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 Cancer Victims Sometimes Suffer Swelling After Surgery By CHUCK CHANDLER & JASON COOK It's a silent condition, one that people hide behind closed doors. And yet, lymphedema affects at least 2.5 million Americans and dramatically alters their way of life. "Lymphedema is not necessarily one of the more glamorous things in medicine," said Daniel Tanenbaum, MD. "It's actually very common. Up to 30 percent of people who have, say surgery for cancer, on a breast or on a limb, can develop this type of problem." Lymphedema is a common after-effect of many lifesaving cancer treatments, including surgery, chemotherapy and radiation therapy, but despite all the recent advances in medicine, there is still no cure for this painful condition. Until recently little relief could be found for the victims of lymphedema. "If somebody has had successful surgery or chemo-radiation therapy to treat a cancer, oftentimes they think, well, 'This swelling is the price I have to pay,'" said Tanenbaum, who is medical director of the outpatient department at Fairlawn Rehabilitation Hospital in Worcester, Mass. In reality, however, the pain and swelling can be managed. Under Tanenbaum's guidance the HealthSouth-managed hospital has developed an intensive lymphedema treatment program. Technically speaking, lymphedema is the painful swelling of lymph fluid, usually in the arm and legs. This thick, clear, protein-rich fluid circulates through the lymph vessels and nodes and is part of the body's healing mechanism. Medical procedures frequently damage the lymph nodes and vessels, which causes excess lymph fluid to accumulate. Chris Mahoney is an occupational therapist at Fairlawn Rehabilitation Hospital who has special training in lymphedema treatment. Fairlawn's program entails an intensive evaluation process, weekly measurements and 45-minute to one-hour manual lymphatic drainage massages, as well as bandaging, compression garments and routine exercise. Patients in the lymphedema program are treated at the hospital for a couple of hours each day for two or three weeks. The key component is the massage, which helps the body reabsorb excess lymph fluid. The bandages and compression garments then keep the vessels from refilling and serve as an external pump. Article from HEALTHSOUTH Corporation's website. Patient Education Key In Preventing, Treating Lymphedema By DR. DANIEL TANENBAUM Four years ago, Fairlawn Rehabilitation Hospital initiated services for individuals with lymphedema. Although lymphedema is sometimes avoidable and almost always treatable, by the time many patients seek treatment at Fairlawn, their physical, functional and psychological status has been compromised. Therefore, improved patient education is essential to ensuring early treatment and reducing complications associated with this condition. With that in mind, I offer the following in hopes that it assists clinicians whose patients are at risk for the potentially debilitating but treatable effects of lymphedema. What is lymphedema and what causes it? Lymphedema occurs when there is abnormal accumulation of tissue proteins, edema, and chronic inflammation within an extremity. Initially, the fluid load exceeds the lymphatics' capacity to return it to the venous circulation. This is followed by accumulation of protein and decreased immunolgic function in the extremity. Over time, there is progressive fibrosis. "Primary" lymphedema may be caused by malformation of lymphatic vessels. "Secondary" lymphedema can develop as a result of lymph node resection, fibrosis due to radiation, and traumatic injury. These factors are common among individuals treated for cancer; it is estimated that 20 to 30 percent of women who have had surgery for breast cancer develop lymphedema. What are the symptoms of lymphedema? Symptoms include swelling, ranging from slight to impressive proportions. Individuals can experience immobility of the limb, as well as pain, tightness, paresthesias, and burning. Some patients have relatively little swelling but experience pain and sensory symptoms; although these individuals can be difficult to diagnose, treatment often brings improvements in comfort and function. What medical complications are associated with lymphedema? Complications include cellulitis, contractures, skin ulcerations, lymphocutaneous fistulae, genital edema, and cancer. Functional impairments affect dressing, hygiene, and mobility. Sometimes people with severe lymphedema do not leave their homes due to decreased mobility and concerns about physical appearance. Interpersonal relationships and ability to maintain employment may also be affected. Can lymphedema be avoided? In many cases, avoiding trauma to the at-risk extremity can prevent lymphedema. For example, phlebotomy should be avoided in the arm if breast cancer surgery has been performed on that side. Once lymphedema develops, it does not resolve spontaneously; it is a chronic and frequently progressive process. How is lymphedema treated? Treatments include: Unfortunately, lymphedema is frequently overlooked or undertreated. However, as we have seen at Fairlawn, its effects can be controlled, leading to reduced patient suffering. Therefore, as a medical community, we need to continue to increase awareness of and attention to lymphedema. Dr. Daniel Tanenbaum is a physiatrist and Medical Director of Outpatient Services at Fairlawn Rehabilitation Hospital. | ||||||||