What is Lymphedema?By Lesley Ronson Brown, Registered Yoga Therapist
Good heavens! It’s hard to understand this disease called lymphedema that some of us get…and some of us don’t…as a side effect of cancer treatment when lymph nodes are removed followed by radiation. We might be given a pamphlet to read about it, but that is usually at a time when we are struggling with much confusion and fear.
So here is some info…the lymphatic system is part of our body’s waste management system and has two main jobs. It transports waste from cells that blood vessels don’t pick up and it acts as a defense system to protect us from infection. Blood transports nutrients to our cells and then transports waste away from the cells. Some of the waste products are too large for the blood vessels or are not the type of thing it wants to pick up. S
o, here comes the lymphatic system to the rescue! It’s similar to trash day. The regular garbage trucks pick up refuse in cans and recycling bins, but if you have an old BBQ grill or couch sitting on your curb, it won’t be picked up. So some other entity has to come along and get it. That’s what the lymphatic system does.
The lymph fluid moves inside vessels, similar to veins. These nodes are bean-shaped storage facilities where the lymph is examined; and valves which help move the fluid along. Lymph fluid contains waste, bacteria, proteins and sometimes something that seems potentially cancerous. The nodes break down these extraneous materials, and then transport the waste via the lymphatic vessels, eventually expelling them from the body in urine.
What helps the lymphatic fluid flow is the movement of our muscles against the vessels, and also very, very light massage. Unlike blood, there is no pumping mechanism like the heart to move it along. Physical movement and light pressure is required. The vessels are close to the skin, which is why after a massage, most people need to use the bathroom since their lymphatic flow has been helped along by light Swedish or specific lymphatic drainage massage. Deep or hard pressure tissue massage is not beneficial since it presses too hard on the vessels, similar to stepping on a garden hose. It might reduce or stop the flow, causing a backup. Not a good thing for those of us who have had more than 6 lymph nodes removed!
So who is at risk? Cancer survivors are at risk. If they had lymph node removal, lymph node damage or radiation; the standard protocol for anyone having a lumpectomy, are at risk for lymphedema. If you had only or up to 1-6 sentinel nodes removed, followed by radiation, your risk is fairly small. For those of us who have had more nodes removed, it is larger, but there is no way to tell exactly how large. What we don’t know is how many lymph nodes we actually have in our axilla (armpit) area. Most people have between 600-700 nodes throughout their bodies, but what isn’t known is the exact number in different locations. So if someone has 40 lymph nodes in the axilla and then removes 8 nodes, it might mean their chance of getting lymphedema is less than someone who has only 24 lymph nodes and had 18 removed. But we have no way of knowing…frustrating!
Once the nodes are removed, the lymphatic vessels are disconnected, for example if you cut a spaghetti noodle in half. So the fluid has lost its direct route. But it is smart! It begins to try and find a way around this traffic jam, just like we do when we are driving. It backs up and tries to flow towards another lymph vessel. Sometimes it finds its way, but the flow is slowed and gets stuck, which causes the swelling. Radiation is problematic because it leaves behind scar tissue. This scar tissue affects the lymph’s ability to flow smoothly, similar to a dam effect. Lymphedema can occur shortly after surgery and radiation or many years later.
So what can you do? Meet with a physical or occupational therapist that specializes in treating lymphedema after surgery and radiation. Do this as part of your Survivor Awareness Plan. While we cannot prevent lymphedema, we can reduce our risk by becoming educated and aware; and by exercising, so our muscles can help move our lymphatic fluid along. Yoga is great to do because it helps us move, and more importantly helps move lymph throughout the channels. Yoga also helps our minds stay sharply focused and calms our spirits.
For More Lymphedema Information:
- http://www.cancer.gov/cancertopics/pdq/ supportivecare/lymphedema/Patient/page1
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