Joachim Zuther, Lymphedema Specialist.
Certain activities may trigger the onset of lymphedema or may exacerbate the symptoms of existing lymphedema. Individuals affected by primary or secondary lymphedema and those at risk for developing it (everyone who has undergone lymph node excision and/or radiation treatments) should observe the following precautions. The “Dos” and “Don’ts” below are based on decades of experience and knowledge of clinical experts in the field of lymphedema management.
- Keep your skin meticulously clean and check frequently for any cracks, infections or rashes
- Moisturize your skin daily, especially after taking a shower or bath
- Use appropriate ointments or lotions
- Dry your skin thoroughly with a soft towel following a shower or bath; do not scrub
- If you undergo radiation therapy, apply the ointments recommended by your physician to any radiation redness on your skin and avoid direct exposure to sunlight
- Avoid cosmetics that irritate the skin
Clothing – Jewelry – Compression Sleeve – Prosthesis
- Avoid clothing that is too tight, for example bras and sleeves that
restrict; you should use a comfortable bra with wide and padded shoulder straps - Do not wear tight jewelry and avoid elastic bands around your wrist
- Wear your compression sleeve all day, and if necessary apply your bandages at night. Use rubber gloves when you put on your compression sleeve. See your therapist at least every six months (or sooner) to check the condition of the garment
- Discuss with your doctor and/or therapist, what kind of external breast prosthesis is appropriate in your case (heavier silicone or lighter foam)
Avoid any Injuries to the Skin
- Shaving: use an electric razor to remove hair from your armpit or
chest; do not use razor blades - Nail care: you should keep your fingernails cut short; avoid the use of scissors for cutting your fingernails; do not cut the cuticles. Avoid artificial nails
- Should you smoke, do not extinguish the cigarette with your affected hand
- Wear gloves when gardening and playing with your pets (scratches)
- Mosquito bites: wear insect repellants, avoid mosquito infested areas
- Injections and blood draws: blood draws and injections on the non-affected limb whenever possible. In patients with breast cancer on both sides, these procedures should be performed on the leg or the foot. If this is not possible, the procedure should be done on the non-dominant arm. If one side had no lymph node removal, the arm on that side should be used, regardless of whether it is the dominant arm. In an emergency, however (such as a car accident), or if a medically necessary procedure (such as a CT or MRI) needs to be performed, and an intravenous line must be started, medical professionals must be allowed to do what they need to do to start the intravenous line as soon as possible, even if it would involve the affected extremity.If a port is present, blood draws should be taken directly from there. In patients with “bad” veins, good hydration and some form of heat (heat pads, warm water) help to dilate the veins prior to cannulation.
- Avoid blood pressure to be taken on the affected arm or the arm at
risk. Have the clinician use the other arm, or if both arms are affected, an oversize pressure cuff may be used on the thigh or calf to measure the blood pressure. If you can’t avoid the blood pressure to be taken on the arm, make sure that the cuff is inflated only 10mm/Hg above the systolic pressure (this is the point at which the pulse stops) and that only manual equipment is used – automated equipment inflates generally to a very high pressure, which is held for a prolonged period - To take care of minor injuries, always carry an alcohol swab, topical antibiotic and a band aid with you
- No piercing or tattoos on the arm, back or chest
Avoid Heat
- Avoid hot showers
- Avoid hot packs and/or ice packs on your arm, back and chest
- Avoid saunas, hot tubs and whirlpools. Do not sit too close to a fire place
- Avoid traditional massage on the arm, chest and upper back area. Note: Manual lymph drainage is not considered to be a form of massage
- Avoid sunburn – while in the sun, use sunscreen, cover the arm with appropriate clothing or a dry towel
- Discuss proper exercises and activities with your therapist
- Avoid movements that overstrain. Should you experience discomfort in your arm, reduce the exercise activity and elevate your arm
- Avoid heavy lifting
- Obesity may have a negative effect on your swelling; maintain your ideal body weight
- There is no special diet for lymphedema. Keep your diet well balanced. Most nutritionists recommend a low-salt and low-fat diet, high in fiber
- Eating too little protein in the hope to have a positive effect on lymphedema (high-protein edema) is not recommended and may cause serious health problems. Reducing the protein intake will not reduce the protein component in lymphedema
- Avoid mosquito-infested regions
- Wear an additional bandage on top of your compression sleeve when traveling by car, train or air. Incorporate frequent stops, or get up from your seat frequently, elevate your arm(s) as often as possible
See your doctor if you:
- Have any signs of an infection, such as fever, chills, red and hot skin
- Notice any itching, rash, fungal infections, or any other unusual changes on the skin
- Experience pain, or an increase in swelling in your fingers, hand, arm or chest
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Thank you for the reminders of the do’s and don’ts , I remind my clients all the time and even give them written copies of the do’s and don’ts they really appreciate that I take the time with them and I am concerned about their Health. Thank you for the information you give, it helps alot.
Cheryl Atkinson, LMT, CLT, CNA
Sun Coast Massage Therapy
I have had Lymphedema in my right arm for 20 years. Only ever had one infection that put me in the hospital for four days. I am doing fine. Lets fine something that will cure this situation.
thanks for the reminder. I will be getting ready to travel for the holidays, and it is always good to have my garments updated and ready for use.
Any tips for breast lymphoedema??
Thank you for putting this in print again as a reminder to all of our patients; helping them realize we are not being alarmist as therapist, just trying to help.
Thank you for complete list. My surgeon gave me this info 20 years ago, but years later I forgot & had an attack of cellulitis & terrible swelling of the hand & arm. Thanks to my physical therapist who used manual lymph drainage & bands, I am now okay. The travel precautions and exposure to heat I did not know. This all helps so much. Thank you!
No mention was made about how much weight can be lifted with the affected arm. My dr. wants me to go to the YMCA for exercise and could not tell me just how much weight I could lift on the machines. It has been 5 years since my surgery for breast cancer and removal of 12 lymph nodes in the arm. I would appreciate a comment please.
Dear Joan – here is a link to an article that covers this issue https://www.lymphedemablog.com/2010/12/27/resistive-exercises-for-lymphedema/
Since lymphedema, when left without treatment, can cause a wide range of additional problems – some quite dangerous – it is necessary for people to seek treatment.So you should be aware of the solutions.Read More
The do and don’t that is given in this blog is really effective and helpful for lymphedema patient and I want to tell my friend about this blog how is facing lymphedema problem.
Source:calf compression sleeve
Has any research been done regarding the cause or onset of early lymphedema from Lovenox (blood thinner) or other required injections in the abdomen? My wife had many abdominal lymph nodes removed during surgery and did not have any swelling or signs of lymphedema until starting Lovenox injections in the abdomen. The abdomen was the only place left after using up the arm and legs. These injections are daily and leave lumps or bruises as well.
Dear Keith: I am not aware of any research on that subject
I had no idea that artificial nails would pose a problem. I have lymphedema in my wrist on the side l had lymph nodes removed. It just came from nowhere! I was fine, then one night I awoke to excruciating pain in my wrist. I can barely move it! It actually feels broken. I am currently seeing an occupational therapist for lymphedema.The pain is still here! Some days it is not as SEVERE. I do get artificial nails. I’m wondering if that has ANYTHING to do with it!!
Good info. I will pass this along to my medical team including my physical therapists. I have also read we aren’t supposed to lift heavy things or take diuretics.
I’m a breast cancer survivor since 10/2005 2 months later I found out I have lymphedema in my left arm. Its been about 4 to 5 years since I had physical therapy for my lymphedema. I was able to keep it under control with no problem. November/2013 I was involved in a car accident. A rollover accident we landed upside down once we stopped rolling. The seatbelt left my left breast bruised & aching. After a ultrasound they found scar tissue was causing the discomfort & now I’m back at physical therapy. Is it possible this accident exacerbated my problems I’m having now with my lymphedema? I was doing great with no problems til this accident. I’m so worried Thank you for your help
This is certainly a possibility. any injury and/or trauma can exacerbate existing symptoms in lymphedema. Here is a link to an article that may be of interest to you: https://www.lymphedemablog.com/2013/10/15/dos-and-donts-for-lymphedema-of-the-arm/
Thank U so much for your reply & information.
Dear Angela.
I too have primary lymph edema that showed up when I was 20. I exercise a lot too but need a lot of compression and it gets very swollen. Where is the site of your blockage?
Thanks rosemary
All at one time i got shingles;lymph edema set in plus i had a dislocated disc in my neck.I felt like i was dieing.I’m now dealing with the lymph edema which is a result of 34 lym. nodes being took out.Is this something that will affect me for the rest of my life or is it due to the radation??
I have primary lymphedema in both arms due to the swelling of lymph nodes from sarcoidosis. Compression garments cut off circulation at the wrists and upper arms. I have been measured many times but can’t get a proper fit. Any suggestions?
You should be measured by a therapist who was trained and certified in lymphedema management. Please click on the “Find a Therapist” tab on the menu bar on tp of this page in order to locate a therapist in your area.
I was diagnosed with breast cancer in March 2014. I had two lumpectomies on left, 4 nodes left side, and 1 node right side during bilateral masectomy. I had the exchange to implants, have nipple surgery scheduled, and was looking forward to finishing with nipple tattoos. After reading this article, I am concerned with the tattoos. Why would doctors recommend this if it puts us at risk for lymphedema?
I have not had any symptoms and can’t imagine the implications should I be diagnosed (I am a dance teacher). Have any studies correlated the onset of lymphedema with nipple tattoos? Thank you.
Dear Tina: Tattoos in this area bear do not cause lymphedema
Thank you. Good to hear!! I really want to look as I did before diagnosis…or as close as I can get.
I recently read about dry brushing the skin to aid the lymphatic system. Is this something you would recommend?
^Regarding Keith’s comment about Lovenox, I was hospitalized for 8 days and getting twice daily blood thinner injections in the abdomen. I started having abdominal lymphedema shortly after I was discharged. I thought there was a correlation, but obviously there is no way to prove it. At the time I didn’t know it was lymphedema, so after multiple tests and 3 different doctors with 3 different answers, I finally figured out what it was. I still have a hard time convincing the doctors it is lymphedema.
I am fortunate to have a couple of amazing therapists that help me keep my lymphedema under control. I don’t know what I would do without them.
It is frustrating to see that we should not use ice/heat & to avoid regular masssge. In addition to lymphedema in my arm from a mastectomy… I also have arthritis & severe back/neck pain issues.
I am affected in both hands and arms and I need to receive a shingles injection. Is there another area in which this injection can be administered? No one has been able to answer this question. The offices I have called only give the injection in the arm. I am very afraid of taking it in my arm even though it is only in the epidermis. Thank you!
It should be possible to receive the vaccine in the epidermis of another body part.
I would never recommend using an electric shaver to shave the hair in the armpit area. I tried that and the shaver chewed up my skin far worse than a razor would’ve. I now use a lotion-based chemical hair remover which works really well.
This site is very informative. I am recooporating from double mastectomy, 7 lymph nodes removed. The does and don’ts are helpful, however I do have a specific question. Was going to start guitar lessons will this create a problem. I think I know the answer I feel I need someone to explain it to me. Thank you for your help.
It should not cause a problem, especially if you will be wearing your compression sleeve.
I am recooperatig come a double mastectomy, must be careful I don’t get lymphema. I have a specific question. I would like to start guitar lessons will this cause problems. I would appreciate a reply. Thank you. This site is very informative.
I am 5 years post double mastectomy and reconstruction. My LE is mild and very stable in my right arm. It started about 8 months post surgery. I would really love to have 3D nipple tattoos. What do you think?
Joan, if your doctor agrees, you should go for it
As a therapist I must admit there are a couple of things missing on this list that I feel are so important to add.
NO CRUTCHES,
I had a client w/ stage 1 and she was managing it well. She saw me weekly for massage, low back & lower extremities and MLD treatment for the effected arm and corresponding quadrants (this gave her a break in her self care regimen)
Long story short she CX’d one week and saw me the following week w/ full blown Stage 2! Come to find out she had sprained her ankle and her physician put her on crutches!!!!
NO GROCERY BAGS
piled up on the effected arm
I have seen my clients and many of us are guilty of wanting to carry ALL our groceries in one trip from the car.
NO PURSES
I have a few clients w/ handbags that weigh more than a small child!! LOL
Just my 2 cents on the subject.
Thanks & love your work, share your posts often!!
Thank you for these important additions, Kriztine!
I was diagnosed with breast cancer March this year.I had lumpectomy in my left and 1node,I’m on my chemoterphy this time,but I have notice that my both upper arm are become bigger,I had ask my onco about this and he said its normal but I’m conscious because it looks like have muscle and abnormal fats.
Thank you,
Dear Loisa: You definitely need to be aware of the risks of developing lymphedema. The swelling you have at this time may recede. However, if it does not, you should consult with a lymphedema therapist. You can click the link labeled “Find a Therapist” on top of this page to locate a therapist in your area
I have lymphedema in my left arm. I can’t wear my wedding ring because sometimes my hand and fingers swell. I want to get a tattoo on my wedding finger. Will this be safe to do?
Dear Daniele: It is not advisable to get a tattoo on a lymphedematous finger. This procedure has the potential of worsening the swelling
I’m a LMT who works with patients with cancer history. I’m certified in MLD (Vodder) and am getting full lymphedema cert in March. I have read that progressive strength training can be effective in reducing onset of lymphedema…
What are your thoughts on this?
Virginia – here is a link to an article providing answers to your inquiry: https://www.lymphedemablog.com/2015/11/12/why-exercises-should-be-part-of-your-lymphedema-treatment-regimen/
Thanks for the reminders. I always pass along your distributed notes on Lymphedema to others I know with Lymphedema. I can always count on you to provide excellent information.
In this article, under the travel section, you listed something I had not seen written before. When you suggested wearing an additional bandage on top of the compression garment for travel, I would like a clarification. By additional bandage do you means the long elastic wrap bandage or something like a Velcro closure night garment? Would you mind being specific in this question please? Many thanks!
A regular short-stretch 10-12cm wide bandage is sufficient. Due to the lower atmospheric pressure additional compression may prevent swelling.
Thank you
When doing MLD, how much pressure should be applied?
If I only have lymphedema in one arm should I only apply the techniques to the affected arm?
I have extreme difficulty applying compression bandages due to the size of my upper arm. Any suggestions? I do not have a sleeve since I cannot manage the bandages.
Thank God for your site.
The pressure is very light since the lymphatic vessels are located very superficially beneath the skin.
I have had lymphedema in R forearm and hand for more than 30 years, post-breast-CA surgery. It has remained stable with exception of slight worsening due to a burn about 20 years ago. I used to get an infection in the arm every year or two, but this hasn’t happened for many years. I take issue with your recommendation for a compression garment. A hand gauntlet must be worn separately, and at least in my case, the arm sleeve pushed fluid into the hand, making it worse, not better. Also, the hygiene implications of wearing a glove on the dominant hand are staggering, and it is totally unfeasible to be removing the hand glove every time a potentially unsanitary activity is engaged in — which is basically constantly, unless you never touch anything.
Hello, I am a new CLT and also a PTA. Can LMD be helpful with Shingles or Lyme Disease? Thank you so much
Dear is no evidence to support the effectiveness of MLD in these cases
I understand avoiding hot tubs but can a person with lymphedema “float”- here’s the description from their website: Floating is a unique experience in a specialized Float Pod filled with a 1000 pounds of Epsom salt and 150 gallons of water. The buoyancy created by the salt content allows the body to float weightlessly on top of the water.
Forgot to mention they try to keep the temp about skin temp and the max is 95.