Lymphedema is the swelling and soft tissue changes that occur in the area of the body where an injury has occurred to the lymphatic system. Fluid builds up in soft body tissues and causes swelling. It may be caused by cancer treatment. Lymphedema usually affects an arm or leg, but it can also affect other parts of the body, such as the trunk, breast or face.
Tom Kennery, a patient with melanoma, says, “The lymphedema therapy keeps my leg functioning. “ He explains, “After cancer surgery I knew that it was going to be a ‘new normal,’ but I wanted that new normal to be as close to the old normal as possible. I’m a walker, and the therapy helped me get back to my normal activities a lot quicker.”
Judy Reaves, a breast cancer patient, recently completed therapy after a sudden onset of lymphedema left her arm swollen and inflamed. “It worked wonders,” she said.
The UNC Comprehensive Cancer Support Program includes three lymphedema therapists, all certified by the Lymphology Association of North America (LANA): Val Collins, Theresa Gilliam, and Dorie Laing.
Val and Theresa are members of UNC Health Care’s Department of Occupational and Physical Therapy, and Dorie has advanced training as a massage therapist. The three see UNC patients as well as those from across the Triangle area.
Therapists individualize treatment for each patient, and the team offers a free monthly class designed for patients at risk for lymphedema following cancer surgery. The class is offered the first Monday of each month from 1:00 – 2:00 pm. Val explains, “We teach people how to take care of themselves. Ultimately, our goal for them is independent management.”
“Lymphedema therapy helps minimize symptoms and may limit progression,” Dorie says. “It’s similar to other chronic conditions where earlier intervention leads to best clinical and functional outcomes.” The most common types of cancer addressed by lymphedema therapy are breast, melanoma, gynecologic, head and neck, advanced prostate cancer, and testicular cancer.
“The UNC lymphedema program began about four years ago," explains Theresa.
“UNC therapists work closely and collaboratively with physicians and nurse practitioners so patients can be evaluated and treated soon after the first symptoms are noticed,” she says.
Frances Patterson explains, “ My UNC radiation oncologist referred me to Val before my surgery She wanted me to meet Val and do some preventive exercises to increase my range of motion. Val gave me exercises to do the minute I woke up from the mastectomy. “
Frances’ lymphedema occurred a year after she finished cancer treatments. Following a long international flight involving wheeling and carrying luggage and a burn to her hand, she began to experience swelling in her arm. “ These injuries caused my arm to swell, so we started an intense treatment. It’s pretty much under control now,” she says.
Tom Kennery’s lymphedema developed following several procedures to remove a melanoma. “The surgeries were close to lymph nodes that didn’t heal, and that’s when the swelling started. After my therapy, the lymphedema is under control. I wear my leg garment daily. I’m getting around a lot better.
Judy Reaves says, “I had been treated before for lymphedema in 2001 after my initial treatments for breast cancer. My arm had been fine ever since then until about a month ago. We think something bit me, and the bite caused my arm to swell and burn and become inflamed. The swelling in my arm has gone down a lot after the therapy and wearing the sleeve. I am so happy that the therapy worked so quickly and so well.”
Lymphedema therapy includes two phases: Intensive phase with a therapist followed by the Self-Management phase. The intensive phase involves four components: manual lymph drainage, compression therapy, skin care and exercise.
“The goal of manual lymph drainage (MLD) is to increase the uptake of fluid and transport the lymph to healthy vessels where it can be processed normally,” says Dorie “ A series of MLD treatment decreases the volume of the affected area. We then teach patients a simplified version as part of their home program.”
Compression therapy may be needed because the skin’s elastic fibers and lymphatic vessels are damaged in lymphedema, and the body part is at risk for fluid re-accumulation. To prevent re-accumulation, external compression is applied to the skin. Compression therapy involves wearing compression garments or wraps to reduce swelling in the limb.
“During the Intensive phase, our patients also learn all about the tools and strategies that they need to manage lymphedema on their own over time,” explains Theresa. “We provide support, as needed, to make sure that garments are in good condition and that symptoms are under optimal control.”
For more information, patients can attend the free lymphedema class. For individualized appointments, patients can ask their physician to fax a prescription for OT/PT lymphedema evaluation to (919) 489-9173 or can contact us at (919) 957-6600.
Elizabeth Sherwood, RN MS ANP-C, CCSP Coordinator for Survivorship Programs and Oncology Integrative Medicine Programs, says, “ Lymphedema therapy is one aspect of oncology rehab. CCSP offers a range of services and resources to support patients and families throughout their cancer experience, including resources and programs for survivors.
Signs and Symptoms of lymphedema
• Aching, discomfort, soreness or pain in the affected area
• Feelings of heaviness, fullness or tightness in the skin
• Less movement or flexibility in a joint
• Clothing, bras, underwear, jewelry or shoes feel tight
• Swelling that fluctuates and may leave an indented spot in the skin when pressed
• Numbness/tingling in the involved limb