How to Avoid Lymphedema

Current methods of breast cancer treatment lower the risk of developing lymphedema. But if you had a radical mastectomy many years ago, you may have had arm swelling, or you may still be at risk for the condition. Prevention is very much in your best interest. Even the safest and most effective therapy may only delay the condition or keep it from worsening. Immediate care is essential with any trauma or infection.

Prevention is the best tool against arm lymphedema. Learn the warning signs and the precautions to take. Make these guidelines and a heightened awareness a regular part of your life.

Skin care is your first line of defense. Since the skin acts as a barrier to infection, any disruption of the skin can spell trouble. Burns, chafing, dryness, cuticle injury (such as hangnails), cracks, cuts, splinters, and insect bites are immediate risks for infection.

Learn to recognize the signs of infection:

• fever
• redness
• swelling, warmth, or tenderness in the at-risk arm

Infection and inflammation can escalate quickly. Redness, tenderness, and warmth can spread from the injury up your arm. Call your doctor as soon as you suspect infection. You may need to start antibiotics immediately with any early sign of trouble. If you already have swelling, or if you have diabetes (whether or not you have swelling) you may need antibiotics after just the smallest of injuries—even without any sign of trouble.

If you already have significant arm edema, sometimes a dental procedure may trigger an arm infection. This is because the work a dentist does on the tissues in your mouth may increase the number of bacteria circulating in your bloodstream. Vulnerable areas in the body, like the compromised drainage of a swollen arm, may become hangouts for the bacteria. If you've already had an arm infection following dental work, talk to your doctor about whether you should take prophylactic (preventive) antibiotics before future dental procedures. (People with heart valve disease take prophylactic antibiotics before or right after a dental procedure for the same reason.)

Dos and Don'ts: Preventing Lymphedema

Dos

• Do moisturize your skin frequently and regularly. Use lotions such as Moisturel, Eucerin, Vaseline Intensive Care, or your own favorite brand to make your skin supple and prevent it from cracking.
• Do keep your hand and arm extra-clean, but don't use harsh soaps such as Ivory (despite Ivory's advertised image as a gentle soap) or Dial. Use Dove instead.
• Do use rubber gloves when you wash dishes or hand-wash clothes.
• Do wear protective gloves when you garden or do outside chores.
• Do take more frequent rest breaks when scrubbing, mopping, cleaning, or while doing other vigorous or repetitive activities, especially if your arm feels tired, heavy, or achy.
• Do wear oven mitts when handling hot foods.
• Do use an electric razor instead of a safety razor.
• Do use insect repellents that won't dry out the skin, such as Avon's Skin-So-Soft, which actually moisturizes the skin. Avoid brands that contain a significant amount of alcohol. (Any ingredient that ends in "ol" is a type of alcohol.)
• Do apply antibiotic ointment (like Bactroban) to any insect bites or torn cuticles (as long as you are not allergic to its contents).
• Do protect your arm from sunburn with sunscreen. Use a product with a minimum SPF of 15, although SPF 30 is much better.
• Do use a thimble when you sew.
• Do REST your arm in an elevated position. But don't hold up your arm without support for a long time because your muscles will tire.
• Do control your blood sugars very carefully if you have diabetes, to minimize the danger of damage to the small blood vessels and infection.
• Do wear compression bandages or a compression sleeve and glove on the affected arm when flying in airplanes (if you already have arm swelling).

Don'ts

• Don't take unusually hot baths or showers.
• Don't go from extreme hot to cold water temperatures when you bathe or wash dishes.
• Don't go into high-heat hot tubs, saunas, or steam baths.
• Don't apply heating pads or hot compresses to the arm, neck, shoulder, or back on the affected side. Also, be cautious of other heat-producing treatments provided by physical, occupational, or massage therapists, such as ultrasound, whirlpool, fluidotherapy, or deep tissue massage. Heat and vigorous massage encourage the body to send extra fluid into the compromised area.
• Don't carry heavy objects with your at-risk arm, especially with the arm hanging downward.
• Don't wear heavy shoulder bags on the affected side.
• Don't wear clothing that has tight sleeves or that restrains movement.
• Don't wear your watch or other jewelry on your affected hand or arm.
• Don't use a heavy breast prosthesis after mastectomy. It may put excessive pressure on alternative routes of lymphatic drainage that are already doing double duty. Find a lightweight model or make one yourself.
• Don't drink much alcohol. Alcohol causes blood vessels to expand and leak extra fluid into the tissues.
• Don't smoke. Smoking narrows the small blood vessels, lessening the flow of fluids in the arm.
• Don't get manicures that cut or overstress the skin around the nails.
• Don't permit blood pressure testing on your at-risk arm. If you've had breast cancer in both breasts, ask that your blood pressure be tested on your thigh. If this is not possible, ask that the person measuring your blood pressure inflate the cuff only slightly above your normal systolic pressure (the first, higher number of your blood pressure).
• Don't permit the skin of your at-risk arm to be pierced for any reason: injections, drawing blood, or vaccinations. (Don't trust anyone, not even your personal physician, to remember which is your at-risk arm.) If you've had breast cancer in both breasts along with underarm lymph node dissections, blood should be drawn from another part of your body. If blood must be drawn from your arm, use your non-dominant arm (your left arm, if you are right-handed; your right arm, if you are left-handed). If one side had no lymph node dissection, use the arm on that side, regardless of whether it's your dominant arm.

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source: http://www.breastcancer.org/tips/lymphedema/avoid.jsp