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Medical Forum / Diseases and Disorders / Breast Cancer / December 2003

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Lymphedema Concern

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bartalo@webtv.net - 14 Dec 2003 23:13 GMT
Does anyone know if everyone who has lympnodes removed is destined to
get Lymphedema?  My bc surgeon says the puffy feeling in my right arm is
from the surgery and not Lymphedema.  He also said I may have it feel
that way for the rest of my life which confuses me.  He has never told
me to take precautions concerning Lymphedema and I only bought the
bracelet to protect myself after hearing from a concerned email friend
and reading your posts.  

If I continue to protect my right arm, will that assure me I am safe
from getting Lymphedema?  I apologize for having so many questions but
my doctor does not seem to want to talk about it and just tells me "I am
fine and do not have Lymphedema".  I think he takes it as a personal
insult that I would think I could get it.  Thanks!

Bea
Tim Jackson - 15 Dec 2003 00:27 GMT
> Does anyone know if everyone who has lympnodes removed is destined to
> get Lymphedema?  My bc surgeon says the puffy feeling in my right arm is
[quoted text clipped - 11 lines]
>
> Bea

No and no.

I think about 30% get lymphedema sooner or later.

It is likely that taking measures to protect your arm will reduce the risk
somewhat, but I don't think anyone really knows how effective any of the
recommended measures are.  Some are probably quite useless.  I don't think
even meticulous care will eliminate the risk completely.

Your doctor or surgeon may believe that there is little benefit in trying to
avoid it, that it will come anyway if it is going to so it is not worth
worrying about.  He may well be right, but some would disagree.

Tim Jackson
Balsey - 15 Dec 2003 05:23 GMT
I never had lymphedema until 2/2 years after my operation and i looked after
my arm, so no I feel you are never safe from it take care balsey

> Does anyone know if everyone who has lympnodes removed is destined to
> get Lymphedema?  My bc surgeon says the puffy feeling in my right arm is
[quoted text clipped - 11 lines]
>
> Bea
Marianne - 15 Dec 2003 13:42 GMT
Hi Bea,

My surgery is nearly one year ago, and I still have a puffy feeling under my
arm. I think it is because nerves were damaged, because there is no
swelling, although it "feels" swollen.  So don't worry too much about
lymphedema.

Marianne

> Does anyone know if everyone who has lympnodes removed is destined to
> get Lymphedema?  My bc surgeon says the puffy feeling in my right arm is
[quoted text clipped - 11 lines]
>
> Bea
Kaye301 - 15 Dec 2003 16:38 GMT
Marianne wrote: << I think it is because nerves were damaged, because there is
no
swelling, although it "feels" swollen.  So don't worry too much about
lymphedema.

Marianne, it is good that what you have is not  lymphedema, but lymphedema is a
reality and can be a big problem which is both frustrating and serious.   I
know of several with lymphedema--including my mom.  Mine isn't 'that' bad
(compared to some pictures I've seen) but it has the potential of becoming that
way if treatment is NOT done routinely.  In addition I still have a problem
with wearing some clothes.  I HATE it.  It has affected the quality of my life
so much more than the loss of my breasts have.  I don't know whether or not I
was getting it after surgery, but my elbow hurt after surgery for quite awhile.
I was sent to an occupation therapist and then the physical therapist who
eventually said I had the beginnings of lymphedema.
A. P. Thorsen - 15 Dec 2003 17:09 GMT
> Does anyone know if everyone who has lympnodes removed is destined to
> get Lymphedema?

> If I continue to protect my right arm, will that assure me I am safe
> from getting Lymphedema?

Like Tim said, "no", and "no".

I was worried about lymphedema (only 9 nodes removed, but I did have
extensive radiation on that side), so read as much as I could on the
subject.  IIRC, the only things that (in largely retrospective studies)
have shown correlation with lymphedema are (1) trauma to the arm, or (2)
weight gain after surgery.  (Those of us taking Tamoxifen have reason to
feel grumpy about the latter!)

As far as I can tell, the "lymphedema precautions" lists have been
created based on anecdotal evidence coming largely from lymphedema
specialists . . . i.e., they see the people who *get* lymphedema, not
those who did all the same things and *didn't* get lymphedema.

So far (3 years out), I don't have lymphedema.  I've had numerous cuts,
bruises, blisters, etc., on the affected arm.  I routinely work out
using weights of > 20 pounds.  So far, I've been lucky.

Ann T.
Remove 'dontsendspam' from address to reply by email
DebITRC - 15 Dec 2003 17:25 GMT
One reason your MD was not helpful about Lymphedema possibilities, is that it
may reflect somewhat on the surgeon.

I know my surgeon was proud to say in an advance meeting that his hospital's
rate of lymphedema was significantly lower than the standard.

Also, I am five years out, and only recently does my arm feel nearly normal.  I
had strange sensations and the feeling of an orange in my armpit for years.

Deb
darla - 15 Dec 2003 23:04 GMT
I'm three weeks out from a lumpectomy with several nodes removed.  I
had a lot of swelling under my arm immediately post op, but the
swelling has drained by itself. My arm/armpit was feeling much better
until a few days ago and now I'm experiencing severe discomfort down
the surgical side of my body and around and under the breast, the
involved breast is very, very tender and somewhat swollen. The
incision under my arm is a little red but not warm to the touch. I'm a
little confused about exactly what is lymphedema? I see the surgeon
that did my lumpectomy tomorrow for port insertion, are there any
questions I should be asking him?
Darla

> > Does anyone know if everyone who has lympnodes removed is destined to
> > get Lymphedema?
[quoted text clipped - 22 lines]
> Ann T.
> Remove 'dontsendspam' from address to reply by email
Tim Jackson - 16 Dec 2003 09:37 GMT
> I'm three weeks out from a lumpectomy with several nodes removed.  I
> had a lot of swelling under my arm immediately post op, but the
[quoted text clipped - 7 lines]
> questions I should be asking him?
> Darla

Lymphedema in this context is a swelling of the whole arm and hand on the
affected side only, it isn't confined to the area of surgery where it is
normal to have some inflammation, swelling and perhaps collection of fluid.

Think of lymphedema as the main drain getting blocked by scar tissue (or
cancer) and the lymph backing up in the arm causing pressure.

You can usually tell if it is happening by comparing the circumferences of
your two wrists or forearms, eg by using a piece of string to measure.

Tim Jackson
Kaye301 - 16 Dec 2003 05:03 GMT
Ann wrote <<  the only things that (in largely retrospective studies)
have shown correlation with lymphedema are (1) trauma to the arm, or (2)
weight gain after surgery.  (Those of us taking Tamoxifen have reason to
feel grumpy about the latter!)

I had 12 nodes removed and 9 were positive.  I took all the precautions and
have not had any trauma to that arm.  However, I still got lymphedema.  I have
worn both regular sleeves and now wear custom sleeves, one during the day and
one at night, and the lymphedema is slowly worsening.
Residual cancer cells may 'cause' and/or worsen lymphedema  as well.   Of
course I hope that is not what is going on, but at this point have no  idea.
Cathy Emerson - 16 Dec 2003 16:42 GMT
Here's my lymphedema story. I developed mild lymphedema 4 mos post mast.
I went through PT, wrapping and sleeve fitting.  This was not something
I could do on a daily basis as I work and have a life. The sleeves are
miserable. So I would just wear it occasionally at night if the swelling
increased due to overworking the arm or flying.  That served me quite
well for 3 yrs until I started Taxotere last spring which causes fluid
retention.  I couldn't get my sleeve on because of fingernail damage and
no one to help me. The my arm got so big that I outgrew it.  My arm got
huge. I had a bad experience  with the PT and prosthetic people and
didn't want to go back.  So I just let it go.  It went down some what
after end of Taxotere but then parts of it fibrosed-hardened. I now have
limited flexibility in my wrist and poor dexterity in my hand. This is
permanant. I also had to get rid of 1/2 my clothes because they don't
fit my big arm.  I don't mean to scare you because I did well with it
till the darn Taxotere.  
Cathy
bell-lady - 19 Dec 2003 04:28 GMT
Cathy, I'm sorry you had such trouble. It IS a problem getting it on by
yourself, its touch to pull, hard on the opposite shoulder and you do break
alot of nails. I  trimmed my nails, and kept tugging til shoulder got
stronger, I worked real hard, takes alot of patience and getting up early,
but that's what I did. I also worked full time, volunteere dhours a week at
church, and run a home computer business, have 2 kids 3 grandkids and a big
house with a cat to care for. all that's what kept me fighting at it til it
got easier.

I encourage you to keep trying, as Cathy implies, the bandaging and sleeves
ARE worth it; if you stop it can indeed get worse or even permanent. You
don't want permanent fibrosis, weaked or useless joints. If PT says bandage
and sleeve, and teaches you self massage the DO it. (that part is REAL
important to keep swelling down, do it whenever you aren't out in public,
and don't have a sleeve on...TV time, sit around time..falling asleep time
etc).

Bandaging keeps the swelling down and I found it best at night. Sleeve keep
the masage going during the day, enhancing the movement of your skin, and to
some extent helping keep the swelling down. Thats my opinion, YMMV.

I found it frustrating as it did consume time and I'm always late and in a
hurry, and it was difficult to type (my business), but I did it. Now its
relatively under control, at least no permanent damage, on only occasionally
need bandaging. I still always massage, almost a habit. I'm now 3 yrs from
lumpectomy w/9 clear nodes, chemo & radiation. Breast is still swollen and
tender, more lumpy than usual (they call it peau d'orange - skin of an
orange, cause that's the kind of surface the breast has where they did the
last 6 days of electron radiation). I am alive thru the docs and grace of
God. The rest is just tiny bumps in the road.

One other poster said about how docs might take lymphedema in their patients
personally. My surgeon had a REAL ego problem. When I showed up at my first
after-surgery visit, I said I had lymphedema and showed him he said "It
can't be, I didn't do anything that could have caused that; I didn't even
get NEAR the area that would cause that!" Needless to say, I didn't go back
to him for anything else, and turned others from him for breast surgery.

But alls well that ends well. Merry Christmas, focus on the good things, and
manage the bad as best you can. I REALLY love my grandson I probably
wouldn't have seen without this trip thru the hospital etc.

Ann in PA
 
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