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Margulies mammogram imageJosephine was elated. She had just survived breast cancer and was looking forward to a life full of laughter and joy with her husband, children and friends. But there was one problem. Josephine hated her arm. She had her the lymph nodes under her arm removed because of breast cancer. There was some cancer in her lymph nodes, so she had all of her lymph nodes removed.

Josephine heard about lymphedema, that dreaded condition associated with breast cancer survivors whose arms could swell, become painful and useless. Josephine was angry because her arm hurt, her arm was numb and her arm looked like it was starting to swell. Did she have lymphedema?

Lymphedema does not start immediately after surgery, although the breast and arm can swell from the surgery itself.

What is lymphedema?

Lymphedema is swelling of the arm, much like a your kitchen sink sponge is after you add water. Lymphedema can develop when the lymph vessels are disrupted. Arteries bring blood to the arm. Veins bring the blood back from the arm. But there are leftover proteins and fluids that still need to be returned. Sort of like when you cook dinner and ask your teenager to clean up. There is always leftover dishes and garbage that you need to clean up after your teenager has completed their clean-up process. This is what the lymphatic system does, cleans up after teenagers. The lymphatic system also clears the body of bacteria and cancer. So, if the lymphatic vessels get broken during surgery, leftover proteins and fluids, “lymph,” can remain in the arm. This causes the arm to swell and the edematous and swollen arm can become sore, heavy and even hurt.

Fortunately, we are learning more about lymphedema every day and the rate of lymphedema is decreasing. Surgically, we can reduce the risk of lymphedema by doing a Sentinel Lymph Node Procedure or using the Axillary Reverse Mapping Procedure.

But there are some things that patients can do to limit the risk of lymphedema after surgery. Obesity is the greatest risk factor for lymphedema that a woman can control and by eating a low-fat diet, losing weight and having a healthy body-mass index between 20-25 pounds per square inch, a breast cancer survivor can significantly reduce her risk of developing lymphedema (and of a recurrence)!

The second most important consideration is prevention of an infection and of inflammation. Infections can occur after scrapes and cuts, so when gardening or walking in the woods, wear a long sleeve shirt and glove. Inflammation can occur most commonly after a sunburn so wear protective clothing or put on sunblock of UPF 15 or higher on the arm and the breast when outside in the sun.

Encouragingly, we are starting to understand the tremendous benefits of exercise and the role exercise plays in the prevention of lymphedema. Weight lifting, not power lifting like Olympic athletes, but “toning” type weight lifting, can prevent lymphedema by up to 70% of women who have had a full axillary lymph node dissection. Likewise, women who have lymphedema can reduce the severity of their lymphedema by a weight lifting protocol.

Exercise has tremendous health benefits from prevention and lowering the risk of recurrence to improving the results of therapy to bringing about an improved quality of life. Proper exercise, i.e. “not over doing it” has very little, if any bad effects.

If you want your best chance of survival from breast cancer; if you want your best quality of life after beating breast cancer; if you just want to be happy, then you need to exercise.

In my next blog, we will discuss exercise and what needs to be included in an exercise program to make you as happy as can be.