What to Know Before Traveling With Lymphedema

A common side effect of breast cancer treatments is a condition called lymphedema, in which lymph fluid builds up and creates an uncomfortable swelling. This happens because lymph nodes have been removed to check for cancer or because they were cancerous, and after the surgery is complete, the body loses some of its ability to move lymph fluid through the area. Chemotherapy and radiation therapies can also damage lymph nodes, which are an important part of the body's immune system.

Dr. Roman Skoracki, division chief for oncologic reconstructive surgery at the Ohio State University Wexner Medical Center, explains that the body uses lymph fluid to monitor for infections. Lymph fluid, which results from cellular processes, "moves from the extremities to the core in unidirectional flow," he says. The muscles of the body act as sort of pumps to help move the fluid along until it hits a cluster of lymph nodes. "This is the whole point of the system," Skoracki says. "The fluid gets filtered and examined in the lymph nodes. It's the immune system's way of surveying the entire body constantly."

[See: 7 Innovations in Cancer Therapy.]

These clusters of nodes are scattered throughout the body, with most people having anywhere from 20 to 40 nodes in the axilla area -- the armpit -- and that's the source of the problem for most cases of breast cancer-related lymphedema.

For many breast cancer patients, some lymph nodes in this region may be removed as part of their treatment, and this can create a stopping point for that fluid as it tries to clear the body. "The fluid continues to get produced and collected and moves up the extremities. But then it hits a dead-end" when it reaches the axilla area, Skoracki says. "That's where it starts to swell like a traffic jam, where the cars pile up," and fluid can back up down the arm.

Most people have enough redundancy in the system that the fluid can find another way to get around the blockage, but according to The Memorial Sloan Kettering Cancer Center, about 15 to 25 percent of patients who've undergone an axillary lymph node dissection will develop lymphedema. The National Cancer Institute reports patients who've had sentinel node biopsies have a 5 to 17 percent risk of developing lymphedema.

This development can create real problems for these patients, as lymphedema can negatively impact daily life. Cases of breast cancer-related lymphedema typically occur in the arm on the same side where the cancer was, and in severe cases of lymphedema, limb functionality may be reduced. The swelling and heaviness of the limb that are the hallmark symptoms can progress to a point where the limb becomes less usable. But long before that, even formerly simple activities like flying to another city can become problematic.

Although there's currently no cure for lymphedema, there are several ways to manage it, and if you're getting ready for a trip -- particularly one that involves air travel -- you'll want to make sure you're on top of your lymphedema management routine. One of the most common ways of controlling the condition is the use of compression garments. Typically shaped like a tight sleeve and worn along the arm where the lymphedema has developed, these garments squeeze the tissues in the affected limb and prevent fluid from building up.

Dr. Richard Klein, section chief for plastic and reconstructive surgery at Orlando Health Aesthetic and Reconstructive Surgery Institute, says that when traveling, "the most important thing is anyone who's had lymph nodes removed ... if they fly, they wear a sleeve even if they don't have a [lymphedema] diagnosis." That's because the conditions inside the standard commercial airliner can cause swelling. "In an airplane, the air is pressurized to the equivalent of about 8,000 feet. The altitude can trigger an episode in someone with lymphedema and exacerbate the condition."

[See: Breast Pain? Stop Worrying About Cancer.]

According to an airline travel guide prepared by the National Lymphedema Network, this happens because "changes in fluid production in the tissues occur when the external pressures exerted on the limb are changed. Diminished pressure in the airplane cabin will result in a decrease in the fluid moved in to the lymphatic system. The fluid will remain in the extracellular spaces and an exacerbation of lymphedema may result."

To help prevent this, Klein says, "the most important thing is applying pressure to the limb." And lymphedema patients should visit with their lymphedema therapist before and after a flight to remove as much fluid from the limb as possible. "Lymphedema care is not only the garment. Doing manual lymphatic drainage and getting the fluid out is also important. The garment isn't going to get the fluid out, but it's going to prevent it from coming back," he says.

In addition to wearing your compression sleeve, Klein recommends that anyone who's had lymph nodes removed watch their salt intake prior to a flight, as salt can cause the body to retain more fluid than it normally does, which can lead to a worsening of the lymphedema.

And depending on where you're headed, you may need to be mindful of the limb and how it's responding to local conditions. If you're traveling to Denver, for example, where the elevation is more than a mile up, wear your sleeve and stay vigilant for changes in the limb. Similarly, if you're headed somewhere hot and humid, you may experience more swelling than if you go to Alaska.

Because hot, humid conditions can cause blood vessels to dilate and move more fluid into the affected limb, keeping cool is important for lymphedema patients. In a blog post for the NLN, lymphedema therapist DeCourcy Squire offers tips for staying cool. "Drink lots of water, even more than you do in the winter, to help keep yourself well hydrated. This makes it easier for your body to regulate its temperature. Even if salty foods don't normally affect your swelling, they may be more likely to in the summer. For crunchy snacks, go for fresh raw vegetables instead of potato chips." And when it comes to clothing, selecting loose or free-flowing garments can help keep you cooler.

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And if you're headed somewhere to enjoy the great outdoors, be sure to remember your insect repellent and sunblock. Insect bites and sunburn can both increase swelling from lymphedema, as the immune system attempts to clear the damage to the skin.

The bottom line, says Kate Howell, a doctor of physical therapy and certified lymphedema therapist with Peltz and Associates Physical Therapy in Santa Rosa, California, is that lymphedema patients must "constantly pay attention. You always want to be acting prophylactically. Once you have it, it's got to be on your radar and you can't ignore it. Lymphedema is a marathon with no end. You need to figure out how you can manage it," and following your doctor or lymphedema therapist's recommendations can help you keep traveling and doing all the other things you want to do.

Elaine K. Howley is a freelance Health reporter at U.S. News. An award-winning writer specializing in health, fitness, sports and history, her work has appeared in numerous print and online publications, including AARP.org, espnW, SWIMMER magazine and Atlas Obscura. She's also a world-record holding marathon swimmer with a passion for animals and beer. Contact her via her website: elainekhowley.com.