Lymphedema of the leg (secondary lymphedema) often occurs following treatment for cancer of the abdomen. Lymph nodes are removed in the course of surgery and/or radiotherapy resulting in damage to the lymphatic system. A genetic predisposition to insufficiency of the lymphatic system can also lead to the development of (primary) lymphedema.
Special recommendations have been defined for cancer patients in aftercare, which are intended to help avoid or at least delay the development of leg lymphedema.

1. At home and at work

– Void any injuries, overexertion, heat and cold.
– Avoid standing for long periods.
– Beware of boiling water – there is a risk of burning even from steam.
– When working at a hot stove or oven, always wear clothing to protect your legs and use oven mittens.
– Always wear rubber gloves while working.

2. Clothing

– Avoid underwear and slips with tight elastic bands that cut in either around the waist or the legs.
– Avoid wearing tight knee socks.
– Acquire footwear of an ample size so that your bandaged foot can fit in the shoe without difficulty.
– Avoid wearing tight belts.

3. Beauty treatment and body care

– Try to keep as clean as possible and care for your skin thoroughly.
– When doing your fingernails, avoid cutting away the nail folds.
– Be careful when filing.
– Avoid pushing back or cutting away the cuticles.
– Avoid using any irritating or allergenic cosmetic products.
– Avoid using the sauna.
– Avoid sun-bathing.
– When massaging, avoid kneading the leg.
– Avoid shaving the leg.

4. In the garden

– Avoid injuring yourself when working in the garden (by prickles, thorns or tools).
– Always wear long pants and use gloves when doing garden work.

5. With household pets

– Be sure to avoid any bites or scratches to the swollen legs.

6. Sports and recreation

– Avoid over exerting yourself.
– Avoid exposure to heat or cold.
– Avoid injuring yourself.
– While swimming is one of the activities recommended in therapy, avoid overexerting yourself when doing so.

7. Food and nutrition

– Maintain your weight.
– Make sure you are getting a balanced diet (meat, vegetables, and fresh fruits).
– Limit your intake of table salt as far as possible.

8. During the day

– Perform your special gymnastic exercises with the leg sleeve from time to time.
– Wear the leg sleeve prescribed by your doctor.

9. During the night

– Prop up your swollen leg in bed.

10. When planning a vacation

– Avoid destinations where insects are prevalent.
– Be sure to wear compression stockings when travelling by plane.

11. At the doctor’s

– Avoid having injections administered (to the skin, muscles, veins or joints) on the side of your body that has been treated by surgery or is swollen.
– Avoid injections to the surgical scar.
– Avoid acupuncture or neural therapy to the side of your body that has been treated by surgery or is swollen.

12. Immediately consult your doctor

– If your swollen leg becomes infected (fever, reddening of the skin, shivers).

Lymphedema Assessment Patient Form

About Lymphedema

Lymphedema is an abnormal accumulation of protein-rich fluid in the interstitium, most frequently seen in the arms or legs. It is a chronic condition but can be controlled.

Primary vs. Secondary Lymphedema

Primary Lymphedema develops due to imperfect development of the lymph vascular system. This can occur at birth or often appear later in life.

Secondary Lymphedema has a known cause such as destruction or removal of lymph nodes related to surgery and radiation for Cancer, Filariasis (elephantiasis), obesity, severe trauma or infection.

Usual Signs and Symptoms

Discomfort – feeling of heaviness, tightness and the feeling of tension.
Symmetry – if bilateral, Lymphedema is usually assymetrical.
Skin changes – swelling, tissue hardening or thickening and hyperkeratosis, papillomas if left untreated.

Stages of Lymphedema

Stage 0 – Latency – Patient may have subjective complaints/symptoms.
Stage 1 – Reversible – Pitting and reduces with elevation
Stage 2 – Spontaneously irreversible – displays evidence of fibrosis
Stage 3 – Lymphostatic elephantiasis – Severe edema with severe skin changes

How to manage Lymphedema

Manual Lymph Drainage (MLD)– increases lymphangio activity used to reroute fluid around blocked area into healthy lymphatic regions and lymph nodes. It promotes relaxation and reabsorption of protein-rich fluid.

Compression Bandaging – prevents re-accumulation of fluid and assists in the breakdown of deposits of indurated tissue. Compression alone does NOT adequately treat Lymphedema. Compression therapy without MLD can lead to proximal edema and fibrosis of the adjacent trunk quadrant.

Exercise – to facilitate lymphatic and venous return, it should be done at a moderate level while wearing compression garments.

Skin care – To decreased incidence of infection. And do not forget to moisturize your skin.

Eat a balanced healthy food – Weight management is important to patient’s with Lymphedema.

With the help of a Lymphedema Therapist, you will know more about your condition and how to manage it.