improvement after active treatment?
Ladies, I'm hoping you can help me figure out how to approach my lymphedema... I need to get back in to see my LE therapist but I think it is going to be a week or two.
I developed LE at the end of chemotherapy, I guess it is stage 0 or 1. I had 3 sentinal nodes removed, not a complete dissection. I was dx'd with cancer during my pregnancy and started taxol 3 weeks after my baby was born. I'm pretty sure my lymphedema started because I hurt my arm lifting my baby. The first two times I swelled were both at night after I had gone to mommy and me yoga and lifted her up above my head (why was I doing this while on chemo, I don't know!)
SO, I got manual lymphatic drainage weekly during my 33 days of radiation. I wore my sleeve every single second of the day, up until recently, 4 weeks after my last radiation.
Lately my arm has been feeling great. No swelling. My radiation oncologist's resident measured my affected arm (which is also my dominant hand) as 1cm larger than my other arm both above and below my elbow (he only did two measurements).
I'm thinking I am going to keep on with not wearing my sleeve unless I'm exercising. Does this seem like a bad idea? How do I know if my issues are getting better? I know I'll have to continue to take precautions for the rest of my life, and I don't mind wearing a sleeve if I need it.
Comments
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Lisa, there are times when our lymphatic system is more stressed--like right after surgery, while on chemo, during rads--and right after pregancy, there is a general relaxation of connective tissues--seriously, your body creates something called relaxin, to help the pelvis stretch for delivery--so you kind of hit the trifecta of risks, and then lifted your little girl up and triggered the swelling.
http://en.wikipedia.org/wiki/Relaxin :
In animals, relaxin widens the pubic bone and facilitates labor; it also softens the cervix (cervical ripening), and relaxes the uterine musculature. Thus, for a long time, relaxin was looked at as a pregnancy hormone. However, its significance may reach much further. Relaxin affects collagen metabolism, inhibiting collagen synthesis and enhancing its breakdown by increasing matrix metalloproteinases.[6] It also enhances angiogenesis and is a potent renal vasodilator.
[edit]Now you're stable, and there's no need to over treat.
One of the researchers we work with, Mei Fu PhD from NYU, feels like compression if used when not needed, can cause the lymphatics to become "lazy", and my LE therapist is always worried about compression trapping fluid.
So, I would vote that you should only wear compression when needed, and I'm so glad things got better, and you were so proactive about treating it early.
(There was a study done on post op women, and if their arms swelled a bit, they were put in compression, and most came to a point where they no longer needed it. It's not clear if the early use of compression prevented progression, or they were at a vulnerable point, but whatever the mechanism, it worked. Study done by Nicole Stout about three years ago.)
Here's the abstract:
http://onlinelibrary.wiley.com/doi/10.1002/cncr.23494/abstractThe incidence of breast cancer (BC)-related lymphedema (LE) ranges from 7% to 47%. Successful management of LE relies on early diagnosis using sensitive measurement techniques. In the current study, the authors demonstrated the effectiveness of a surveillance program that included preoperative limb volume measurement and interval postoperative follow-up to detect and treat subclinical LE.
METHODSLE was identified in 43 of 196 women who participated in a prospective BC morbidity trial. Limb volume was measured preoperatively and at 3-month intervals after surgery. If an increase >3% in upper limb (UL) volume developed compared with the preoperative volume, then a diagnosis of LE was made, and a compression garment intervention was prescribed for 4 weeks. Upon reduction of LE, garment wear was continued only during strenuous activity, with symptoms of heaviness, or with visible swelling. Women returned to the 3-month interval surveillance pathway. Statistical analysis was a repeated-measures analysis of variance by time and limb (P ≤ .001) comparing the LE cohort with an age-matched control group.
RESULTSThe time to onset of LE averaged 6.9 months postoperatively. The mean (±standard deviation) affected limb volume increase was 83 mL (±119 mL; 6.5% ± 9.9%) at LE onset (P = .005) compared with baseline. After the intervention, a statistically significant mean 48 mL (±103 mL; 4.1% ± 8.8%) volume decrease was realized (P < .0001). The mean duration of the intervention was 4.4 weeks (±2.9 weeks). Volume reduction was maintained at an average follow-up of 4.8 months (±4.1 months) after the intervention.
CONCLUSIONSA short trial of compression garments effectively treated subclinical LE. Cancer 2008. Published 2008 by the American Cancer Society.
Kira
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Lisa, how great that things have settled down for you!
YES!!
I'm with Kira on this, and only want to add that you can learn to self-monitor (measure) and come up with a way to keep track of it. (Somebody here has a spreadsheed their husband worked out for them to track measurements and offered to share it. Natsfan, I think. My therapist does this for me so I don't self-track). That way you're not worrying about it all the time or relying on guesswork, and you can act quickly if you run into a problem.
Then again, maybe "mommy and me" water aerobics instead of yoga?
Hugs to you both!
Binney -
Anyone who wants a copy of my dh's spreadsheet, please PM me with your email address and I'll be glad to send it. You put in the measurements of your unaffected arm as a base measurement. Then you put in your affected arm measurements each week or however often you measure. The spreadsheet will not only measure the actual and percentage difference between your unaffected arm and your affected arm, it also tallies the difference in your affected arm since the last measurement. That way you can see the difference in your arms, but also see the difference in the affected arm from week to week.
My dh is an Excel wizard (and a wonderful guy as well) and he developed this sheet so I could track my measurements.
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thanks!!
The Excel spreadsheet sounds great, I will send a PM.
Does anyone have a way to track truncal swelling? I think my arm is doing really well but I feel like I'm getting some swelling under my arm when I do certain activities (like bike riding). I'm still only a month out from radiation. I guess I could just measure around my trunk!
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Lisa, measuring truncal swelling doesn't actually work because...well, because we breathe.
(Which is why when my fitter measures me for truncal garments I take a deep breath and hold it, so the garment doesn't get made too tight.) You might be able to judge swelling by the fit of your bra or cami, or any long-lasting indentations in your skin when you remove your bra/cami. It helps to check yourself in the mirror daily, arms down and arms raised, so you get used to how it looks and comparisons become easier. Comparing the affected side to the other side is also helpful.
The whole thing is irritating, yes?
Hugs,
Binney -
My first clue that I need a truncal LE evaluation by a therapist was that I noticed some puff over the top of my panties late in the day that is not visible in the morning. These are not tight panties, but they do land right about where my diep incision is, and where I suspect there's some serious interruption of the lymphatic flow. Will have my evaluation next week and won't be surprised to have my suspicion confirmed. So--any bulges that peek out from undergarments, and especially if they like to play hide-and-seek? I think that would be a good clue to investigate.
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