Jennifer Marie J. Yang, MD

My weekend trip to Singapore came with an unpleasant – though not entirely unexpected – souvenir: lymphedema. Lymphedema (as defined by the CDC) is swelling due to build-up of lymph in the body. This Cleveland Clinic webpage has a good definition of lymph: it is a collection of the extra fluid that drains from cells and tissues (that is not reabsorbed into the capillaries) plus other substances. In persons with breast cancer, this often occurs after the surgeon takes out lymph nodes that are “connected” to the breast; these nodes contain lymph fluid coming from the breast area. Breast cancer often spreads to the lymph nodes in the armpit (axillary lymph nodes; axilla = armpit), so a surgeon would remove nodes during surgery as a biopsy – the nodes are sent to the pathologist so that they can determine whether cancer has spread to the lymph nodes.

Back to lymphedema: I noticed my left upper limb was swollen, and worst in the left hand. The swelling made it more difficult to make a fist – while I *could* make a fist and did not lose significant range of motion in the wrist, palm and fingers, I could feel the tightness in my fingers when they were in full flexion (i.e., making a fist). Apparently this happens in people who have armpit (axillary) lymph nodes surgically removed, like during breast cancer surgery. It never really bothered me before, other than last week when I had to get extra links attached to my metal watch strap for more “wiggle room” on my wrist.

Self-massage helped. Elevating the left upper limb also helped – I slept with my left arm on top of a pillow. Finally I got a proper, professional massage which jumpstarted the lymph drainage, and five days after my trip the left upper limb was close to normal again. The massage also helped the tightness and loss of range of motion from cording. I had some swelling around my thumb, but that was due to arthritis or tendinitis instead of lymphedema. I attributed that to too much texting!

Anyway, this website has good information on travel and lymphedema. Most strikingly, this is what they say about travel:

“Triggers of Lymphoedema when Travelling

When travelling, it is important to know what may exacerbate existing symptoms or trigger the onset of lymphoedema.

These include:

• Physical inactivity when flying which may reduce lymphatic flow and cause swelling
• Low cabin pressure – this can change the pressure inside the tissues
• Travel related factors e.g. carrying heavy luggage, change in normal exercise routines
• Heavy shoulder bags/suitcases – bag straps can cause a tourniquet and impede lymphatic circulation, whilst heavy bags can increase muscle stress
• Dehydration

Although there is no conclusive evidence to show that air travel or long trips cause lymphoedema, anecdotally, many people have experienced an increase in their swelling.”

Physical inactivity – being seated for a long time on the plane!

Low cabin pressure – can’t do anything about that, it’s a necessary thing for the plane ride.

Travel related factors – suitcase was a little heavy, but I often pulled or carried it using my right (unaffected) side. Change in normal exercise routines – guilty! I did not do my arm exercises while on the trip. Too tired everyday, especially on Saturday in which I took 32,000+ steps and walked a bit over 23 kilometers.

Dehydration – yep. Agree, I wasn’t drinking enough on this trip. Plus it was very humid in Singapore.

What does this mean for me now? My exercise program consists of more arm exercises aside from general conditioning. Must take care not to over-tire myself, and drink enough water to prevent dehydration.

And there you have it. I forgot to take a photo of my swollen left hand, so photos from my Singapore trip will have to do.

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