Treatment is best when physicians, physiotherapists, nurses, massage therapists, and psychosocial counsellors work together.
Once lymphedema develops, lifelong management is important. Treatment can control but does not cure the lymphedema.
Early lymphedema can be treated with a compression garment alone.
- A compression garment consists of sleeves, stockings or gauntlets (which are like gloves). These garments require measurements by a certified fitter in a medical appliance shop or a pharmacy that specializes in such garments. A list of these shops is available at the B.C. Lymphedema Association website.
- Your family doctor, oncologist or nurse practitioner can write a prescription for the garment. You can bring the prescription to the fitter.
- If the prescription specifies that it is cancer treatment related, Pharmacare (MSP) covers part of the cost of the garment after a specific deductible is reached.
- The garment will need to be replaced every 6 – 12 months.
More advanced lymphedema needs to be treated with a combination of compression therapy, compression garment, and/or pneumatic compression. These complex treatments are best coordinated and initiated by a Certified Lymphedema Therapist.
- Several massage therapy schools can certify a lymphedema therapist. In B.C. most of the therapists are certified by the Vodder School in Victoria. These therapists can have a physiotherapy, nursing or massage therapy background. A list of the certified therapists can be obtained from the Vodder School or the B.C. Lymphedema Association websites.
- Compression therapy uses a combination of massage, manual lymphatic drainage and compression bandaging to reduce the swelling. This is sometimes called Complex Decongestive Therapy (CPD). It often involves a series of sessions costing $70 – 150 each.
- If you qualify for “premium assistance” with MSP, your costs will be covered. Unfortunately the expenses are not covered by the standard provincial pharmacare MSP.
- Lymphedema patients who cannot afford private massage therapists can possibly be referred by their physician or nurse practitioner to hospital-based physiotherapy departments.
- Another treatment option to reduce swelling is pneumatic pumps which use an inflatable sleeve. The sleeve has many sections to provide serial compressions to the affected limbs. Treatment sessions can be long (1 – 2 hours each). The pumps are expensive and tend to be equipped in the physiotherapy departments of regional hospitals only.
- The compression therapy is then followed by a maintenance phase with compression garments.
The Canadian Lymphedema Framework and the International Lymphedema Framework have publications and guidelines for health professionals for treating lymphedema.
If you have an infection or a blood clot in your affected limb you should not have lymphedema treatment, especially compression and massage (MLD and CDP) therapy.
The following therapies may or may not work. They need further study before they can be recommended. These therapies include: laser; electrical muscle stimulation; cryotherapy; transcutaneous electrical nerve stimulation (TENS); microwave; thermal therapy.
Therapies that should not be used are:
- Diuretics do not work. These are pills to reduce water retention.
- Benzopyrones. These can poison the liver.
- Therapeutic ultrasound. This can cause cancer growth in mice. Don't confuse therapeutic ultrasound with the very safe diagnostic ultrasound that you may have had to diagnose a breast lump.
Gentle exercise helps to control lymphedema by stimulating lymphatic drainage. These exercises include most activities of daily living, swimming, biking, and walking.
In the past, vigorous repetitive exercise against resistance was discouraged by some healthcare professionals. Examples of this type of exercise include rowing, cross-country skiing, playing tennis and lifting weights.
Newer studies of the effects of exercise on lymphedema seem to show no harm. Over one hundred B.C. women with breast cancer have become dragon boat racers. They have not been found to develop more lymphedema.
Gentle progressive weight lifting has also been shown to be safe when a compression sleeve is worn during the exercise.
Discuss your planned exercise program with your doctor, physiotherapist or healthcare team.
Try to maintain an ideal body weight. Obesity is a risk factor for developing lymphedema and makes established lymphedema harder to control.
Keep the limb at risk clean, and use moisturizer to keep the skin from drying out.
Health professionals used to discourage blood taking, blood pressure measurements and injections in the arm on the side of breast surgery. A study was published in 2016 about women who have had these procedures in the arm on the breast surgery side. The researchers studied a large number of breast cancer survivors and they showed no increase in risk of lymphedema. These were women who had not been diagnosed with lymphedema. Now we know that it is probably safe to have the occasional blood pressure measurement and injection in that arm if no swelling has been noticed.
The same study also did not find any higher risk of lymphedema in women who travel by airplane. There have been some reports of arm swelling developing after long flights. However, if you do not find any new arm swelling after an air trip, no special precautions are needed on flights. If you already have swelling before the trip, your fitted arm sleeve should be worn during the flight.
Watch very closely for infections in your arm. An arm or leg with lymphedema is more prone to infections. These can show up as a region of progressive redness, warmth and pain.
- Report any infection to your doctor
- Infections in the arm should be treated promptly with antibiotics
- If infections recur a few times in the arm, you may benefit from some antibiotics taken for a week per month, or your doctor can give you a prescription to start yourself on antibiotics at the earliest sign of infection. Consult your doctor.