Cellulitis

Tamiami

I'm posting here because from my research, it seems that cellulitis sometimes goes along with LE.  The search feature is not working today, so I can't locate the info I need. 

My story is this:  BMX with TE's on 1/4/13.  Sentinal nodes (0/3) removed on left side only.  4 weeks post-op started showing signs of truncal LE on my left side.  PS referred me to LE PT...3  week waiting list everywhere.  This morning was my evaluation.  She suspects arm and truncal LE and I will begin therapy Wednesday.  But suddenly today between 9am and 11am, my RIGHT breast became bright red, hot, and hard.  PT was concerned about it being cellulitis and sent me right to the PS office.  PS is concerned too, and took a fluid sample from the breast...that she said looks cloudy...and is sending it out for a culture.  That could take 10 days, in the meantime she started me on Bactrim and wants me to rest all week.  No excercise, no PT, just short of bed rest!  She will see me again on Friday, but wants a daily email about how I'm feeling and if it gets any worse to come right in.  I just called because now I am achy and have a low fever, she said to take Tylenol for the fever and call back if it goes over 101. 

So now I've been reading on breastcancer.org as much as I can about cellulitis, and it seems like it is always on the side that the lymph nodes were removed.  Mine is on the opposite side.  Has anyone els had that?  Actually any info on cellulitis (good or bad) would be appreciated! 

Tami

carol57

Tami, have you seen this page from the stepup-speakout website? 

http://stepup-speakout.org/Emergencies_and_Medical_Care_lymphedema.htm

It's true that when we lose lymph nodes, that quadrant of the body becomes more susceptible to LE.  But keep in mind that not only does the axilla have nodes (that we often lose to sentinel node biopsy or axillary node dissection), the breast itself has a few nodes.  So, you lost nodes on your non-SNB side, too.  

And, I believe that cellulitis can occur for reasons that have nothing to do with node loss, although the lymphatic impairment that results from node removal makes it easier for injuries that introduce bacteria to lead to infection.  Where nodes have been removed, our protein-rich lymph moves slowly, sometimes is pretty stagnant, and thus becomes a sort of petri dish when bacteria find their way in.  With your bmx and TE surgery, you had a lot of drama going on in your breast tissue, no doubt causing inflammation even without considering any node loss.  

Your breast symptoms do sound like cellulitis and it's very good that your PS is working with you on it.  It's nothing to fool around with, because if the oral antibiotics don't do the trick, the only recourse is IV antibiotics administered for several days in the hospital.  So if you think you're not getting better, call your PS again and again if needed. 

Keep us posted!

Binney4

Tami, really sorry for this new development! But you've gotten prompt help and have a concerned PS keeping close watch on you, so whew!

Here's information on cellulitis:
http://www.stepup-speakout.org/Emergencies_and_Medical_Care_lymphedema.htm

Cellulitis is a skin infection that can occur without any nodes removed, and in fact it needn't be connected with breast cancer at all. It does have a complicated relationship with lymphedema, though. First off, a cellulitis infection can trigger lymphedema if the lymph system is already compromised. And secondly, lymphedema (whether diagnosed or still undiagnosed) results in stagnant lymph fluid in the tissues. It's protein rich and warm, which makes it a perfect bacteria breeding ground. So any skin break (even micro-breaks from dry skin) that allows bacteria to enter can result in cellulitis. Sometimes cellulitis happens with no known break, though--it's a sneaky bugger!

Lymphedema can occur with any breast surgery, nodes or not, though node removal raises the statistical risk. Even women without cancer who have breast augmentation or reduction surgery can develop lymphedema. And it can be present initially with no swelling. So, while I have not had cellulitis on my prophylactic side, I do have lymphedema on that side as well as the cancer side. And lymphedema can predispose us to cellulitis. Or cellulitis can trigger lymphedema. Or (and hopefully this will be your case!) cellulitis can just happen and have nothing whatever to do with lymphedema.

Hope that helps some. Rest and no therapy for now sounds like a good plan. Be sure to stay really well hydrated, and remembering to take a few deep abdominal breaths every so often will help too (it stimulates the largest lymph vessel in our bodies). Elevate your LE arm with pillows, rest up, stay in touch with the doctor, and GET WELL SOON!

Keep us posted! Gentle hugs,
Binney

carol57

Tami, you must feel like you're seeing a re-run, because Binney and I were apparently typing some of the same information at the same time.  Of course, she's the expert and I see that she gave you some wonderful suggestions I did not think of!  Good luck and don't be tempted to skip the rest part of the doctor's orders!

Tamiami

Carol and Binney~ I appreciate you both responding!  I will check out the links as well.  I was one of the unlucky few to have my drains in a long time.  Left one came out at 4 weeks post-op and the right one just came out on Friday, so that drain site may have been the opening that the infection needed!  I did a course of Bactrim at 3 weeks post-op for a high fever, but there was no redness then...I'm hoping this isn't chronic.