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What is the Lymph in Lymphedema?
The lymphatic collecting vessels are tiny tubes
that carry fluid from all parts of the body back to the heart. The little lymphatic collecting
vessels just under the skin carry the lymph fluid to bigger collecting vessels like tributaries
carrying water from creeks and eventually into bigger rivers. The lymph fluid contains water,
proteins, cancer cells and bacteria. The lymph’s primary job is to carry protein molecules back to
the heart that are too big to fit back into the veins. The fluid is transported through a series of
connected vessels flowing to the lymph nodes in the drainage basin of that area (the armpit for the
chest and arm). Once in the nodes, the floaty bits get smashed up like a garbage disposal and they
are filtered out. The lymph nodes are like having Cookie Monster inside that particularly loves to
feast on the nasty bits like bacteria.
What happens when the Lymph
vessels are injured?
While undergoing treatments to kill off cancer,
the other tissues of the body take quite a beating. The superficial lymphatic collecting vessels
are those just under the skin. These get injured when the skin gets cut with surgery or inflamed
during radiation. The skin and all the structures in or around the skin get scarred. If the lymph
vessels are injured so badly that they can no longer carry fluid away from the area, this can
increase the risk of developing lymphedema. In an area of the body that has sufficient damage to
the lymphatic system, the fluid (including the protein) is left to pool in that area and this
swelling or edema problem is called lymphedema. When the lymphatic system in an area is damaged,
the fluid pools in the area and the protein molecules collect and cause congestion or hardening of
the area. (Imagine a plate of refried beans left out on the counter overnight, it gets hard and
crunchy.) Lymphedema is this high-protein fluid that sticks around in an area because it cannot
find its way back to the heart on its own.
How does radiation affect this?
While undergoing radiation the reason the skin
turns red, warm, swells and becomes painful is the inflammatory reaction that is occurring. Any
trauma to the body causes a rush of chemicals to the area to help heal the area which is the
inflammatory response. While the inflammation is a natural response to heal this area, it also
creates a challenge. This results in more fluid collecting on the inside of the skin causing excess
pressure to the skin. For radiated skin that is trying to heal each day after radiation treatment
is over, this increase in fluid pressure makes it harder for the fibroblasts (little cells like
knitting needles) to knit the skin back together and create new skin. The skin is getting it from
the outside (radiation beam) and the inside (fluid pressure).
What can you do about
Lymphedema?
The lymph fluid can be carried back to the heart by helping it find an alternative route to get
there. A physical therapist can evaluate you and determine the best route for your fluid to take
and teach you how to do a simple massage--a technique called Manual Lymphatic Drainage. When a bad
accident occurs on the highway, traffic is rerouted by a different road. The same can be done in the lymphatic system to help the
fluid find an alternative route to the heart. For example, when an arm is swelling from breast
cancer treatments, we can take the fluid back to the heart by first going to the front of the hip
and joining that fluid river. Each person is evaluated by the physical therapist to determine the
best route to help move the fluid so your personal massage program may be very different from
another person. The therapist reviews your history with you to make sure there is not another area
that is “at risk” of developing lymphedema and should not be used to help move extra
fluid. Once this has been determined, the
good news is there is something very simple you can do to help ferry this fluid away from the
inside of the healing skin reducing the pressure to this area. By moving
fluid that is closest to the heart out of the way first and progressing along the designed path
helping to clear each area of the fluid that is already present, this makes a path for the fluid to
move along and find its way back to the heart and out of the area of
stagnation.
How do you know it is
helping?
As soon as you move the fluid out of the area you may notice an improvement in the quality of life
in that area of the body. Some people notice a sense of burning or aching that resolves immediately
once the fluid is moved. The effects of the radiation are continuing to cause the inflammation to
return to the area-remember the discomfort you had from being sunburned-that was also due to the
inflammation. If you notice any discomfort or other sensation about the area of the body being
radiated that was not there prior to starting the radiation-use this as a signal from your body.
Assess the region of your body that is being radiated before and after you perform your simple self
massage to reroute the fluid. If this symptom improves it was simple a sign that your brain was
receiving from the area that the fluid needed to be drained again. Ideally you want to stay ahead
of any symptoms. The lymphatic self massage (Manual Lymphatic Drainage) acts like a water pump.
When the area gets filled again, or congested-the pump handle has to be operated again to get the
water coming back up from the well into the tube of the pump. When the lymphatic flow slows again,
doing the massage will get it moving again.
Determine how often you have to do your massage to prevent any
symptoms. If you notice symptoms increasing at 4 hours, perform your massage every 3-1/2 hours. If
you do it more often you are just keeping the fluid moving and it may not require as many pumps to
get the fluid moving again once it has slowed. Some people find it very easy to get this massage in
when they go to the bathroom or when they shower and use their soap and dry off with their towel
performing the massage as they go.
If the skin gets so badly injured you cannot touch the area-you still
want to make sure to do the rest of the massage to the areas that are not injured. By starting
where the fluid will end up and getting that fluid out of the way it will suck the rest of the
fluid to this now evacuated region creating a suctioning pump. By keeping the fluid moving during
radiation and a few months beyond radiation (ideally doing the self massage 4 times a day
continuing to at least 2 months after radiation is completed) this will help prevent lymphedema or
the possibility of needing to wear a compression garment to the area. With cancer it is
overwhelming to have so many medical appointments and such trauma to your entire body and soul so
adding one more thing to your day is not ideal—but with the lymphatic system the more you can do
now the less you will hopefully have to do later.
What are some benefits of treating
Lymphedema?
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PREVENT WOUNDS: If the skin becomes dry and cracked or has any damage then pressure from fluid
building on the inside can cause it to open up and this becomes a wound. According to Michael
F
öldi,
M.D., world-renowned lymphologist, “a wound will never heal as long as it is swimming on
edema”.
- LOWER
RISK OF INFECTION: The Cookie Monster-effect of the
lymph nodes works to get rid of any nasty bits in the blood but if they cannot keep up the
system gets overloaded and that is how you end up with an infection. The only thing that
will kill off a bacterial infection is a strong enough antibiotic. When the lymph system is
moving bacteria out of an area and into the lymph nodes, then you decrease the likelihood
of infection.
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AVOID NEEDING COMPRESSION GARMENTS: If the skin gets stretched out, then
massage may not be enough and you may need to wear compression garments to hold the fluid in
the system.
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