Physically demanding job

colleen1609

I was diagnosed 3 weeks ago with IDC BC on the left side. I am now in the process of deciding on a lumpectomy plus radiation or a full mastectomy on the left side. I am terrified of getting lyphedema. I am a massage therapist at a hospital so my job can be pretty physically demanding, utilizing a lot of upper body and arm strength, especially with deep tissue massages. I know that having a SNB and radiation will increase my chance of getting lymphedema but can a job like mine also be a factor? It's not like I can wear a compression sleeve while I give massages.

kira66715

Colleen, there's no real solid way of predicting who will get LE (lymphedema)--clearly if you have a full axillary dissection and radiation you're at higher risk than "just" a SNB, but plenty of us--me included--got it after a SNB.

When they do a mastectomy the inframmary nodes are removed, and some surgeons will take the full "tail of Spence" which tends to have many axillary nodes. 

So, I'm not sure that lumpectomy plus rads puts you at lower risk than mastectomy, but rads does definitely increase the risk--the lower axillary nodes get some radiation in whole breast radiation.

Here's a link to preventing LE:

http://www.stepup-speakout.org/riskreduction_for_lymphedema.htm

Exercise is good, but the timing is important--don't do a lot during the immediate post op period and during rads, and slow and steady are the keys. Here's a link to the National Lymphedema Network Position Papers

http://www.lymphnet.org/lymphedemaFAQs/positionPapers.htm

I work in rad onc and worry about my patients who are waitresses or work in jobs that require lifting, and so far, none have had problems. Some women will get all their nodes out and radiation and never develop LE, and others will with just one node out. 

Just to be a devil's advocate: why couldn't you do your job with a sleeve? A glove might be an issue, but not a sleeve.

Many of the women on these boards work at demanding jobs and wear daytime compression as needed.

Perhaps you might want to see one of your colleagues who is trained in LE to get a pre-op evaluation, measurements and education--it's currently the recommendation of standard care by the National Lymphedema Network

http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm

Colleen, this is a really difficult time, just being diagnosed and having to make hard decisions, and dealing the emotions of the diagnosis. Remember that the odds are ALWAYS in your favor that you will never get lymphedema.

Good luck with all of this, and being pro-active and getting information is very wise.

I have tons more links, but don't want to overwhelm you.

Kira

Binney4

Colleen, welcome! I'm sorry about all the concerns that bring you here, but glad you found us.

Kira's covered the ground, so I won't add any more, but just wanted to note that the strength you already have in your arms will be a help with risk reduction as you gradually resume your work post-treatment.

Wishing you smooth sailing and no "swell" days ever!

Be well,
Binney

colleen1609

Kira, thanks for all the info. I will definitely be proactive about prevention. It's helpful to get the info from people who have already been down this road. To answer your question about not being able to wear a sleeve, a massage therapist uses their whole arms to do massage. Just relying on your hands is not practical. We would all have carpal tunnel syndrome or tendonitis or a host of other things if we just used our hands and wouldn't last past a couple of years in the profession. I use my arms all the way past my elbows and half way up my upper arm.

kira66715

Colleen, have you noticed professional athletes wearing compression sleeves? Many basketball players do. They don't limit mobility, and heaven forbid, you needed one to contain swelling, I doubt a compression sleeve would impact your ability to do your job.

A glove is another issue: I work with patients and have to wash my hands all day, and don't wear a glove a work, although my swelling is in my hand--but--due to wrapping at night, my hand doesn't swell at work. I do avoid putting on vinyl/latex gloves whenever possible, but do it if indicated.

Hopefully these are all sepculations, and you'll never need to deal with lymphedema.

A great lymphedema PT: Jodi Winicour PT of Klose Training, really feels that women with axillary surgery should not lift their arms above should height for 10 days post op, to allow delicate lymph vessels to re-connect. 

Forget "reach for recovery"--your range of motion won't be impacted by 10 days of limited motion, and you'll avoid axillary seromas.

Wish I'd met Jodi before I got LE: I stretched like crazy, got a huge axillary seroma, axillary webs and then LE--heard Jodi at the National Lymphedema Network Conference, and she described women like me, and again, just wish I'd had her to advise me then.

We put a page for health care providers on the site, and this info is on it: there are links on the page--

http://www.stepup-speakout.org/essential%20informat%20for%20healthcare%20providers.htm

Peri-operative and Post-operative Management:

--Handle the tissues gently during surgery: Janice Cormier, M.D., NLN lecture 2010, Physicians' Intensive

Lecture slide: Critical Surgical Technique 1) Gentle handling of tissues, 2) Orientation of incisions (extremities) and 3) Hemostatic control at time of surgery

--Treat seromas promptly: from San Antonio Breast Conference 2010, "Seroma usually leads to prolonged wound healing, tissue inflammation and subsequent fibrosis and necrosis. It has been hypothesized that seroma formation is one of the main risk factors for post-breast cancer lymphedema." Seroma Formation Is Associated with Lymphedema-Related Symptoms.
http://www.abstracts2view.com/sabcs10/view.php?nu=SABCS10L_478

---Consider limiting stretch on the axillary area for 10-14 days post-operatively, as lymphatics have limited time to regenerate: NLN Conference Lecture, 2010, Jodi Winicour PT

From Foldi Textbook of Lymphology: Lymphatic regeneration occurs as the stumps of the afferent or efferent collectors of a removed node connect as the result of proliferation of the endothelium at the terminal portion of the damaged vessel. Regeneration of superficial vessels in dogs takes 4 days, and deep vessels in 8 days.

Have your patients limit their arm movement to shoulder height for the first 10-14 days post-op-to allow the efferent and afferent vessels to connect during the limited time of lymphatic regeneration.

Systematic review of early vs. delayed exercise has shown delayed exercise decreases seroma formation: http://www.ncbi.nlm.nih.gov/pubmed/15830140

A study in 2008, published in Physiotherapy, showed higher risk of development of lymphedema in women who had axillary node dissection and performed early vs. delayed exercise: http://www.lymphoedemaleeds.co.uk/Pages/Research.aspx

Kira (who saw my amazing LE LMT today, I see her twice a month for MLD and refresher advice and support--she is very pleased with how things are going, which I attribute to her care and support.)

cp418

I had lump, chemo, rads at breast site and under arm with 18 nodes removed in 2006.  Post lump surgery I had some issues with cording under my arm and did lots of stretching exercises in the shower. I own a farm and do physical outdoor work lifting feed bags, etc. For my activity level it has had no effect on my arm movement which is excellent and so far no signs of any lymphodema.  I think exercise and movement is to your benefit - - kind of like if you do not use it you may loose it.