after ovarian cancer surgery, Gail Chepenik (pictured) was dressing for work when she discovered her left foot and leg were twice their normal size.

Both women were diagnosed with lymphedema, and both found help through lymphedema programs at South Miami and Baptist Hospitals.

Four certified lymphedema physical therapists educate and care for patients, primarily women, who develop this unsightly and sometimes painful and debilitating swelling.

Caused by removal of or damage to lymph nodes, typically as part of cancer treatment, the condition has no cure. But therapy helps control symptoms.

No one knows exactly what percentage of breast cancer patients will develop lymphedema, and less invasive surgical procedures have lowered the risk in recent years.

“It is important that patients understand that the majority of breast cancer patients do not develop lymphedema,” said breast cancer surgeon Gladys Giron, M.D., associate medical director of Baptist Health Breast Center.

“If a patient does develop lymphedema, well-trained therapists can offer treatment to improve symptoms and prevent worsening.”

Primary lymphedema is a rare, inherited condition. But the more common secondary lymphedema can develop from multiple causes, such as infection or trauma, in addition to cancer treatment. Typically affecting arms and legs, lymphedema also can develop anywhere lymph nodes are compromised. Without treatment, complications can result, including cellulitis, a serious bacterial skin infection.

“Patients need to know that lymphedema is manageable if they follow recommendations,’’ said Arlene Sotolongo, lymphedema program coordinator at Baptist Hospital. “They can lead a nearly normal life and aren’t restricted from doing most activities — household chores, gardening, shopping.”

Though no one can predict who will develop lymphedema, and when, another risk factor is radiation, which can cause lymph node scarring and inflammation.

Ms. Torregroza, 73, of Miami, developed lymphedema about a year ago, though her surgery occurred in 1996. Therapy at Baptist Hospital’s program has decreased the swelling and lowered infection risk.

“It has been wonderful because I found first-class attention,” she said. Therapists use manual lymphatic drainage, applying gentle pressure on the skin, and teach patients special exercises, all to stimulate the flow of lymphatic fluid, which reduces swelling.

Initially, patients also wear shortstretch compression bandages daily, which a therapist or family member applies. When patients can manage independently, they wear a compression garment, typically an arm sleeve or a knee- or thigh-high leg stocking made of elastic fabric, which applies pressure to the affected area.

Typically, therapists see patients with early-stage lymphedema two to three times weekly for a month.

At South Miami Hospital, physical therapist and rehabilitation supervisor Mary Crosswell worked with Ms. Chepenik, 63, who  underwent surgery in 2008.

“Mary is a phenomenal educator who makes certain you understand what’s involved,” Ms. Chepenik said.

Current lymphedema programs encompass more than in the past, when breast and gynecological cancer patients didn’t see physical therapists until they already had lymphedema. Now, women are given information about the signs and symptoms of the condition early on.

“Today, we use a comprehensive approach that allows us to educate patients while they’re still in cancer treatment,” Ms. Crosswell said.

Patients learn to avoid hot tubs, saunas and sun exposure, because heat can exacerbate swelling, and to try to keep skin free of punctures, burns and cuts, which are pathways to infection.

“This program empowers women to take care of themselves,’’ said South Miami Hospital physical therapist Dessislava Dakova. Ms. Chepenik agreed.

“I stay on top of it,’’ she said. “I can still function and be with my family and friends and enjoy my life.”

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