A clinician and patient perspective. By Anna Kennedy and Pam Hammond

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1 A clinician and patient perspective By Anna Kennedy and Pam Hammond

2 Who are we? Anna Kennedy Executive Director of the Lymphedema Association of Ontario and a cancer survivor living with lymphedema Pamela Hammond Registered Massage Therapist and Certified Lymphedema Therapist treating lymphedema patients

3 Lymphedema - who needs to know? You are at risk if you have had Surgery that includes removal of lymph nodes Radiation involving lymph nodes 1 in 4 or 5 breast cancer survivors will develop lymphedema over their lifetime

4 Why you need to know Cancer treatments may have compromised your lymphatic system Avoid factors that may trigger lymphedema Obesity, smoking, diabetes and high blood pressure increase your risk Recognize this condition early to manage it better Lymphedema can occur at any time and remains a life-time risk

5 What is lymphedema? A condition of protein rich localized fluid buildup caused by damage of the lymphatic system Its main symptom is swelling of the affected area lymph edema

6 The lymphatic system Consists of lymph fluid, lymphatic nodes, ducts and vessels Plays a major role in protecting body against infection and illness Moves excess fluid and blood protein from the tissues to the bloodstream

7 Different types of lymphedema Primary Lymphedema Can be present at birth, develop at puberty or in adulthood, due to genetic malfunctioning lymphatics Secondary or acquired lymphedema Can develop as a result of surgery, radiation, infection or trauma Cancer treatment is the leading cause of lymphedema in Canada

8 Lymphedema has many faces

9 Signs to watch for Be aware of sensations in your hand, arm, shoulder, chest, trunk, back, leg, foot neck or face Persistent swelling (your jewellery, clothes don t fit) Feeling of heaviness, aching, tightness of skin Tingling, throbbing sensation Skin texture changes Pain

10 What can you do? Skin Care inspect, monitor, recognize and take precautions Healthy Lifestyle maintain a healthy body weight stretching, strengthening, aerobic conditioning all play a role in lymphedema management Recognize signs of cellulitis fever, hot, red streaking that is expanding along arm or chest needs immediate medical attention

11 Triggers to try and avoid Infection in the affected area Injury to the affected area Extreme heat or cold Constricting your skin in the affected area

12 Travel Tips Get up, walk around and practise deep breathing Pump your ankles, open and close your fists Roll your shoulders Pack your moisturizer, sunscreen and antibiotic cream Avoid carrying, pulling or pushing heavy luggage with the affected arm

13 Lymphedema Treatment CDT = Combined Decongestive Therapy MLD = Manual Lymphatic Drainage Skincare Exercise CDT MLD Lymphatic Self- Massage techniques are based on MLD Compress ion

14 Complete Decongestive Therapy Manual Lymph Drainage To remove excess fluid and protein Compression Therapy Bandaging and the fitting of compression garments Skin Care Anti-bacterial cleansers and PH lotions Exercise To promote lymphatic flow

15 What is Lymphatic Self-Massage? A specialized type of gentle massage that is designed to aid lymphatic circulation by moving the fluid Affected Arm Neck Unaffected underarm Groin (same side as arm)

16 Lymphatic self-massage routine Support arm or leg with pillows, table or chair Massage with light pressure on skin, keep hands and body relaxed Use flats of hands instead of finger tips Massage toward the unaffected/alternate lymph nodes Self-massage should always be pain free Do not do self massage if you have an infection

17 Deep breathing Place the palms/flats of your hands on your stomach Slowly, breathe in deeply through your nose, allowing the stomach to expand. Breathe out slowly through pursed lips (like blowing out a candle, allowing the stomach to flatten) Repeat 5 times with a short rest between each breath to avoid dizziness

18 Neck Routine at the collar bone Place the flats your fingers on either side of your neck just above your collarbone. Some people find it more comfortable to cross their hands when they do this stroke. Place your 2nd and 3rd fingers just above your collarbone on either side of your neck and stretch the skin just as far as it naturally goes. Stroke down towards your collarbone and inward. This stroke would look like two J strokes facing one another. This motion helps lymph fluid drain back to the heart. Repeat 15 times

19 Neck Routine side of your neck Place your flat hands on either side of your neck just under your ears and gently stretch the skin down towards your collarbone and release. Try to stroke your neck in a slow, gentle and rhythmical manner. Repeat this stroke 10 to 15 times. Remember to keep your pressure light

20 Neck Routine back of neck Place your flat fingers on the back of your neck just below your hairline on either side of your spine. Stretch the skin towards the spine and then down toward base of neck and release. Repeat times

21 If swelling happens to you Rest your arm Elevate your arm Make an appointment with your oncologist to rule out other problems Make a referral to the lymphedema clinic Call the Lymphedema Association

22 Where to go for help? The Lymphedema Association of Ontario can help Help Line: toll free telephone or Support groups and peer to peer support Website with resource information Books, DVDs, CDs and support material Lymphedema Matters publication Annual lymphedema education conference

23 Canada s largest conference dedicated to lymphedema education and awareness For patients, family members, caregivers, and health professionals

24 What else do we do? Advocate for improved access to treatment and increased health care and insurance coverage Outreach through education and awareness events geared to patients and health care professionals Collaboration and partnerships to promote research and build a stronger lymphedema community

25 Committed to improving the quality of life for people living with lymphedema The Lymphedema Association of Ontario

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