Hike Your Way Back To Health After Cancer Treatment

April 3, 2012 - PRLog -- While not all women who undergo treatment for cancer (breast or other) will develop arm  lymphedema , for those who do treatment and maintenance can be difficult since medical literature on the subject only goes back 30 years or so. .

What exactly is lymphedema?

“Edema” is the medical term for swelling while “lymph” refers to interstitial water, proteins and organic detritus that bathe the cells in our body. The lymphatic system is the other circulatory system in the body whose function includes the absorption and elimination of excess fluids and it assists in the absorption of fat. Another very important function is that it is critical to our body's ability to fight infections and is critical in the immune system functions. When this system is not formed correctly, is damaged through injury or infection, or is removed (nodes), then lymphedema is a very real possibility.

In the case of upper arm edema, most often it is the compromising of axillary, neck and chest wall lymphnodes through biopsy and/or radiation therapy that leads to swelling of the upper limbs. It is then referred to as secondary or acquired  lymphedema –caused by injury.  It ranges from mild to severe, with 3 different stages  of severity.

Is exercise recommended in the treatment of arm lymphedema?

No.
And…Yes!

Up until the late 80’s, lymphedema was vastly dismissed as a “you-just-gotta-deal-with-it” condition. It is only over the course of the past 30 years that studies –most of them inconclusive when it came to forming a definitive opinion - have been conducted on the topics of lymphedema, and exercise . If there is a consensus amongst the medical community, it would be that every individual’s physiological reaction and adaptation to exercise are different; however, the lack of hard rules does not mean exercise is an absolute no-no. Understanding what the lymphatic system does and how exercise impacts it is the foundation upon which a safe and beneficial exercise routine can be built on.

When lymphnodes are diseased, scarred or removed the delicate balance between lymph load (amount of fluid that needs to be processed by nodes) and transport capacity is upset, which causes limb swelling. And as if that were not enough, increased levels of interstitial fluid and proteins negatively impact the body’s natural ability to fight off infections. As a consequence it is advised to take extra precautions in order to protect the affected limb from scratches, bites, cuts, excessive heat and sunburn.

So, how exactly does exercise affect a lymphedematous arm?

During exercise, heart rate and core temperature elevate while blood rushes to the muscles in order to sustain the demand for oxygen. Muscles –now gorged with blood, interstitial fluid and debris- upset the organic balance, thereby causing the lymphatic system to work harder in order to filter out detritus and fluid and decrease internal and superficial temperature. While this would not be a problem in a healthy individual, an already compromised limb will not be able to keep up with the process and more swelling will ensue.

And therein lies the problem, as lymphedema is a incurable, progressive condition  that is adversely affected by situations such as the one described in the above paragraph. However, exercise and the tremendous benefits it yields (weight control, decreased blood lipids, decreased resting heart rate, increased bone mass and muscular density) should not be overlooked simply because of a lymphedematous arm.

Hiking and the lymphedematous upper limb: challenges, compromises and solutions.

For the Outdoors enthusiast, managing one’s lymphedema presents a unique set of
challenges which need to be addressed in order to minimize worsening of the condition while hiking.

Thankfully there are some basic steps that can be taken to help alleviate short-term discomfort and prevent long-term damage to the diseased limb. And it all starts with the cardinal rule of lymphedema management, which applies to everyday life situations as well as on-the-trail ones.

The cardinal rule of lymphedema management.

Listen to your body. Listen to your body. And did I mention, listen to your body?
There may not be another condition for which the saying “Better be safe than sorry” applies more directly so yes, you guessed it, listen to your body, especially when dealing with heavy backpacks, hot weather, the possibility of insect bites and sunburns. Let’s examine each of these challenges one by one and try to define a workable protocol and make your next hike as enjoyable as possible while managing upper arm lymphedema.

•   Carrying a backpack

When considering a physical activity such as hiking, one must keep in mind the added hurdle of carrying a backpack. Let’s begin our journey into lymphedema management by reminding us of how the body evacuates lymph back into the central circulatory system.

Lymph nodes abound throughout the body. Arm lymphedema will occur when the axillary nodes are disrupted, scarred or removed, thus causing adjacent node pathways to work overtime. As it made obvious by the picture at left, one major pathway is located at the junction of the arm and the chest. No matter how light or heavy, backpack straps do compromise that area and make lymph return even more of a challenge for the body.
One very simple preventative step is to pack smartly (ergo, lightly).

Also, make sure to invest in an internal frame backpack that is designed for the female anatomy and use the different straps and belts to provide as much support as possible to the load and keep it from weighing to heavily on the shoulders.  

And, of course, wear a medical compression garment.

Compression garments and bandages act as a new "tight" skin for the muscles to contract against, assisting in pumping the lymph out of the extremity into the central circulation .  And while hiking without a compression garment/bandage does not necessarily mean there will be an aggravation of the condition, wearing it while on the trail offers a peace of mind that should not be underrated.  Always consult with a medical professional to determine the level of compression as well as the type of garment best suited to your particular case of lymphedema.

Note: if all else fails and your condition drastically worsens during a hike, cease all activity and elevate the limb for 10 to 15 minutes and take deep breaths to positively impact lymphatic drainage; indeed,  exaggerated ribcage expansion gently massages the axillary and thoracic node networks, which are most likely to be affected by surgical and radiation treatment and chemotherapy.

•   Hot Weather

It is important to try and stay as cool as possible while hiking in hot weather. Avoid tight-fitting clothes and drink plenty of cool fluids to help keep  body temperature down and prevent  worsening of your condition.

•   Insect Bites & Sunburns

A limb affected by lymphedema does not take well to wounds of any kind as whatever is left of lymphatic system is already working overtime. Therefore, avoiding ulterior strain should be a number one priority. Use natural insect repellant and sunscreen to protect your arm and if a wound does happen, tend to it immediately by disinfecting and bandaging it. Sunburns should also be considered as a serious threat to the health of a lymphedematous limb and need to be avoided at all cost .

In Conclusion.

Remember that lymphedema is irreversible and that it is just as easy –if not easier- to worsen the condition as it is to keep it under control. Thoroughly evaluate the benefits of being outdoors versus that of staying indoors and exercise caution if/when you do decide to go walk on the wild side.


About the author:

Adelaide McMillan is an avid hiker and a cancer survivor and has been living with lymphedema for the past 30 years.

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