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Lymphedema and Infection

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Infection is a special concern after you’ve had any lymph nodes removed — whether or not you’ve ever had any symptoms of lymphedema. This is because of two key roles those lymph nodes play for the hand, arm, and upper body.

1. Lymph nodes take care of “foreign invaders” from specific regions of the body and signal the body to launch an immune response. “I liken the lymph node to a taxi dispatcher who gets a call from someone at an address and then says, ‘Hey taxi, go there,’” says Kathryn Schmitz, Ph.D., MPH, FACSM, professor of public health sciences and physical medicine and rehabilitation at the Penn State Cancer Institute. “So let’s say you have an underarm lymph node or nodes that serve your hand. You get a cut in your finger and dirt and debris get into the body. The lymph carries the debris up to the lymph nodes, which strain the debris out and then tell the immune system to respond, to stop the infection. So what happens if you no longer have all of those nodes? A cut that wasn’t a big deal before has the potential to turn into an infection that, left unchecked, can spread throughout the body.”

2. Lymph nodes filter out bacteria and toxins so they can’t get into the blood. In the case of this cut finger, the lymph is trying to carry the bacteria and debris out of the finger tissue, but some of the lymph nodes and vessels you had before aren’t there to filter it out. The remaining nodes and vessels may not be able to keep up with all the lymph that needs to be filtered. Bacteria can then start to multiply in the lymph. Because lymph is rich in nutrients, it provides a great environment for bacteria to hang out and reproduce.

The more lymph nodes that have been removed or damaged, the harder it may be for your lymphatic system to deal with injury. Cuts or even small breaks in the skin — sometimes not even visible to the naked eye — can get infected, causing local symptoms such as redness, tenderness, and warmth. In some cases, these symptoms can spread from the original injury up the arm or into the upper body. A spreading rash that is warm and tender indicates cellulitis, a serious bacterial infection of the skin and underlying tissue. Cellulitis requires immediate medical attention and treatment with antibiotics. Left untreated, cellulitis tends to spread rapidly and can even become life-threatening. If you can’t get in to see your doctor right away, go to the nearest emergency room for treatment.

What to do if you notice a cut or break in the skin

For many women, infection is the trigger for their first episode of lymphedema. If you notice a cut or break in the skin anywhere in the hand, arm, chest, or upper body on the side of your surgery — no matter how minor — be sure to:

  • Wash the area with soap and water.
  • Apply an over-the-counter antibiotic ointment, such as Neosporin, Polysporin, Bactroban, or the store-brand equivalent.
  • Cover with a clean, dry bandage and change it regularly, keeping the area clean and covered until it heals.
  • Check every day for signs of infection, such as redness, swelling, increased heat, or tenderness in the area, or chills, fever, and/or fatigue. You may feel ill — almost like you have the flu coming on — before you notice any changes in the skin.
  • Call your doctor if you think you have an infection.

Note: If you get a cut, it doesn’t mean it will definitely become infected, or that you will develop lymphedema. Just use good common sense to reduce the risk of infection and take quick action if any symptoms appear.

If you develop infection or recurrent infections

Any infection should be treated right away with an antibiotic, whether or not it has progressed to cellulitis. Your doctor may recommend that you rest in bed and elevate the affected area. If you already have lymphedema, you can continue wearing your compression sleeve if it’s not too painful to do so. (If the area is inflamed and sore, you may need to take a break until symptoms improve — see your doctor for more guidance.) Any massaging of the area with manual lymphatic drainage should stop until the infection has resolved.

Typically, your doctor will need to see you within a few days to make sure the antibiotic is working. Symptoms of infection should start clearing up within a few days, although you’ll likely need to continue taking the medication for longer than that. If your infection doesn’t respond, you may need to be admitted to the hospital to receive antibiotics intravenously, which means the medicine is delivered directly into your bloodstream through an IV or a port. Just be sure the IV isn’t inserted into the arm or hand on the side of your body that has the infection.

Let your lymphedema therapist know that you’ve had an infection. He or she can monitor you for any signs of lymphedema if you’ve never been diagnosed, or for symptom flare-ups if you already have it. Since infection can trigger lymphedema, it’s important to take action quickly if symptoms develop.

Some people go on to experience recurrent infections. If this happens to you, ask your doctor about getting an emergency supply of antibiotics to be taken at the first sign of trouble. If you have persistent lymphedema and get frequent infections, you may need to take antibiotics whenever you get a cut or break in the skin. Your doctor might recommend taking a low-dose antibiotic regularly as a preventive measure, even without any signs of injury or associated infection. Or you may only need to take an antibiotic before any medical procedure that could introduce outside bacteria into your body, such as dental work or surgical procedures. Your doctor is the best judge of what's right for you.

If you've had problems with infection and are planning a trip or an extended out-of-town stay, see your doctor. He or she may advise that you can take a prescription for antibiotics or a medication supply with you.

Another important step is ramping up your current treatment plan, advises Nicole Stout, MPT, CLT-LANA, Senior Rehabilitative Services Practice Leader at Kaiser Permanente, Mid Atlantic Region. “With my own patients, I find that when we find ways to manage their lymphedema more consistently, they tend to have fewer infections. This may mean more consistent nighttime bandaging or compression, or more compression during the day.”

Be sure to review and follow all of the guidelines for protecting your skin. See Reducing the Risk of Lymphedema and Lymphedema Flare-Ups for more information.

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