Management of Upper Extremity Lymphedema
You are at risk for lymphedema in your arm if you have had trauma insulting the lymphatic system, had breast cancer in combination with lymph node dissection and/or radiation treatments, malignant melanoma or trauma insulting the lymphatic system. Lymphedema can occur immediately after surgery, months, or even years later. With education and care, lymphedema can sometimes be avoided and if it does occur, can be kept under control.
- Do not ignore any slight increase of swelling in the arm, hand, fingers, neck or chest wall. Occasionally measure the circumference of your arm. If you find that the swelling is increasing, if your sleeves are fitting tighter, or you have a feeling of “heaviness” in your arm, consult with your doctor immediately.
- Never allow an injection, IV, a blood drawing or blood pressure check in the affected arm(s). Consider wearing a lymphedema alert bracelet to alert health care workers. These are available at medical supply stores or over the Internet.
- Keep the at risk arm clean. Be sure you gently but thoroughly dry between each finger and in any creases. Use a quality lotion with a low-pH, free of perfumes and alcohol free. Two examples are Eucerin or Nivea.
- When manicuring your nails, avoid cutting your cuticles (inform your manicurist) and ensure cleanliness of the facility as your risk for infection is higher.
- Use an electric razor to remove hair from your underarms. Maintain electric razor properly, replacing heads as needed. Be sure irritation is kept to a minimum.
- Do not wear tight jewelry or elastic bands around fingers or arm(s).
- Avoid extreme temperature changes when bathing or washing dishes. No sauna or hot tub use.
- Keep the arm protected from the sun. Use sunscreen that is labeled “SPF 15” or higher.
- Your lymphedema could become worse due to various occurrences. These include but are not limited to: fractures, sprains, surgery, generalized infection, cuts or scrapes.
- Avoid any type of trauma such as bruising, cuts, burns, sports injuries, insect bites and cat or dog scratches. Wear insect repellent when outdoors. If you receive a minor injury clean the area and use over the counter antibacterial cream. If it is more serious, seek emergency treatment. Be sure and inform the medical personnel that you have lymphedema or are at risk for it.
- Exercise is recommended, but must be done in moderation without overtiring your leg. If you were active before, slowly progress back to the activities you enjoy. Suggested exercises include walking, swimming, light aerobics, bike riding and yoga. Avoid vigorous, repetitive movements against resistance (working out in the gym using heavy weights) with the affected arm(s). Do not lift above the weight limit recommended by your physician.
- Avoid heavy lifting with the affected arm. Never carry heavy handbags along the elbow crease or bags with over-the-shoulder straps.
- Wear gloves while doing housework, gardening or any type of work that could result in even a minor injury.
- When traveling by air, patients with lymphedema (or at risk) should wear a compression sleeve. Additional bandages may be required on a long flight. Increase fluid intake while in the air.
- Patients with breast prostheses should wear a light prosthesis. Heavy prostheses may put too much pressure on the lymph nodes above the collarbone. Soft pads may have to be worn under the bra strap. Wear a well-fitted bra: not too tight and with no wire support.
- Patients with lymphedema should wear a well-fitted compression sleeve during all waking hours. The sleeve should be replaced at least every 4-6 months. If the sleeve is too loose, most likely the arm circumference has reduced or the sleeve is worn.
- Maintain your ideal weight with well-balanced, low sodium, high-fiber diet. If you are diabetic watching your sugar is very important. You should not smoke or drink alcoholic beverages. Your diet should contain protein that is easily digested, such as chicken, fish or tofu.
- Contact your physician immediately, if you notice a rash, blistering, redness, increase of temperature or fever in your arm. Inflammation or infection in the affected arm could lease to worsening of your lymphedema and must be treated with antibiotics.
The above information was adapted from recommendations by the National Lymphedema Network.