This is an old revision of the document!
These guidelines, originally came from an article from the American Lymphedema Society and even though they are “aged” are still valid.
1. Keep the entire at-risk quadrant spotlessly clean. Natural gentle cleansing products are strongly encouraged. Dry skin in a gentle but thorough non-vigorous fashion. Pay special attention to creases in the skin and the areas between toes and fingers.
3. Use a top quality moisturizing lotion to help maintain the integrity of the skin. The lotion you choose should not contain alcohol, dyes, lanolin, mineral oil, petroleum products, talc, or perfumes. (Note that pure essential oils have a fragrance, but are not considered perfumes.) The lotion should also have antiseptic properties and correct ph. If you have lymphedema, apply it before and after removing bandages or compression garments and after bathing.
4. Avoid chemical hair removers. If possible, use a well maintained electric razor, replacing the heads regularly. Because of the danger of cuts and nicks, we do not recommend using a regular razor. If you do use one, wash the blades in hot soapy water, and change them often.
5. Avoid extreme temperature changes when; a. Bathing, showering, swimming. b. Washing anything; dishes, floors, laundry, etc. c. Receiving therapeutic treatments. d. At the gym; no sauna or hot tub.
6. Protect the affected quadrant from weather extremes; a. In hot weather seek air conditioning and keep the limb cool. b. In cold weather seek central heating. If you must go out, have the at risk quadrant well bundled, but not sweaty. c. In sunny weather, protect the limb with sun screen and/or covering.
7. Medical care, such as injections, blood pressure, drawing blood,allergy tests, etc., needs to be performed on an unaffected limb.(Note: A leg can often be used if both arms are at-risk.) Any procedure which punctures the skin in the affected quadrant is to be avoided, including acupuncture.
8. Avoid all tight clothing, jewelry, and elastic bands on the affected limb, including watches, rings and binding stockings.
9. Be careful cutting nails. Do not nick skin or cut cuticles. If someone does your nails for you, inform them of your risk. If you must push back cuticles, use a cuticle stick covered with cotton.
10. Avoid all types of trauma; cuts, scrapes, bruises, burns, including sun burns, sports injuries, insect bites, all animal bites and scratches, and forceful impact. This does not mean withdrawing from living, but be sensible and protect yourself; use seatbelts, use a thimble if you sew, wear rubber gloves when washing dishes or gardening, wear closed shoes to avoid foot injury for an at-risk leg. Wear insect repellent when outdoors, sunscreen and clothing to cover an at-risk quadrant. Any measure you can take to prevent the onset of lymphedema is worth the effort, as it can mean avoiding a lifetime of maintenance and pain.
11. Avoid pushing, pulling, or lifting with the affected limb. Do not kick or slide heavy packages with an affected leg. Do not use over the shoulder straps on an affected arm. Do not lift anything over 15 pounds, less if you are out of shape or the weather is hot and humid. This includes the lifting of babies, children and pets. Carry packages, purses, or briefcases only on your unaffected side, and ask baggers at the store to place your bags in the car for you.
12. Exercis is important. However, if the affected limb begins to ache or feels tired, rest it immediately, and elevate it if possible. Consult a lymphedema specialist before proceeding with an exercise routine. Safe recommendations are walking, swimming or water exercise. If you have lymphedema, it is important to be bandaged during exercise.
13. Avoid any repetitive movements, especially those against resistance.
14. Never do anything to exhaustion. Your at-risk quadrant will fatigue more quickly than the rest of your body, and will take longer to recover from physical exertion. If your arm or leg begins to ache, rest and elevate the limb. If elevation does not alleviate the symptoms, see your physician.
15. Barometric pressure is reduced at high altitudes, and can lead to the onset of lymphedema, or exacerbate the condition. Therefore, a compression garment is extremely important if you travel by air, or hike in high altitudes. This is recommended even if you don't have lymphedema. It becomes essential if you have lymphedema, even if the swelling has subsided. In this case, you should consider wearing bandages when flying, as they offer greater protection than a compression garment. For an at-risk limb, over the counter garments are available for a modest cost. This small step may prevent a lifetime of maintenance.
16. If you have had an axillary dissection you may want to wear soft pads under your bra straps, as this protects the lymph nodes and vessels around the collar bone. Avoid wearing a heavy prosthesis, or under wire supports.
17. If you live in a damp or humid climate, and your skin is frequently moist, try dusting the skin with cornstarch. This also works for feet during the summer months. Keeping the skin dry helps reduce fungi.
18. Maintain your ideal weight and drink plenty of pure water. The recommended quantity of water is one ounce for every two pounds of body weight. Example: If you weigh 128 pounds, drink 64 ounces, or two quarts of water daily. If you do not normally drink this much water, increase intake gradually until the recommended quantity is acheived.
19. Many patients have a misunderstanding about protein. They believe that because lymphedema is a high protein edema, they should avoid eating protein. This is not true. While we do not recommend a high protein diet, a no protein diet will weaken connective tissues and cells. This in turn will make the condition worse. We recommend a diet in which easily disgestible proteins make up between 10 and 30 percent of your total caloric intake. Know when to get help.
20. It can be helpful to have a professional assessment annually. If you have a leg at risk, visiting a podiatrist can insure that your feet stay healthy. Be sure to inform him or her that you are at risk for developing lymphedema.
21. MLD, manual lymph drainage, is a recognized therapy not only as a treatment for lymphedema, but for prevention as well. If you have had lymph nodes removed, your immune system is compromised.
MLD helps to increase immune response. Other forms of massage therapy should be avoided on the at-risk quadrant, because they temporarily shut down the lymph vessels in that area. These include deep tissue, reflexology, rolfing, shiatsu, Swedish, etc.
22. Thoroughly examine the affected quadrant monthly. Do not ignore any swelling in the affected arm, leg, chest wall, armpit, back, groin, abdomen or genitals. Report any glossary:swelling|swelling]] immediately. Or, if any of the following are present; redness, inflammation, blistering, rash, warmth in the limb, fever, change in the texture of the skin, or lymph leakage through the skin, see your oncologist or physician immediately.
Any of these can be the onset or worsening of lymphedema.
23. The lymph system is an important part of your immune system, and removal of lymph nodes compromises your immune response in the at risk quadrant. If you get a cut, scrape, or other break in the skin, use a topical antibiotic, and notify your physician at once. He or she will probably prescribe an antibiotic to reduce your risk of developing an infection. Remember, an infection in an at-risk limb or quadrant can lead to the onset of lymphedema if it is not treated promptly.
24. Lymphedema is often preventable, or at least can be postponed for many years. If you notice any slight increase in fingers, hand, arm, chest wall, back, toes, feet, ankles, abdomen, or genitals, see your physician for a proper diagnosis. If you are diagnosed with lymphedema, seek treatment. Lymphedema is easier to control at its onset, as further deterioration can be prevented and often an initial reversal is possible. Your limb will still be at risk, but you will remain symptom free. Remember what renowned lymphologist Dr. Foldi has written, “There is no insignificant swelling.”
Originally from American Lymphedema Society
CA Cancer J Clin. 2009 Jan-Feb
Lawenda BD, Mondry TE, Johnstone PA. Radiation Oncology, Naval Medical Center, San Diego, CA, 92134, USA. email@example.com
The primary goals of oncologic therapy are the compassionate care of cancer patients, eradication of disease, and palliation of symptoms. Advances in various targeted therapies such as highly conformal and image-guided radiotherapy techniques, sentinel lymph node dissection, and molecularly targeted agents hold the promise of allowing those goals to be reached with fewer treatment-related complications. Unfortunately, certain side effects remain problematic due to the inability to completely avoid injuring normal tissues. Lymphedema, a chronic condition that occurs as a result of the body's inability to drain lymph fluid from the tissues, is a common treatment-related side effect experienced by cancer patients. In this review, many of the important aspects of lymphedema with which clinicians who treat cancer patients should be familiar are outlined, including the anatomy, pathophysiology, diagnosis, and management of this condition. The authors also identify some of the resources available both to cancer patients with lymphedema and to the clinicians who treat them. It is hoped that this review will convey the importance of the early identification and management of this incurable disorder because this is essential to minimizing its complications. © 2009 American Cancer Society.
Clin J Oncol Nurs. 2008 Dec
Poage E, Singer M, Armer J, Poundall M, Shellabarger MJ. Rehabilitation Associates of Naples, Fort Myers, FL, USA. firstname.lastname@example.org
Cancer treatment is the leading cause of lymphedema in developed countries. Development and severity of lymphedema have a significant impact on comfort, psychological distress, and overall quality of life. Incidence statistics have ranged from 5%-60%, with onset of symptoms ranging from immediately after treatment to 30 years after treatment. Oncology nurses caring for patients throughout the cancer trajectory have a critical role to play in early assessment of risk, prompt identification of lymphedema, and implementation of evidence-based, individualized treatment plans in collaboration with therapists. As part of an Oncology Nursing Society (ONS) project team, the authors of this article undertook a review of current literature to identify effective interventions for the treatment of secondary lymphedema. Following the guidelines established by the ONS Evidence-Based Practice Resource Team, the authors evaluated current clinical practice guidelines, systematic reviews, and research studies conducted since 1998. The team reviewed and synthesized the literature and developed evidence tables and a Putting Evidence Into Practice(R) (PEP) card. The data were reviewed by experts in the field of lymphedema management. The lymphedema ONS PEP card, a user-friendly, succinct summary of interventions, was released at the 33rd Annual ONS Congress in May 2008.