Ways to mind yourself following breast cancer- lymphoedema

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Breast Cancer

No matter what stage of your breast cancer journey you are at, whether it following a diagnosis, in the middle of treatment or 10 years post diagnosis, it can be a scary place sometimes.  I have spoken about survivorship before and how difficult it can be to live with issues post diagnosis and treatment. Lymphoedema is one of these issues and one which so little is known about in both the medical field and in the public domain. This is slowly changing and so it is important to continue to educate the people who are at risk of developing lymphoedema so they can understand why it can develop, the signs of the condition and where to go to seek information and advice about ways to manage it.

Support Centre

Cancer support centres like Eist in Carlow are a great resource for cancer patients and survivors. These centres provide an oasis for people who are on their cancer journey. They often provide treatments such as reflexology, massage, art therapy, mediation plus many others to help clients who are dealing with the many issues associated with cancer and its treatments. One such issue is Lymphoedema. Most cancer support centre provide Manual Lymph Drainage for clients who have developed Secondary lymphoedema post a cancer diagnosis or treatment. The therapist in these cantres are a vital resource for clients who are either at risk or who have developed lymphoedema.

Lymphoedema

Lymphoedema occurs when your lymph vessels are unable to adequately drain lymph fluid, usually from an arm or leg, can also effect the head, neck and trunk. This results in the accumulation of protein rich fluid in the affected area. Risk factors for developing lymphoedema include lymph node removal, radiation, seroma post surgery, high BMI, injury or infection in the limb or at risk area.

Lymph system 

The lymph system is the secondary circulatory system in our bodies. It plays a role in our immune system defending against bacteria and viruses, transport vital nutrients around the body while removing metabolic waste from the tissues. It transports long chain fatty acids and protein.  Its plays a role in regulating the balance of interstitial fluid, which is an essential fluid needed to regulate new cells and create energy. Interstitial fluid which is not used by connective tissue is collected by the lymph system and is know as the Lymph Obilgatory Load (LOL)

Our initial lymphatic system lies under our skin, these initial vessels lead to the precollectors and finally collector vessels. They join up with the lymph nodes forming the lymphatic system along with the principle deep lymph vessels the thoracic duct and right lymphatic duct. Our bodies are divieded into watershed which are essentially drainage basins, delinating skin territories. These play an important aspect during the treatment for lymphoedema.

Watesheds

So are bodies are divided into watersheds. Principal watersheds include the vertical watershed which divides the body in half while the hortizional watershed divides the skin into upper and lower body. These create quadrants, where the lymph of each relevant quadrant draining to the relevant lymph nodes.  The secondary watershed involves the head.

How it works?

The lymphatic system does not have its own pump and so it needs five things to allow it to function.

These are muscle contraction, atrial pulsation, gravity, peristalsis and deep abdominal breathing. Issues like being immobile, suffering from constipation or diarrhoea, sitting or standing for too long can have an negative effect on the lymph system and its funstion.

Stages of Lymphoedema

Latency stage or subclinical stage can be difficult to detect or diagnose. There may be subtle changes which a person can find difficult to describe. 

Stage I presents as pitting oedema,  an indentation forms on the skin when pressure is applied. The oedema or swelling reduces on elevation or overnight.

Stage 2 swelling does not reduce with the development of protein rich oedema and fibrotic or hardened tissue.

While Stage 3 presents with hardening of the skin or elephantiasis, the affected area has extensive swelling and there is skin changes present.  

It is vital that lymphoedema is diagnosed as soon as it starts to present and  treatment  initiated as soon as  possible. The thought process now is to treat at Latency or Stage I instead of allowing the swelling to develop into Stage 3.

Treament for lymphoedema involves Manual Lymph Drainage, compression garments, skin care and movement. Contact your local cancer support centre, GP or oncology team who will give you details of locally trained MLD therapist. Their role is to provide information, treatment and resources for you to manage this life long condition.

Symptoms of lymphoedema

  • Pain/ discomfort in the affected area
  • Altered sensations:
    • tingling
    • sensation of something crawling on the skin
    • feeling like you have a newspaper under their arm
    • Numbness on upper arm or chest wall
  • Heaviness
  • Swelling
  • Skin changes
  • Lymph fluid oozing from skin
  • Symptoms vary depending on Stages

Impact of lymphoedma

Lymphoedema can have a negative effect on the person who develops it. So it is vital that we understand ways it can affected the person. They may experience issues associated with body image, not wanting to look at themselves, feeling that their clothes are  not fitting them properly and having to buy bigger size due to a larger limb. Negative body image can lead to sexual problems and they may find that they do wish to have intimidate relations with their partner or spouse which can have a negative impact on their home life. This can lead to depression or low mood.

The presentation of lymphoedema can cause fear, fear that a person’s cancer is back. Or it may be a constant reminder that they had cancer in the first instance. It can cause reduced mobility or ability to carry out activities or hobbies which they once enjoyed. While the financial aspect of a cancer diagnosis is well documented.

Ways to minimise risk of developing lymphoedema 

The difficulty about lymphoedema is no way of highlighting or identifying who will develop the condition or when it will develop.

If you are at risk of developing lymphoedema that risk is a  lifelong risk, so it is  important to know the ways to minimise the risk of developing it.  Lymphoedema is life long condition if it develops so early detection and treatment is vital allowing for easier management of the condition.

  • No venopuncture or blood pressure readings on the at risk limb
  • Do not carry heavy objects
  • Continue with your exercises
  • Stay active- swimming, aqua aerobics, walking, dragon boat racing     
  • Reduce BMI
  • Do not wear tight clothes or jewellery
  • Travel- when planning a holiday aboard speak to doctor
  • •Wear insect repellent
  • •Avoid heat and sunburn
  • Use electric shaver
  • Nail care- avoid artificial nails
  • Good skin care- treat cuts and cover
  • Wear gloves when gardening & housework
  • Wear handbag on opposite shoulder or across body

Post mastectomy bras

It is never an easy task going to purchase a new bra and this can be made more difficult after having surgery for breast cancer. A properly fitted bra improves posture, increase positive body image and can reduce risk of developing lymphoedema.

 Points to remember when going fro a bra fitting,

  • Get properly fitted by a trained bra fitter
  • Get measured regularly
  • Get a proper prosthesis if needed
  • Bras should not be too tight as this causes irritation
  • Get a pocketed bra to hold prosthesis or breast form in place
  • Straps should be wide for comfort and adjustable
  • No underwire

In conclusion

Lymphoedema is a life long risk and a lifelong condition. We need to educate people who have gone through cacner about their risks, where to go to seek help and what to do should they develop it. Survivorship can be diificult and often it can be tough to access services or get information about issues post a cancer diagnosis. Should you need any further information please contact Wellbeing Techniques on 053 9106190 or your local cancer support centre.

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Contact Info

You can contact me the following ways...

Wellbeing Techniques, Tottenham Green, Taghmon, Co. Wexford

087 7510761

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