Lymphedema is the accumulation of a particular kind of fluid, typically in one part of the body. Lymph is the protein-rich body fluid that accumulates when the lymphatic system for fluid transport is damaged.
Fluid transport is one very important component, but many do not realize that the lymphatic system is part of the immune system. It fulfills the function of ‘immune trafficking,’ the process whereby infection-fighting cells can be mobilized to the tissues that require assistance.
Melissa Monte, a Stoughton Hospital Occupational Therapist, is here to discuss how Stoughton Hospital can help if you've been diagnosed with Lymphedema.
Lymphedema: Stoughton Hospital Can Help
Featured Speaker:
Melissa Monte
Melissa Monte is an Occupational Therapist with Stoughton Hospitals. Transcription:
Lymphedema: Stoughton Hospital Can Help
Melanie Cole (Host): Lymphedema can be a potential side effect of breast cancer surgery and radiation therapy that can appear in some people during the months or even the years after treatment ends. My guest today is Melissa Monte. She’s an occupational therapist with Stoughton Hospital. Welcome to the show, Melissa. So, first tell the listeners, what is lymphedema?
Melissa Monte (Guest): Well, lymphedema, most people have heard of the venous system and the arterial system. Well, the venous system is part of the lymphatic system, and is part of the circulatory system. It actually aids in the bringing, extra water and plasma protein cells back to the heart, back to the kidneys so that it can be excreted from the body. What lymphedema is, is there is a breakdown or an obstruction of this lymphatic system and if you can imagine it as a bathtub. If the drain is working properly you have no problem, the water just runs in, runs out, and your tub will not overflow, but, let’s say that drain gets backed up, what happens is, the fluid still keeps flowing, but we have this back up, and, eventually our bathtub is going to overflow. What happens, then, is we get all this extra fluid and extra protein-enriched fluid that is sitting there and stagnant in our body and that is actually what lymphedema is. It’s this build-up of fluid that the body can’t get rid of because there’s an obstruction, there’s a breakdown of our lymphatic system.
Melanie: What a wonderful explanation. So, how does surgery and radiation therapy for breast cancer contribute to lymphedema? What does that do to the lymphatic system?
Monte: Well, it causes that breakdown or that obstruction that I was talking about, so unfortunately, when you have cancer and you have surgery, you are at a higher risk of developing lymphedema. Now, not everybody does develop lymphedema and if you have radiation and surgery together your risks do increase, but they say 1 in 3 women have the surgery and radiation may develop it and they are unsure of a clear reason why some do and why some don’t. There could be a genetic component to it. That they’re not certain of but just because you do have surgery and radiation, doesn’t guarantee that you’re going to get lymphedema. I think that scares people a lot because they think that they’re automatically going to get lymphedema and that’s just not the case.
Melanie: So, does it begin with a series of stages, Melissa? Is it something that you’ll notice at the beginning that maybe you can get help for before it starts to get really bad?
Monte: Yes, that’s a really good question. Recently, I’ve had more individuals referred to me right after surgery or maybe even before surgery to kind of give them an idea of signs to look out for. Initially, the first week--the first 6 weeks actually--after having surgery or radiation, there is going to be this acute edema that a significant amount of people develop. Again, not everybody but that is not the most worrisome. That’s when you start to develop it and 6 months later, you start to see the swelling. That’s when I always tell people, the first 6 weeks, it’s ok if you see some. We’ll try to manage it. We’ll give you some treatment ideas to get it down but if you start to see it 6 months from now, that’s when we really want to get you in and get into the treatment aspect of it.
Melanie: So then, what will the notice if they’re starting to see that fluid build-up? What can they do about it?
Monte: One of the best things is elevation and then, often times, a referral to a certified lymphedema therapist would be ideal. We start you off doing manual lymphatic treatment and what it is, it’s a technique where - it’s very hands-on – we use a circular motor pattern and we clear pathways and we open up pathways and then flow the fluid back to try to get that swelling to go to other pathways. When those pathways are destroyed, it’s not like all the pathways in your body are destroyed. We try to route the fluid around those injured areas and up around those obstructions to try to get new pathways to open up so we that can get that fluid flowing. So then, we have the manual aspect that we do during treatments and we also have metal compression bandaging that we use and it’s a light wrapping system. The bandage actually looks like an Ace Wrap but we don’t put it on nearly as tight. So, it’s actually pretty comfortable and people say they hardly notice that it’s on at times. So, we use those bandages to try to get--the bandages take the place of my hands after a treatment session. So, they wear those, and they re-wrap and then, that’s how we try and get the fluid out of the extremity and then we top that with some light movement exercises. So, we flow the fluid and the lymphatic system doesn’t have its own pumping system. It uses your muscles to help pump the fluid out. So, we give you some home exercises to do that help, again, promote that movement of that fluid. Finally, after we’ve done the manual therapy, we’ve done the compressions and when the fluid level has come down, we fit you with a compression, either a stocking or an arm sleeve that you can wear 23 out of 24 hours a day to help push that fluid out and keep it out of the extremity.
Melanie: Is this something they’re going to have to do for the rest of their life?
Monte: Unfortunately, yes. Now, there are a chance that if we get it down you won’t have to wear the compression garment as often and once those pathways get created, you might be able, you might be able to keep it at bay but it’s always something that you have that obstruction, you have that, you have those lymphatic systems that are destroyed. So, you’re going to have to be on watch for signs of increase of fluid again in the arms. Some people complain of fatigue, pain, a lot of people just say they just know it’s coming on. They just feel that they’re more swollen, so then they just put on the compression garments and wear it for a couple of days. Yes, it’s something that you’re always going to have to be aware of and know that the swelling can come back and you are at greater risk because of it.
Melanie: In just the last few minutes, Melissa, what great information you’re giving today, give your best advice for women who may have been diagnosed with breast cancer, on this concern about lymphedema, and what you really want them to know about things they can do at home and who they should talk to.
Monte: Well, I would say as soon as somebody comes in, I think it’s great that they’re being proactive and I think the most important thing is that once you notice, even if it’s those first 6 weeks and you know that you’re having some swelling and you know that, “Okay, well, this isn’t 6 months but I want to know what I can do, you know,” talk to your doctor, come in and see a specialist and we can give you some ideas. Make sure you elevate, make sure you protect your skin because when you have that increased fluid, you’re at risk of infection, and once you have a wound and you don’t have that good circulation, again, it’s going to be harder for your body to get rid of it. So, just be proactive and really talk, talk to individuals, talk to other people that have had cancer, just to get as much information as you can.
Melanie: And, why should they come to Stoughton Hospital for their care? Tell us about your team.
Monte: Well, we are very dedicated and we’re a personalised hospital. We have good individualized care, and myself, I’m certified in lymphedema and so I’ll definitely take the time and explain to you what’s going on in your system and give you some good techniques to take home to, hopefully, improve your living quality.
Melanie: Thank you so much for being with us today, Melissa. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.
Lymphedema: Stoughton Hospital Can Help
Melanie Cole (Host): Lymphedema can be a potential side effect of breast cancer surgery and radiation therapy that can appear in some people during the months or even the years after treatment ends. My guest today is Melissa Monte. She’s an occupational therapist with Stoughton Hospital. Welcome to the show, Melissa. So, first tell the listeners, what is lymphedema?
Melissa Monte (Guest): Well, lymphedema, most people have heard of the venous system and the arterial system. Well, the venous system is part of the lymphatic system, and is part of the circulatory system. It actually aids in the bringing, extra water and plasma protein cells back to the heart, back to the kidneys so that it can be excreted from the body. What lymphedema is, is there is a breakdown or an obstruction of this lymphatic system and if you can imagine it as a bathtub. If the drain is working properly you have no problem, the water just runs in, runs out, and your tub will not overflow, but, let’s say that drain gets backed up, what happens is, the fluid still keeps flowing, but we have this back up, and, eventually our bathtub is going to overflow. What happens, then, is we get all this extra fluid and extra protein-enriched fluid that is sitting there and stagnant in our body and that is actually what lymphedema is. It’s this build-up of fluid that the body can’t get rid of because there’s an obstruction, there’s a breakdown of our lymphatic system.
Melanie: What a wonderful explanation. So, how does surgery and radiation therapy for breast cancer contribute to lymphedema? What does that do to the lymphatic system?
Monte: Well, it causes that breakdown or that obstruction that I was talking about, so unfortunately, when you have cancer and you have surgery, you are at a higher risk of developing lymphedema. Now, not everybody does develop lymphedema and if you have radiation and surgery together your risks do increase, but they say 1 in 3 women have the surgery and radiation may develop it and they are unsure of a clear reason why some do and why some don’t. There could be a genetic component to it. That they’re not certain of but just because you do have surgery and radiation, doesn’t guarantee that you’re going to get lymphedema. I think that scares people a lot because they think that they’re automatically going to get lymphedema and that’s just not the case.
Melanie: So, does it begin with a series of stages, Melissa? Is it something that you’ll notice at the beginning that maybe you can get help for before it starts to get really bad?
Monte: Yes, that’s a really good question. Recently, I’ve had more individuals referred to me right after surgery or maybe even before surgery to kind of give them an idea of signs to look out for. Initially, the first week--the first 6 weeks actually--after having surgery or radiation, there is going to be this acute edema that a significant amount of people develop. Again, not everybody but that is not the most worrisome. That’s when you start to develop it and 6 months later, you start to see the swelling. That’s when I always tell people, the first 6 weeks, it’s ok if you see some. We’ll try to manage it. We’ll give you some treatment ideas to get it down but if you start to see it 6 months from now, that’s when we really want to get you in and get into the treatment aspect of it.
Melanie: So then, what will the notice if they’re starting to see that fluid build-up? What can they do about it?
Monte: One of the best things is elevation and then, often times, a referral to a certified lymphedema therapist would be ideal. We start you off doing manual lymphatic treatment and what it is, it’s a technique where - it’s very hands-on – we use a circular motor pattern and we clear pathways and we open up pathways and then flow the fluid back to try to get that swelling to go to other pathways. When those pathways are destroyed, it’s not like all the pathways in your body are destroyed. We try to route the fluid around those injured areas and up around those obstructions to try to get new pathways to open up so we that can get that fluid flowing. So then, we have the manual aspect that we do during treatments and we also have metal compression bandaging that we use and it’s a light wrapping system. The bandage actually looks like an Ace Wrap but we don’t put it on nearly as tight. So, it’s actually pretty comfortable and people say they hardly notice that it’s on at times. So, we use those bandages to try to get--the bandages take the place of my hands after a treatment session. So, they wear those, and they re-wrap and then, that’s how we try and get the fluid out of the extremity and then we top that with some light movement exercises. So, we flow the fluid and the lymphatic system doesn’t have its own pumping system. It uses your muscles to help pump the fluid out. So, we give you some home exercises to do that help, again, promote that movement of that fluid. Finally, after we’ve done the manual therapy, we’ve done the compressions and when the fluid level has come down, we fit you with a compression, either a stocking or an arm sleeve that you can wear 23 out of 24 hours a day to help push that fluid out and keep it out of the extremity.
Melanie: Is this something they’re going to have to do for the rest of their life?
Monte: Unfortunately, yes. Now, there are a chance that if we get it down you won’t have to wear the compression garment as often and once those pathways get created, you might be able, you might be able to keep it at bay but it’s always something that you have that obstruction, you have that, you have those lymphatic systems that are destroyed. So, you’re going to have to be on watch for signs of increase of fluid again in the arms. Some people complain of fatigue, pain, a lot of people just say they just know it’s coming on. They just feel that they’re more swollen, so then they just put on the compression garments and wear it for a couple of days. Yes, it’s something that you’re always going to have to be aware of and know that the swelling can come back and you are at greater risk because of it.
Melanie: In just the last few minutes, Melissa, what great information you’re giving today, give your best advice for women who may have been diagnosed with breast cancer, on this concern about lymphedema, and what you really want them to know about things they can do at home and who they should talk to.
Monte: Well, I would say as soon as somebody comes in, I think it’s great that they’re being proactive and I think the most important thing is that once you notice, even if it’s those first 6 weeks and you know that you’re having some swelling and you know that, “Okay, well, this isn’t 6 months but I want to know what I can do, you know,” talk to your doctor, come in and see a specialist and we can give you some ideas. Make sure you elevate, make sure you protect your skin because when you have that increased fluid, you’re at risk of infection, and once you have a wound and you don’t have that good circulation, again, it’s going to be harder for your body to get rid of it. So, just be proactive and really talk, talk to individuals, talk to other people that have had cancer, just to get as much information as you can.
Melanie: And, why should they come to Stoughton Hospital for their care? Tell us about your team.
Monte: Well, we are very dedicated and we’re a personalised hospital. We have good individualized care, and myself, I’m certified in lymphedema and so I’ll definitely take the time and explain to you what’s going on in your system and give you some good techniques to take home to, hopefully, improve your living quality.
Melanie: Thank you so much for being with us today, Melissa. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.