National Breast Cancer Awareness Month comes each October and though there continue to be many people diagnosed with cancer, there are also a whole lot of survivors, 3.8 million to be exact. Sometimes the very treatments that are lifesaving leave a long lasting impact, such as lymphedema.
Lymphedema is a challenging problem and can negatively impact many aspects of a person’s physical capabilities and quality of life. Conventional and naturopathic approaches used together can offer relief even for those who have had lymphedema for a very long time. Whether this is a new condition for you, or you have been diagnosed previously, the following article offers solutions that you may not have considered.
Please consult with a naturopathic doctor before trying any of these remedies. If you are in need of a naturopathic physician, please see our Find and ND directory. For more information on naturopathic oncologists, please check out our partners from Oncology Association of Naturopathic Physicians (OncANP), a professional association of naturopathic physicians who offer supportive healthcare for people who have been diagnosed with cancer.
What is Lymphedema?
There are numerous kinds of cancers and respective treatments that can potentially lead to lymphedema. The actual tumor, trauma to the area from surgery, radiation or infection can all lead to a lymphedema diagnosis. The most common complaint from patients with lymphedema is fullness and swelling due to the increased volume of fluid. Skin changes include itching, a tendency for infections, a sense of heaviness of the limb, changes in strength and range of motion, along with varying degrees of discomfort and pain.
Breast cancer treatments are the most familiar cause of upper extremity lymphedema. Risk factors for lymphedema include axillary (armpit region) or sentinel lymph node dissection (location can vary) and/or radiation to the breast or armpit area. Additional contributors include having more than eight cancer-positive nodes, being overweight, or having larger breasts.
Lower limb lymphedema can also happen often after gynecological or prostate cancer treatments. Head and neck cancers can also lead to lymphedema in the jaw, neck, and chest areas. Also, internal lymphedema is possible. There are other conditions that can cause some of these same symptoms, thus accurate and early diagnosis is always best. If you suspect you are having symptoms and are not under medical supervision and were not assessed for risk factors before any cancer or surgical treatment, please get help right away.
Risk of Infections is Higher
When swelling occurs, the area contains higher concentrations of protein in the fluid buildup. The high protein environment creates a welcome space for bacteria to multiply and a higher-risk environment for bacterial skin infection (cellulitis) and inflammation of the lymphatic channels (lymphangitis). As such, infection can be both a cause and a result of lymphedema. It is important to keep your nails short and filed and address any breaks in the skin right away to reduce the risk of infection. Likewise, being sure your skin does not become too dried out from stretching due to swelling is paramount. I recommend coconut oil or other low-chemical moisturizers. It’s also important to work on creating a robust and diverse microbiome to reduce the risk of infection. Taking probiotics and eating cultured and fermented foods can help.
State of the Art Treatment of Lymphedema
Wherever the lymphedema takes place, the care approaches are similar, though they should be tailored to the person and the presenting symptoms. The main treatment for lymphedema is non-invasive, complete decongestive therapy (CDT), which consists of manual lymphatic drainage, compression therapy, a daily exercise program, along with skin and nail care. Some lymphedema specialists use Kinesio Taping to decrease fluid volume as well. Surgery may be performed for those who do not respond well enough to CDT, though CDT approaches should be continued before and after surgical procedures.
Compression garments limit the build-up of lymphatic fluid and encourage fluid to move to areas where there is better drainage by helping local muscles pump the fluid away. These recommendations can be beneficial, though not everyone says they are beneficial. In addition, they take significant time to put on because they are so tight and they can be expensive. Because of this, many people want a fresh perspective and new ideas about how to augment treatment. The following may be just what you’ve been looking for.
Naturopathic and Integrative Medicine Adjunctive Treatment of Lymphedema
As natural and integrative medicine approaches are studied, there are a number of treatment options that should be considered: Exercise and yoga shows are helpful for lymphedema because they help with overall blood and lymph flow. But before you decide to go all out, your exercise and yoga routines may need to be modified based on lymphedema symptoms. Ask your doctor or physical therapist for advice. One kind of exercise, resistance training, previously thought to possibly worsen lymphedema, has in fact been shown to help build muscle, which in turn helps pump excessive fluid away without creating further risk of developing or worsening lymphedema. Obesity is another risk factor for developing lymphedema and can complicate treatment. It can be difficult to take up an exercise routine and change your diet when you don’t feel well because of lymphedema. Consult with your physician about how to get the support you need to safely lose excess weight.
- Botanical medicine, optimal nutrition, and nutritional supplements each have a role to play. The herbs Astragalus (Astragalus membranaceus) and Peony (Paeoniae rubra), when administered orally, have been put to the test in clinical trials and have shown positive results. Consult with a medical professional, please do not self prescribe.
- An anti-inflammatory diet is important because it helps to reduce overall inflammation in the body. One should also monitor salt intake, as excessive sodium may add to swelling.
- Ensuring you are replete with folate and B vitamins makes good sense, as being deficient in these will lead to further capillary fragility and more swelling. Bioflavonoids like quercetin and hesperidin may prove useful as they help stabilize capillary membranes. Selenium has also been shown to reduce the risk of developing lymphedema. Another supplement, pycnogenol, derived from French maritime pine bark, has helped people with chronic venous insufficiency (CVI). While these diagnoses are different, lymphedema and CVI share certain features, especially in the lower extremities. It is possible to have a combination of CVI and lymphedema, called phlebolymphedema. Taking the supplement pycnogenol may well reduce the sensation of heaviness and the fluid volume. And, as always, consult with your doctor about these supplements.
- Acupuncture is another approach to consider; research confirms it helps with swelling and improves quality of life related to lymphedema. Of note, when getting acupuncture for lymphedema, no needles should be placed in the affected side. And, when you receive blood draws, finger pricks, and blood pressure measurements, make sure they are taken on the non or less-affected side. Likewise, ensure properly fitted undergarments, no restrictive clothing or jewelry in the area of swelling.
- Low Level Laser Therapy (LLT) may be a good option. This therapy is defined as “…. low intensity light therapy. The effect is photochemical, not thermal.” The light works by triggering biochemical changes within cells, similar to the process of photosynthesis in plants. The treatment has shown good results. Consult your doctor on which device to purchase for home use and which local health professionals offer treatments.
- Localized hyperthermia, the application of heat to a specific area of swelling and fluid accumulation can be effective with few side effects. This is a therapy that requires special equipment so ask a licensed naturopathic doctor about this type of treatment.
- Sauna use is contraindicated for those with lymphedema. While a sauna may sound relaxing and have other beneficial attributes, it can aggravate lymphedema, so please avoid sauna treatments.
- Aquatherapy, basically exercises or a gentle aerobics class in a pool, can reduce swelling and improve range of motion for some people with lymphedema even many years after the difficulties begin.
- Hydrotherapy or balneotherapy is another beneficial approach. Hydrotherapy is when water, hot, warm, cold and/or ice, is applied to the lymphedema site by a trained naturopathic physician. Hydrotherapy has been around since the beginning of time and has many uses for health conditions. An example is alternating hot and cold hand or “baths” or soaking tubs to encourage circulation to, and most especially away from, the areas in question. Naturopathic doctors have extensive training in hydrotherapy and can help design a tailored hydrotherapy program as part of a plan to treat cancer-related lymphedema. Learn more about hydrotherapy in this video.
In conclusion, lymphedema should never be ignored. Lymphedema, when left unchecked can cause permanent fibrosis, which is a hardening of the affected tissue. The natural medicine approaches listed above aim to keep tissues oxygenated and reduce fluid build up that can lead to further complications.
This article is excerpted from Dr. Rothenberg’s upcoming book, You Finished Treatment, Now What? Natural Medicine Approaches for Cancer Survivors/Thrivers. Amy Rothenberg ND, DHANP is a contributor to INM and practicing licensed naturopathic doctor in Northampton, Massachusetts. Dr. Rothenberg is the American Association of Naturopathic Physicians 2017 Physician of the Year. Dr. Rothenberg’s writing can be found on NaturalMed.org, Better Nutrition’s Naturopathic Health Hub, Medium, Thrive Global, andThe Huff Post. She is the proud mother of 3 adult children.