October is both National Breast Cancer awareness and Physical Therapy month. According to www.cancer.org, one in eight women will develop breast cancer over the course of their lifetime. A person with breast cancer may cross roads with physical therapy during their journey of treatment and recovery.Surgical intervention and/or radiation therapy can help treat breast cancer; however, other complications may arise as a result of these treatments. A person may experience limited range of motion of the involved shoulder, pain, scar tissue restriction, weakness, and lymphedema (swelling of the chest, arm, and/or hand).Lymphedema can occur months or years after treatment and the onset is not predictable. Forty two percent of women with breast cancer will develop some form of lymphedema one year post operatively. Fifty to 75 percent will develop some form of lymphedema five years later.Lymphedema is an accumulation of lymphatic fluid in between the tissues that causes swelling. This usually occurs most often in the arm(s) and/or leg(s), and occasionally in other parts of the body. Lymphedema occurs when the subnormal lymphatic system cannot keep up with the lymphatic fluid of the body.Women with breast cancer develop lymphedema when the lymph vessels are damaged or lymph nodes are removed. This is known as secondary lymphedema. It can develop as a result of surgery, radiation, infection, or trauma.There is extensive evidence that people who have lymph node resection with radiation therapy have a higher risk of developing lymphedema than those who have lymph node resection alone.

Symptoms of lymphedema may begin with soft and/or pitting edema (swelling) and may be alleviated by elevating the arm. Other symptoms may include heaviness or tightness of the affected arm, decreased mobility, and feeling that clothing on the arm is tight.If lymphedema is not treated, edema can become fibrotic or hard, less pitting, and may persist despite arm positioning. When people with breast cancer present with new onset of swelling and pain, they should undergo a thorough physical evaluation and diagnostic testing to rule out other common causes such as a deep vein thrombosis (DVT) or tumor recurrence.There is no cure for lymphedema, but it can be treated and people can live normal lives. Lymphedema therapy is known as complex decongestive therapy (CDT). This therapy consists of skin care, manual lymph drainage (MLD), compression bandages, and exercise. Low/short-stretch bandages are used until the lymphedema is stabilized. At this point, a custom fit or over the counter compression garment is applied to maintain the arm swelling.Patient compliance is crucial for successful treatment. Patients should also know how to avoid lymphedema triggers, such as infections (bug bites or scratches), burns, injuries, warm environmental conditions (including hot tubs and saunas), massage, and altered atmospheric pressures that occur during airplane flights. Patients should also avoid blood draws, IV’s, injections, and blood pressure cuffs on the affected arm.Prevention and early detection is the key for successful breast cancer and lymphedema treatment. According to the American Cancer Society, every woman age 40 and over should have a routine mammogram annually.

Maybe October should be your month to have a routine mammogram because it is breast cancer awareness month and it can save lives.For those people that have lymphedema, CDT is available through CMH Regional Health System Rehabilitation Services. CMH physical therapist, Donna Snyder is the only certified lymphedema therapist in Clinton County. Call 937-383-7722 for more information.EDITOR’S NOTE: Donna Snyder is a physical therapist with CMH Regional Health System Rehabilitation Services who has recently become a certified lymphedema therapist. Healthy Outlook, a periodic offering of CMH, includes information from several resources including the writer’s professional experience.