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Melanie Cole: While there is no cure for lymphedema, there are many types of therapy that may help reduce the swelling and discomfort. My guest today is Allison Langlitz. She's a physical therapist and certified lymphedema therapist at St. Luke’s Cornwall Hospital Center for Physical Therapy located on the Cornwall Campus. Welcome to the show. Tell the listeners what lymphedema is and what are some of the most common reasons that somebody would get it?

Allison Langlitz, MSPT, CLT-LANA: Lymphedema is a swelling that can occur in any part of your body. It occurs when a protein-rich fluid accumulates in our tissues just below the skin due to some type of insufficiency of the lymph vessel system. Up to three to five million Americans across a wide spectrum of diseases can get lymphedema most commonly in the United States is actually a result of breast cancer.

Melanie: Is it a foregone conclusion because a lot of women who get breast cancer worry that they're going to get this swelling and lymphedema, is it necessarily followed with treatment that you will get lymphedema or not necessarily?

Dr. Langlitz: No, not necessarily. There's a lot of different studies out there and the numbers vary, but the most common number of breast cancer patients that may develop lymphedema is about 30%. They find that there are some risk factors involved, how many lymph nodes have been removed, radiation therapy and things like that can increase your risk, but it’s definitely not a definite.  

Melanie: What are some of the symptoms? Is it something that gets worse over time that a woman would notice around her armpits that it's starting to swell and can get in for therapy early rather than after it's gotten really swollen? Tell us about the progress of it a little bit.

Dr. Langlitz: Usually, it does develop slowly. There are actually four stages of lymphedema. There is a stage zero, what they consider a latency stage where there's not actually measurable swelling, but your arm can feel heavy, it can feel achy. When it becomes stage one, that's where you have some swelling that comes and goes, sometimes what we call pitting edema, where you stick your finger and it makes a little bit of a dent. A lot of times what women will feel after breast cancer surgery is more of a heaviness or an achiness and that's sometimes a trigger to maybe get things addressed and looked at. What we try to do now is to actually get to a patient before they develop lymphedema. If they are at risk, have had surgery or going to be having surgery eventually having radiation therapy, we try to seem them preoperatively if we can to get measurements, to get a baseline, to educate them as to some of the signs and symptoms that they should be looking for, that you can catch it earlier. Because it is not treatable, it’s definitely a lot easier to manage if you address it early.

Melanie: Let's talk about some of the management. What do you do for a woman? You talked a little bit about pre-physical therapy or prehab that you can do before they go in for surgery, doing measurements and stuff. What about afterward? If you do start to notice some of these things, what can you do for someone?

Dr. Langlitz: The gold standard of treatment for lymphedema is something called completely decongestive therapy. That is a group of treatments. It’s actually something that has to be provided by either a physical therapist or an occupational therapist, sometimes even a massage therapist, and it’s a training that you're certified in and it actually consists of four different things. The first is manual lymphatic drainage, which is a very gentle hands-on massage that uses very light pressure to promote a movement of the lymphatic fluid from the area where it’s congested and into the areas where the lymph vessels and the lymph nodes haven't been damaged and are functioning properly. After that, we follow that with compression therapy and there are several different things we can do as far as compression, most commonly is a type of compression bandage called a short stretch bandage, like an ace bandage, that we will put on the area to help to keep the fluid that we just moved out from re-accumulating in the tissues. There are also specific exercises that we use to increase the lymph flow and helps the body to absorb those proteins that are left behind in the tissues. After breast cancer surgery or any cancer surgery, there are other exercises that we can incorporate into help with posture, to help with the range of motion, to help with scar tissue and things like that as well. The final component of the complete decongestive therapy is education. Teaching the patient how to manage this on their own as there's no cure but is manageable, teaching them techniques to do some of the self-manual drainage or bandaging, teaching them to keep their skin healthy to help decrease their risks of infections and then fitting them for some kind of a compression garment or a device to help them in the maintenance phase of their treatment.

Melanie: You mentioned exercises and such that they can do on their own. Are there any complications to lymphedema if it’s not treated properly? Can it become infected, the skin around it and the tissues? Are there certain things you want listeners to be aware of – red flags?

Dr. Langlitz: Yes, definitely. Unfortunately, having lymphedema or being at risk for puts you at an increased risk for infection. A lot of times, having an infection can trigger your lymphedema and cause your lymphedema to be worse. A patient who is at risk wants to be aware of signs of infection. You want redness to the area, warmth, a fever, a flu-like symptom, increased swelling that comes with a sudden onset, all of those are definitely red flags whether you have lymphedema already or in the limb that is at risk for lymphedema. You want to get yourself to the doctor quickly to get on antibiotics to get it under control.

Melanie: Can it be prevented?

Dr. Langlitz: We like to use the term ‘risk reduction’ because there's really no hard evidence as to who gets lymphedema and who doesn't. They do know some people are more prone to getting it after a surgery than others, but it can't necessarily be prevented. We like to teach what we call lymphedema risk reduction techniques. In that at risk arm or leg, if it happens to be surgery in the legs, you want to do certain things to decrease your risks of infection, you want to maintain an optimal weight – they have shown that weight gain can increase your risk of developing lymphedema – you want to be careful of cuts and scratches, things that might get infected, use sunscreen, insect repellent, if you're going to be working in the garden, make sure you're wearing gloves or working with cleansers and things detergent, put gloves on, be careful with constricting jewelry and wearing having bags and purse straps. They also recommend being careful with blood pressure cuffs in the involved arm, being careful with blood draws, injections and things like that just to decrease your risk of any trauma to that area that might trigger that lymphedema to develop.

Melanie: Wrap it up for us. Tell the listeners what you'd like them to know about finding a certified lymphedema therapist that can help them with some of these exercises and possibly prevent some of the complications that might go along with lymphedema.

Dr. Langlitz: You definitely want to go to a lymphedema therapist who has been certified, who's gone through the proper training, and a good place to start with is actually a group called the Lymphatic Association of North America, or LANA. They are actually a group that has tried to standardize the training of lymphedema therapists. There's a national exam that you have to pass. You have to maintain certain continuing education so that you're staying up to date with your education and your training. They have a website that you can look on and you can put in your zip code and it will populate a lymphedema therapist who’s certified through them. That’s one way to find a therapist. The biggest thing is just knowledge and educating yourself. What you find with lymphedema is it’s not well-known and it’s not talked about a lot and a lot of the patients who are going through these cancer surgeries are thinking they're cured of their cancer, they don’t have this anymore and then they tend to overlook or brush aside the fact that this may be something that can happen to you. Being educated and staying on top of it, and when in doubt, get yourself to a physical therapist or back to your doctor or nurse to address any concerns or questions or anything that might be feeling a little funny or different. Better to address it early than to wait.

Melanie: Thank you so much for being with us today. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit stlukescornwallhospital.org. That’s stlukescornwallhospital.org. I'm Melanie Cole. Thanks so much for tuning in.