truncal lymphedema?
Had a SND July 2009. Apparently these nodes were deep and hard to get to. Since June of this year, have had subtle swelling under armpit and along chest. Not miserable pain, but an on and off dull ache. I had a mastectomy and have no feeling along the scar, nor is it swelling. Did 6 rounds of FEC and 8 months of Herceptin before it had to be stopped. I'm currently on Tamoxifen - could this be causing the ache? I feel no lumps, bumps either along my clavicle, neck or underarm, just this on again off again pressure and fullness under the armpit, along chest and up the side of my neck....any ideas?
Thanks!
Comments
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Brain blip. The SND was April 30...July was when the fun began with chemo....
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WhatR- for most of us with lymphedema, "fullness" is the common presenting symptom. If there are lumps or bumps, they can be other issues, or the symptoms of a longer term untreated lymphedema. About the best thing to do is to get a consultation with a LANA certified LE therapist who can sit with you, see what you see, describe what she sees, do some measurements, and possibly do a very light massage technique to "move" fluids to a different lymph gland area in order to lighten the fullness. For most of us, our doctors were the least helpful, and the OT/PT trained people have been the most helpful - they simply have more training. LANA is the primary certifier, and if you can find someone nearby with this certification, you'll be a long ways down the road in getting good help. Keep asking your questions, we're here to help.
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Here are some links:
http://www.stepup-speakout.org/breast_chest_trunckal_lymphedema.htm
And how to find a qualified therapist:
http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm
As KC wrote, aching and fullness are common symptoms of truncal lymphedema.
Let us know how you make out.
(You do need a doctor's referral for a lymphedema therapist--most are PT's)
Kira
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thanks for the replies - they mean a lot...I am miles away from a large center. My oncologist is 4 hours away and will be seeing him on December 10th. The last time that I went (3 mo ago) I had to ask him to at least look at my incision - after driving 4 hours and waiting 3, as he was late in his schedule, I figured that at least he could look at (what's left) of my chest :>)...he wouldn't have otherwise
Thanks again
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Can you arrange for the onc to send over a rx for an "assess and treat" to a LE therapist who may be near your doctor's office? Or were you able to find a therapist closer? They may be willing to send over a rx before your Dec 10 appt, so you can get things rolling.
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can lymphedema present a year and a half after lumpectomy and rads? My left breast is tender and swollen, I am being treated for infected seroma with antibiotics. I have been on them for a week and there is a little improvement. That breast has been asperated twice and that brought relief instantly. Karen
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Karen,
Yes, you can get LE at any time after surgery. I have a seroma and was trying to that healed.
I just had cellulitis which put me in the hospital for 3 days, YUK!
I just went through MLD (manual lymph drainage) now I am wonder if I need find a different doctor.
BC, the gift that keeps on giving. NJ
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I was afraid that was the answer, I have an appt. with my BS tomorrow. I will ask him about the possibility that it is lymphadema. I already found a PT that does MLD. She is about an hour away from my home. Is it a series of visits or does she teach you how to do it? Thanks Norma June. Karen
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I went on line to the sites that you were so nice to find :>) and the nearest LE therapist is 10 hours away...I will definitely see what options are open to me when I see the onc next month - hopefully he will have a look (without prompting) and have some ideas...as long as I don't do too much the "pouch" in the axilla goes down and the pressure along my clavicle and shoulder subsides...it's really weird as I can work and forget about it and then oops, its back...if it was something other than lymph edema I would expect constant and worsening pain, lump or signs of reoccurrence...all that I'm experiencing is an on again off again pressure and burning under my "pit" and along my clavicle radiating to the base of my neck- it's gone in the morning and back during the day...
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Has anyone tried acupuncture for opening the lymph channels for truncal LE? My LE therapist is switching up her treatment plan for me, eliminating the compression bras during the day, slight compression at night with MLD and wants to add acupuncture. Just curious.. if Kira or Binney reads this, I'd love to know your thoughts on the subject.
Probably the thing I find most helpful after the MLD is exercise and deep breathing.
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There is a theoretical concern about using needles in the at risk quadrant--at one point Jane found an abstract from the NLN that said it's probably safe.
One of the lectures, again I think it was by Andrea Cheville MD of Mayo--or someone else as prominent--that person is a trained accupuncturist, and did not find accupuncture helpful for LE.
I've found accupuncture to be very operator dependent. The lecturer also said, that in Chinese medicine, you can avoid the at risk quadrant, and put the needles in the energy channels at another place.
Deep breathing is key! As is exercise--moves the lymphatic pump.
Is your LE therapist going to do the accupuncture? Is it covered? It's a bit unconventional.
I'm going to ask Binney to give her opinion.
I bumped a thread for you--the general concensus seemed to be it helped--it's never been that helpful for me, but I never tried it for LE.
Kira
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Betsy, we're all so different, so it's hard to know what will work for who. In the Orient acupuncture has long been a sort of standard treatment for edema of any sort. There are two studies that I know of that are presently going on in the U.S. to determine how effective and safe it is (or isn't.) But at present there's no evidence either way.
I met a Chinese doctor, now in the States, who believes acupuncture can help relieve the swelling in LE and she's started one of those two studies. She doesn't think U.S.-trained acupuncturists are "safe," because she finds their training lacking and their practice lax, but I have no way of judging the validity of that belief. She was adamant that when done properly, and with the proper sterile precautions, it would not cause infection in a LE limb, but she was also quick to point out that no needles need ever be placed in the area with LE in order to treat it adequately. I'm very interested to see what the current studies show, but they won't be published for a while yet.
I think what might concern me more, personally, would be the suggestion of eliminating daytime chest compression. Maybe you'd want to try that for only an hour or two at a time and see what happens, extending the time gradually if you see it having no effect on the swelling. There are many factors that can influence swelling, from the weather to activity types and levels, so while you're experimenting with the reduction of compression use, you'd want to keep a close eye on whatever triggers most influence your own swelling, and perhaps be more conservative about using compression during those times when swelling is most likely. We all love the idea of freedom from compression, but getting things back into control if they flare is no fun either, so slow and easy, and one experiment at a time, would be the way to go. JMHO
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Be well!
Binney -
Hi, WhatR:
I am sorry you are dealing with truncal LE - I have it on my right side but it's generally manageable and totally non-problematic (unlike my arm) as long as I do my MLD, drink lots of water, and use my flexi-touch machine.
Are you doing any MLD? This is a big help to me and when I don't do it, I really swell under my arm and on my side.
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Thanks,Suzybelle .No one has shown me how to do MLD - will ask when I see onc. What is a flexi-touch machine? Can one be ordered on line?
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whatRstatsanyway,
MLD=Manual lymph drainage--most oncologists will not know how to teach it, it's usually taught, and it takes a few sessions, by a lymphedema therapist.
There are on-line videos from JoAnn Rovig, but they don't really address the trunk--more extremities, but they're a start
http://www.nwlymphedemacenter.org/
A flexi-touuch is a very expensive pump that requires an hour a day of wearing special garments, and doing MLD to clear the area, and it pumps the fluid. Insurance has to pay for it.
Recently, while searching, I came across the Cigna benefit, and thought of one of the members here who is fighting to get it covered: the benefit lists studies that say it works, and then says they won't pay for it...
Here's a link to flexi touch:
http://www.tactilesystems.com/flexitouch/index.html
It's a steep learning curve, isn't it? But you'll get there--it just sounds like your area is geographically tough for finding therapists and you'll need some extra help.
Kira
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Binney,
I am back to wearing compression bras during the day. It only lasted three days before it was just too uncomfortable for me. I wish I would have read your post before I went cold turkey. Maybe easing into it might have worked better. Oh well...I still think I'm going to try the acupuncturist. My LE therapist gave me two names, one Chinese and the other a N.D., MSOM, LAc., R.D. She told me absolutely do NOT go to anyone my friends recommend. Both practitioners have experience with LE. Her perspective is it will help my stress levels besides opening the channels. Stress happens to be one of my triggers.
WhatRstatsanyway - Before I went to my LE therapist I spoke with my surgeon, who gave me the recommendation. I was also being seen for radiation induced fibrosis. I watched the video clip Kira posted but the technique is different for everyone. I do not have LE in my arm only my chest. I would highly recommend going to a LE therapist, even if it's a 10 hour drive. It's well worth it. If you have someone that can come with you, that would even be better. They give you a lot of information to digest and sometimes having two sets of ears is better. If that doesn't work, bring a tape recorder so you can listen to what was said later. Good luck to you and know that you are not alone in this.
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Thanks Kira and Buzz for your help. I am in an isolated area and physiotherapists are few and far between, let alone anyone who is specialized in LE. I'll check into what is available at the oncology center - hopefully they have something that I can use/do closer to home - the sites that you directed me to were great and I really appreciate your taking the time to reply. I'm still trying to figure out the balance between doing too much activity and getting things done - not easy for a stubborn, independent mule, such as myself, to accept physical limitations:o). It's like I'm afraid of letting BC interfere with living - even after 18 months, I'm not swallowing the "new normal" very well...sigh
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Well I went for my first acupuncture today. My dr. worked on my back only, as I have radiation induced fibrosis too. I see him again on Monday. He said maybe he would start dealing with my chest then, which happens to be swollen again. He said my back channels needed to be opened first. I'm keeping my fingers crossed this will help. Meanwhile, I continue to wear compression bras during the day time and work out at the gym, do my MLD, and my deep breathing exercises.
I am desperate for relief from the TLE.
Betsy
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