- Question from Betty: I know to bandage when I fly. What about a mountain vacation (4000 ft. up)? Will that affect my lymphedema arm?
- Answers - Answer I've had patients go on vacations like that and notice an increase in swelling due to atmospheric pressure. I encourage them to use compression, a sleeve or bandage, as much of the time as possible if they have symptoms.
- Marisa Weiss, M.D. For people who are mountain climbing or doing other activities like that, it's important to rest intermittently and not always have your arms in the downward position. One thing that we have not mentioned so far is the role of elevation. In your normal daily life, you usually are balanced with activity and periods of rest, and you vary the position of your arm. When you arm is above your shoulder level, gravity helps drain the fluid off your arm. This is one way to help ease arm edema, but it's not very practical as a long-term solution, because walking around with the affected arm above your shoulder or head doesn't work for most people.
- Answer It's better to elevate the arm in a resting position rather than holding it up in the air, because the muscles can fatigue which can cause a increase in fluid production.
- Saskia Thiadens If you do go up in the mountains and backpack, don't carry a heavy backpack over the affected side. You can develop lymphedema or worsen it, so have someone else carry the heavy weight. When you are up in the mountains, and I've gone with friends who've had breast cancer and no lymphedema, really cover up the arm, because sunlight or heat can create or worsen lymphedema. So cover up!
- Marisa Weiss, M.D. Sunburn can cause significant injury to the skin of the whole arm and can make matters worse.
- Saskia Thiadens Use a good sunscreen.
- Marisa Weiss, M.D. I recommend to my patients that they use sunscreen with an SPF of 30 or greater.
- Answer Another risk factor is heat in general. In particular, if you're going for some kind of physical or occupational therapy and the therapist wants to use heat treatment, you should let the therapist know that could be a risk for you if you have lymphedema. And try to avoid heat on the arm in the form of hot compresses, because that causes the blood vessels to dilate and can bring more fluid into the arm.
- Saskia Thiadens If you can, avoid saunas or hot tubs. Keep your affected limb out of the hot tub if you go in.
- Marisa Weiss, M.D. I have a patient who had just installed a hot tub in her home when she was diagnosed. It took a few months to work out a compromise, but she does as you say and keeps her affected arm out of the hot tub. They fill the hot tub a little lower so it's not affecting the area of surgery on the breast as well, and she puts the temperature down a few more degrees than most people do. So far it's been fine.
- Answer Generally, physical and occupational therapy are covered by insurance, but always check with your insurance company. There are certain codes that are accepted, and manual lymph drainage has a reimbursement code that is accepted by Medicare and most insurance companies. If the therapist uses that code, it should be covered.
- Marisa Weiss, M.D. The insurance company may cover MLD for a limited number of visits. You may need to be assertive and pushy with your insurance company in order to get as much of your treatment covered as possible.
- Saskia Thiadens Overall, the reimbursement in the U.S. is still very chaotic. If you're under the care of an occupational therapist, depending on where you're located, you can receive reimbursement for a certain amount. Nurses and massage therapists today are rarely reimbursed, and it is becoming more difficult. Most important is that the patient needs to be seen by a physician, ideally a lymphologist—a doctor who is educated in the lymphatic system. Most doctors can evaluate patients, and the patient should continue to stay under the care of the physician.
- Marisa Weiss, M.D. By speaking up as a patient affected by this condition, you can help teach your health care professional about the condition and help him or her become more aware and involved in its proper management.
- Saskia Thiadens In late August, I'm organizing the 5th National Lymphedema Conference, and we're introducing a four-hour instructional session primarily for physicians to educate them in the anatomy and physiology of lymphedema, and to add lymphedema to their existing practice. I'm happy to say that 35 physicians have registered for this.
- Answer Remember, if you develop lymphedema, it can't be cured, but it can be managed, and people should try to get as much information as possible by consulting with a lymphedema specialist and talking about their treatment options and the best course of treatment for their particular case. Although some activities may need to be modified to avoid provoking additional swelling, it's important to participate in pursuits that give you pleasure and satisfaction.
The Ask-the-Expert Online Conference called Arm Lymphedema Prevention and Management featured Sara Cohen, O.T.R./L., C.L.T.-L.A.N.A., Saska Thiadens, R.N. and Marisa Weiss, M.D. answering your questions about preventing and managing arm lymphedema.
Editor's Note: This conference took place in July 2002.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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