Scott Webb (Host): Lymphedema is a common condition that results from cancer treatment. And though there's no cure per se for lymphedema, patients benefit from a variety of treatment options, including physical and occupational therapy. I'm joined today by Marie McGowan. She's a Senior Physical Therapist with Prisma Health.

This is Flourish, the podcast brought to you by PRISMA Health. I'm Scott Webb. Marie, thanks so much for your time today. I'm going to learn about lymphedema along with listeners and the various solutions for folks. This is going to be really educational for all of us. So, I'm glad you're here. And just to maybe start with the easiest one, hopefully, you know, what is lymphedema and how has it caused?

Marie McGowan: Well, lymphedema is swelling that is caused by damage to the lymphatic system. It is most often caused by cancer treatments, so if you've had surgery to remove lymph nodes, and you're more at risk the more lymph nodes that they remove, if you have more radiation, if your BMI is greater than 30, or if you've had any post-op infections or delayed wound healing. It can also result from surgery that removes large amounts of tissue and some chemotherapy medication.

Host: I see. Yeah, because in my notes, I was going to ask you next, is it a sign of cancer? But what you're saying is it's really often a result of cancer treatment, if I hear you right.

Marie McGowan: That is correct. Lymphedema itself does not cause cancer or is not a sign of cancer.

Host: Yeah. I told you this was going to be educational and it ; is already. So then, what are the early signs of lymphedema? Is it just pretty obvious that something's going on?

Marie McGowan: Not always. It can be very subtle. So oftentimes, folks will experience heaviness or aching or tightness or fullness in the affected area. So, it could be an arm or a leg or a foot or a hand. You may have limited flexibility in the joints in that affected arm or leg; jewelry that may be tight or difficult to remove, tightness of the skin or changes to the skin such as redness or hardening. It may be a puffiness that goes away and comes back. You may be able to leave a little bit of a dent in the skin if you push your finger into it and that is called pitting edema, or difficulty with clothing that used to fit and doesn't fit well anymore.

Host: I see. So, there are some signs and symptoms, but unless we're sort of in the office with a medical professional and having this conversation, it might not be obvious exactly that it's lymphedema, of course. And you said it can be subtle. Does it take some time then for lymphedema to develop?

Marie McGowan: It does. So, oftentimes, lymphedema develops within the first three years after cancer treatment. The average time to onset is about a year and a half after you've had surgery or radiation. But the risk for lymphedema can be lifelong.

Host: Yeah. So as you say, it may be immediate, but it could be a year, two years, three years, something like that.

Marie McGowan: Correct.

Host: Yeah. And you mentioned that some of the signs and symptoms may come and go, does that mean that lymphedema will just generally go away on its own?

Marie McGowan: Generally, it doesn't go away on its own. In those early stages, it can kind of come and go. But that should be when people should try to seek treatment, because we can control it better at that stage.

Host: Yeah. As with so many things in medicine, you know, early diagnosis, early treatment, always positive things for positive outcomes, of course. What types of tests then do you do if someone comes in and you get their patient history and they explain what's going on? Are any actual tests needed to diagnose lymphedema?

Marie McGowan: Sure. So, you would definitely want to talk to your physician. They may do some blood work or a CT scan or an MRI or an ultrasound to rule out other things. There is not typically a specific test for lymphedema. We mostly diagnose based on history.

Host: Okay. Yeah. So, good patient history, conversations, things like that. You touched on a little bit of the treatment options. Let's go through that. How do you treat lymphedema?

Marie McGowan: We treat lymphedema with compression. So, we use compression garments and bandages, so a sleeve or a stocking. We use manual lymphatic drainage massage. We use prescribed exercise to improve range of motion and strength. And then, we work on things like risk reduction strategies and skincare and trying to improve the health of that limb.

Host: Yeah. And along the lines of exercise, that mean that physical therapy is something that really works for folks?

Marie McGowan: It does. So, there are both physical therapists and occupational therapists who are certified lymphedema therapists, and they are trained to treat persons living with lymphedema. So, a certified lymphedema therapist would develop an individual treatment plan that treats your specific problems and exercise along with compression does help activate the muscle pump and improve circulation.

Host: That's great. Do you have a sense of the ballpark anyway? So if someone's working with a specialist of physical therapy, occupational therapy, how long before they really begin to see some results?

Marie McGowan: You should see results working with your therapist within the first two to three weeks. It may take longer than that to fully reach your goals. But, usually, folks will begin to see improvement very quickly.

Host: Yeah. Now, you mentioned earlier when we think about lymphedema, it's not a sign of cancer. It's usually a result of being treated for cancer. So then, is there anything that triggers it? Maybe foods, activities? Is there anything that triggers lymphedema?

Marie McGowan: So, we tell folks to avoid needle sticks and blood pressures in that affected limb. Heat can aggravate lymphedema. Foods that are high in salt or highly processed can make lymphedema worse. And a low-protein diet can make swelling worse. So, we want folks to make sure they're getting enough protein.

Host: All right. So, there could be some triggers or things that exacerbate it. This has been good stuff, really educational today. I told you I've hosted a lot of these and never did one on lymphedema. So glad to have you on. Just want to finish up here and just, you know, if folks had the cancer treatment, right? And they've had some of the signs and symptoms that we've talked about here today, what would be their next steps?

Marie McGowan: Certainly. Well, you definitely want to talk to your physician, whether it be your medical oncologist or your primary care provider, and discuss your individual symptoms. You can also ask for a referral to a certified lymphedema therapist.

Host: Yeah. And as we've talked about here, sort of the early diagnosis of lymphedema, early treatment of lymphedema, maybe avoiding some of those triggers, things that we can do to help ourselves, good stuff today. Thank you so much.

Marie McGowan: Thank you for having me.

Host: For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I'm Scott Webb. Stay well.