What can I do to avoid getting Lymphoedema?
There is no proven research that lymphoedema can be prevented. However, therapists, clients and doctors have over time noted that certain factors may increase a person’s risk of getting oedema, as well as worsen the lymphoedema in people that already have the condition.
These potentially preventive measures apply to all people who are at risk of developing lymphoedema, as well as those who already have Lymphoedema. A person is at risk of developing lymphoedema if they have had surgery involving lymph node removal, post-operative radiation or removal of a large portion of tissue (e.g. excision of a melanoma).
These life long precautions need to be observed always, even years after your surgery.
- Don’t ignore a slight increase in size, or a constant ache in the area “at risk”. If treated quickly the progression of Lymphoedema may be stopped, or at least controlled.
- Keep the lymphoedematous limb, or limb “at risk” spotlessly clean. Use a hypoallergenic, mild soap that won’t dry out your skin. It is well known that infections can trigger lymphoedema in a person at risk. Infections in the limb may be an indication of dysfunction of the lymphatic system before swelling is seen. However, lymphoedema often results following infection. The most significant factor known to worsen or increase lymphoedema is infection in the involved area. It is vitally important that this risk in minimised.
- Keep your skin moist and supple with good moisturisers, preferably hypoallergenic and fragrance free.
- Avoid any trauma (knocks, cuts, burns, sports injuries, insect bites, sunburn etc) as far as is possible. Although this may seem obvious, it is most important now. Be careful when cutting your nails. Don’t cut the cuticle, rather ease it back with a cotton-wool
covered orange stick (if you get manicures, please advise the manicurist of this). If sewing, use a thimble, if gardening, use a glove. If bush-walking use boots and protective clothing, wear insect repellants, keep out of the sun or wear clothing that covers the limb. When shaving in the affected or at risk area, use an electric razor (which is well maintained) rather than a safety razor, to avoid small cuts. Remember that the lymphoedematous limb is much more susceptible to infection than before. Infection can become serious very quickly and must be treated.
- Any increased redness (a sign of possible infection), particularly if associated with increased pain, must be treated immediately by a doctor. Antibiotics are usually required. Generally antibiotics in the Penicillin category are very effective, but your doctor will decide which is best for you. Other antibiotics are also effective if you are allergic to penicillin. If you cut yourself, immediately clean it and apply an anti-biotic cream, e.g. Bactroban or similar.
- Do not carry heavy loads (heavy cases or shopping etc), a heavy shoulder bag or handbag with the arm at risk.
- Do not allow anyone to measure your blood pressure, take blood, give an injection or a drip in a lymphoedematous or at risk limb. It may require some convincing of the staff, but you must insist on it.
- Avoid whatever will bring heat to the area, including sunburn, jacuzzi’s, saunas, hot baths and heat producing ointments (like deep-heat). If you live in an area with a hot climate, try and keep as cool as possible. Try not to take vacations in very hot regions during the summer. Use at least SPF15 sun lotions if it is necessary to be out in the sun.
- Avoid constrictive clothing. Don’t block your remaining lymphatics. A well fitting bra is essential and should have wide straps, or a pad may be worn under your bra strap. Underwear should not be tight fitting. Wear your watch on the unaffected arm. Avoid tight cuffs and waistband e.g. on jeans.
- If travelling by air wear a compressive sleeve/stocking, especially for long flights. Flights have been known to trigger lymphoedema.
- Avoid vigorous activity. Don’t do activities until your arm aches or fatigues. If you already have Lymphoedema, wear a compression sleeve or stocking while doing resisted, repetitive activities like vacuuming, scrubbing, pushing, pulling etc.
- Don’t over exercise. Exercising until “it burns” or your arm/leg feels very fatigued should be avoided. Regular exercise is important to your general health as well as to controlling your Lymphoedema (if you already have it). Overworking muscles can cause an increase in lymph fluid, and can make Lymphoedema worse. Swimming is an excellent form of exercise, as is walking or bike-riding. However if you already have Lymphoedema, please discuss appropriate exercising with your therapist. If you have bandages or pressure garments it may be helpful to wear them during exercise. If you’re starting to exercise, start slowly, and gradually increase the level and intensity, while monitoring your affected or at risk limb.
- Avoid the use of diuretics (water pills) for lymphoedema. They may decrease the fluid, but don’t remove the proteins, and other waste products. This may worsen the problems associated with lymphoedema, and cause increased fibrosis and increase problems with fluid removal.
- Eat well and healthily. There are no specific diet guidelines affecting the development of lymphoedema. However eating a well balanced and healthy diet does enhance your immune system. General guidelines include eating lots of fresh fruit and vegetables and whole grain foods. Try to minimise the amount of fat in your diet. Although lymphoedema is a high-protein oedema, do not reduce your protein intake thinking that it will reduce your Lymphoedema. Protein should be eaten in moderation. Too little protein does not reduce the protein in lymph fluid, and will weaken your connective tissue. It is also important to drink a lot of water. It may seem reasonable that because there is an excess of fluid in Lymphoedema that you should reduce your fluid intake. However it is imperative that you drink a lot of water. Drinking less water will deprive the rest of your body of water, while your Lymphoedema will continue.
It is important to remember that no matter how careful you may be, some lymphoedema may not be preventable. While following the above guidelines may prevent or help control your lymphoedema, don’t become obsessive about them. Use common sense and enjoy your life. Simply try and build these guidelines into your daily life and schedule. It’s worth it in the long run.
What about Surgery?
In recent years there have been significant advances in possible surgical intervention for the treatment and improvement of lymphoedema. Very careful diagnosis and evaluation is required to determine if a surgical procedure would be a possible or beneficial. Each surgical procedure has very specific indications and requirements. There is no procedure appropriate for all forms of lymphoedema. Surgery should only be performed by a surgeon specially trained in these procedures as they require a very high degree of specialization and skill, as well as a deep understanding of lymphology. Worldwide there are only a few surgeons that have achieved this specialized training. In many cases some aspects of conservative treatment are still required despite surgery. It is best to discuss any options with your doctor or therapist.
What about Diet?
There are currently no studies demonstrating the effects on specific foods on lymphoedema. However, it is well documented that being overweight or obese results in a significantly higher risk of developing lymphoedema, and also presents greater challenges to reducing the lymphoedema.
In general it is recommended that people with lymphoedema eat a healthy and balanced diet, rich in fresh fruit and vegetables. Fried and processed foods should be minimised.The role of vitamins and supplementation for the management of lymphoedema still needs to be researched.
The two most frequently asked questions regarding diet are:
- If Lymphoedema is characterized by relatively high protein content in the oedema, should I cut down on protein in my diet?
The protein found in the lymphatic fluid is not related to dietary protein. Therefore it is not necessary to reduce your intake of protein, unless it is recommended as part of a weight management programme.
- If the swelling is excess fluid that is not draining, should I drink less water?
It is very important for healthy body functioning to drink sufficient water. Drinking less water will not improve your lymphoedema. Drinking an adequate amount of water is critical to your overall health and does not affect the amount of swelling present.
Exercise, Sport and Lymphoedema
Many recent research papers have reported the positive and beneficial effects of sport and exercise as part of the management of lymphoedema.
The presentation, location and cause of each person’s lymphoedema varies considerably. In the same way each person’s lymphoedema may also respond differently to exercise. However, as always, exercise has a very positive effect on a person’s physical, mental and emotional wellbeing, and is therefore an important aspect of maintaining your overall health.
The general guidelines regarding exercise for people with lymphoedema are:
- Resume or begin exercise slowly, and monitor your own body’s response to the exercise. Take particular note of how the lymphoedematous limb feels during and after exercise.
- Increase your exercise time, intensity or weight slowly, and always monitor the effect on your affected limb. Try to increase or add only one exercise at a time, so that if and exercise results in an increase in oedema/swelling it is easy to identify and modify.
- Try to do some cardiovascular exercise along with other exercises that you may do. Swimming/ hydrotherapy is ideal due to the external compression of the water on the affected limb while exercising.
- Light exercise on a mini-trampoline (light jogging or jogging with some light arm exercises) has been shown to improve lymphatic flow.
- Deep diaphragmatic (tummy) breathing is important to assist clearing lymph fluid from the trunk. This is important for all types of lymphoedema, including lymphoedema of the trunk, arm, legs, breast and other areas.
- Pilates and yoga are recommended due to the core stabilization, deep breathing and excellent tissue stretching gained, resulting in better flow through the lymphatic pathways.
- A fairly long warm-up and cool down of breathing and stretching is strongly recommended.
- Monitor the affected limb during exercise, and eliminate or reduce the intensity of exercises that seem to increase your oedema. Discuss these with your therapist.
- In most instances, exercises should be done while wearing a well fitting compression sleeve, stocking or bra.