Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And today, we're going to talk about lymphedema, what it is, and are there treatments for this condition. Joining me is Laura Anderson. She's an occupational therapist at Crete Area Medical Center. Laura, thank you so much for joining us today. You know, we've heard this term bandied about for a while now. Tell us a little bit about lymphedema. What is it and how common is it?

Laura Goracke Anderson: Thank you for having me. Lymphedema is a chronic condition, and it happens when the lymphatic system is unable to drain fluid from the body. And this can cause swelling most commonly in the arms and legs, but it can also affect the chest wall, the trunk, or even the head and neck.

Melanie Cole, MS: So, who gets lymphedema? Is this something that just pops up or is it someone who's had lymph nodes removed or some condition that would otherwise preclude it?

Laura Goracke Anderson: So, it's both actually. There are two main types. There's primary and secondary. So, primary lymphedema is caused by genetics or developmental concerns. Secondary lymphedema happens after damage to the lymph system. So, that could be from cancer treatment, surgery, radiation, trauma, infection, or even venous insufficiency. In my practice, most patients develop lymphedema after breast cancer treatment, which can cause arm or chest wall swelling or after surgeries or injuries to the legs, hips, and abdomen.

Melanie Cole, MS: So, how do we know? Because as somebody who has it mildly right now, I noticed I had seroma after my surgery, and then it sort of became a lymphedema situation. So, tell us a little bit about the signs and symptoms. How do we know that's what it is versus something like a seroma or just a fluid buildup that could be temporary?

Laura Goracke Anderson: So, lymphedema is swelling that doesn't go away. So often, one arm can be a lot more affected than the other side. It could feel like a heaviness, a tightness, or a fullness. Sometimes you can experience some skin changes where it just feels really thick and hard. Other folks will mention aching or reduced motion in their arm or hand or leg. Even in breast cancer survivors, sometimes a visible cording texture or swelling across the chest wall or underneath the arm.

Melanie Cole, MS: So, does this get diagnosed or we just kind of know it happens? And who do we see for that?

Laura Goracke Anderson: Yes, it definitely gets diagnosed. It's usually based on clinical symptoms, your medical history, and even a physical exam. So, we can use limb measurements, special testing or imaging. And this is a combination approach between your medical doctor, oncologist, your therapist. But the key is catching it early. So, if you notice changes like your rings are a little extra tight, or your shoes are feeling a little extra tight, it's important to get in and get it checked out.

Melanie Cole, MS: So then, once we've gotten it diagnosed, and we know that's what the situation is, what treatments are available for it, especially if you catch it early? What can be done about it?

Laura Goracke Anderson: So, the gold standard treatment is called CDT, which stands for complete decongested therapy, and it includes a variety of things. The first one is manual lymphatic drainage, which is a gentle massage and it just helps move the fluid. The second is compression therapy through bandages or compression garments, and they help reduce and maintain the swelling. Exercise is also very important. it promotes movement. It helps pump the fluid back through the lymphatic system and also skincare. That way, we can prevent infections like cellulitis.

And treatment is going to look different for everybody. So for example, in breast cancer rehab, we may also work on arm mobility, scar tissue, and posture in addition to the swelling.

Melanie Cole, MS: So, I want to step back to-- you mentioned compression garments. So after surgery, if that's the situation that is precluding this, there's compression. Tell us what that means, compression garments. And where do you find such things?

Laura Goracke Anderson: So, compression garments, an exciting new fact about that is that it's actually covered by insurance, thanks to the Lymphedema Treatment Act. It went into effect in 2024. Medicare now covers three daytime garments every six months, and two nighttime garments every two years, which has been a huge step forward. Because in the past, people have had to pay out of pocket, which was a big financial barrier. But compression garments basically just provide containment for the limb, the arm or the leg or chest wall, and it helps maintain that size. So that way, when you go through the bandaging protocol, you reduce the fluid, you can maintain the lymphedema size long term.

Melanie Cole, MS: So, what can we do? What can patients do on their own to help manage lymphedema if that is the situation? And tell us a little bit about some treatments that you offer. You mentioned lymphatic massage. Tell us a little bit about that as well.

Laura Goracke Anderson: Sure. So, lymphatic massage is a very gentle massage. What I find with my patients when they come in is they've had like a muscular massage before from a massage therapist. But the lymphatic massage is actually very light. It's very gentle. It can help with pain management, and it basically just helps promote fluid drainage. It helps the body move that lymph fluid a little bit better. And as far as what patients can do on their own, I highly recommend meeting with your medical team, seeing a therapist. But beyond that, wearing your compression wear, staying active, recommending walking, swimming, yoga, maintaining good skin hygiene and moisturizing to prevent infection. Avoiding injury to the affected limb. So, that could be like avoiding blood pressure cuffs, avoiding cuts and burns as much as you can. And then, if you notice any additional swelling or you have the redness in the skin, worsens, to seek help.

Melanie Cole, MS: And do you have some final thoughts, Laura, for patients? Is there any way to prevent it in the first place? And what would you like listeners to know about lymphedema?

Laura Goracke Anderson: So definitely, maintaining a healthy lifestyle. I know I mentioned before such as staying active with exercises like walking, swimming, and yoga. Maintaining a healthy weight is also a good option for you as well. If you do happen to experience it, I highly recommend seeing a therapist who can help you manage it early. That way, you can prevent any future complications that may develop. But I have to say, this kind of work does give me quite a bit of fulfillment. You know, helping a breast cancer survivor regain arm mobility or seeing someone walk comfortably again after years of swelling, it's very, very rewarding.

Melanie Cole, MS: Thank you so much, Laura, for joining us today. And I'd also like to thank our Bryan Foundation partner, Swanson Russell. To listen to more podcasts from our experts, you can visit bryanhealth.org/podcast. That concludes this episode of Bryan Health Podcast. Please always remember to subscribe, rate and review Bryan Health podcast on Apple Podcast, Spotify, iHeart and Pandora. Until next time, I'm Melanie Cole.