"Edema" is the medical word for swelling. Lymphedema is swelling that you are born with or that can occur in your arm or leg after having lymph nodes removed during surgery. (If you have had nodes removed from your armpit, you should observe precautions for your arm. If the nodes have

been removed from your groin, the precautions apply to your leg.) The swelling can begin soon after your surgery, or not for several months or years. Not everyone who has surgery with lymph node removal will get swelling. If you notice that your arm or leg looks swollen or that your clothes or jewelry feel tighter than usual, or that your arm feels heavy, call your doctor.

Lymphedema is a condition that may be treated with physical therapy, but there is currently no cure to make the swelling disappear permanently. Following the activity and exercise guidelines in this booklet will decrease your risk of developing swelling as much as possible. If you have further questions, contact the Physical Therapy Department at Woman's Hospital at 924-8450.

The lymphatic system is responsible for returning fluid and protein to your circulatory system. Small amounts of protein and fluid continually escape from blood vessels. Tiny lymph vessels pick up these materials along with waste products and foreign materials (Re bacteria) and transport them to larger and larger lymph vessels. Fluid-inside the lymph vessels is called lymph. Lymph is moved along to larger vessels partly by activity of surrounding muscles. Lymph nodes filter the fluid and break down foreign substances and help fight infection. Lymph is pumped through vessels in the body until it is returned to the circulatory system near the neck.

Lymphedema occurs when the lymph system is damaged or blocked, or if there is a problem with development of the lymph system; both of these situations may prevent fluid from moving out of the space between tissues and into the one-way valves of lymph capillaries. The protein-rich fluid collects in the tissues and can be cosmetically unappealing

• decrease the amount of oxygen that reaches the tissue
• slow wound healing
• promote infection by serving as a medium in which bacteria can thrive
• lead to chronic inflammation and fibrosis, which further restrict fluid flow

Primary lymphedema is caused by an underdevelopment of the lymph system and. is present at birth, although swelling may not start until puberty, or, in women, at the time of menopause.

Secondary lymphedema occurs when the lymph system is damaged or injured. The most common example of this is when surgery for cancer involves removal of lymph nodes or if lymph tissue is damaged by radiation therapy.

Work/Home/Hobbies: It is important to prevent skin irritation, cuts, scrapes, and needle sticks, since breaks in the skin can promote infection.

• Wear gloves for gardening and housework.
• Use an electric razor rather than a blade razor.
• Use a thimble when sewing with a needle.
• Have injections and blood, samples in an uninvolved limb.
• Take good care of your skin. - See the skin care section of this booklet.
• Avoid heavy lifting with the swollen limb.
• Avoid forceful, repetitive motions against resistance (rubbing, scrubbing, pushing, waxing, painting, stirring).
• Avoid tools which vibrate (sanders, drills).
• Use sunscreen and insect repellent when outdoors.
• Take care to avoid bites and scratches from pets and insects.

Heat Exposure: The body cools itself by increasing circulation to the hot area. When you increase circulation to a swollen limb, this increases the chance of additional fluid "leaking out" into-the tissue space, which can cause more swelling.

• Avoid prolonged exposure to sunlight. Use sunscreen, when outdoors.
• Use oven mitts instead of smaller pot holders when reaching into the oven.
• Avoid hot tubs and saunas.
• Avoid spending lots of time under hot hair dryers.
• Look for clothing made of breathable fabrics for hot weather.

Circulation: Anything that will reduce the circulation of blood flow will also restrict flow of lymph.

• Have blood pressure measured in an uninvolved limb.
• Avoid clothing with tight sleeves.
• Avoid tight watches and jewelry.
• Elevate the swollen area when possible.
• Move the involved limb frequently.
• Avoid letting a heavy handbag hang over the involved arm or shoulder.
• Avoid sitting with your legs crossed.

General: Adopt healthy living habits.

• Consult your physician or physical therapist about starting or resuming conditioning exercise such as walking, aerobics, or swimming.
• Avoid alcohol and smoking.
• Maintain your ideal weight.
• Keep your sodium intake at a moderate level. (<2400 mg/day)
• Fat a moderate amount of protein to maintain tissue integrity. (USRDA for adults is around 50 grams per day, but depends on your weight.)
• If you travel by air, wear a compression garment during the flight.

Your skin is the best defense you have against infection in your arm or leg. Since lymphedema can occur as a result of infection, it is important to protect the skin from injury and keep it clean and dry.

• Use antibacterial soap.
• Keep the skin dry to avoid breakdown.- Be sure to wash your hands
• frequently and dry them thoroughly.
• Keep the skin moisturized to avoid cracking or peeling. Use
• moisturizing lotion if you are prone to dry skin. You may need to use lotion only occasionally, or seasonally (in winter, for example). If you have sensitive skin, Eucerin lotion is a good choice. It is available at grocery stores and pharmacies.
• Avoid hangnails, and do not pull or bite cuticles. Use moisturizer and cuticle remover.
• Use sunscreen designed for babies or sensitive skin users. Consider prescription sunscreen if you spend lots of time outdoors. Be sure that the SPF is 15 or higher.
• Avoid casual injuries. It is important for you to make changes in your lifestyle to reduce your risk of cuts, scrapes, burns and other injuries to the involved limb. (See Precautions in this book.)
• If you get a cut, wash immediately with antibacterial soap. Apply a topical antibiotic cream or ointment (like Neosporin, Bacitracin or Triple ABX) and cover with a sterile adhesive bandage.
• Be aware of the signs of infection. Notify your doctor immediately if you notice
• increased swelling
• redness (generalized, or localized small, red dots)
• heat (your arm or leg feels warm, or you run a fever)
• pain

Call your doctor as soon as you suspect infection. Most are easily with antibiotics, but it is important to treat early.