Advice/info/ help needed
Good Morning,
First, a quick background - dx'd 6/2007, uni mast w/immediate recon with te's, SNB, 5 nodes removed, no surgical complications. This past week, the hand on my mast side felt like the skin is bruised. It feels very tender and when I rub it (lightly) it feels like it is tight while being stretched. Sunday morning it was swollen (just like LindaLou's picture!). It is still swollen this morning.
Advice/comments anyone?
Thanks,
Trish
Comments
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Trish, I think the best thing would be to be evaluated by a qualified lymphedema therapist--I have LE in my hand, and when it came on, the hand was sore.
The only things you do not want to miss are--1)cellulitis=skin infection, so if you feel flu like, your skin is red, call your doctor immediately and 2) a blood clot in the arm--many doctors will check for it for new swelling
You will need to see a doctor to get a referral to a lymphedema therapist--so please see whichever doctor is easiest to access and seems receptive to lymphedema
here is a link to how to find a qualified therapist:
http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm
Here's info on what to do while waiting for the evaluation:
DO NOT try and treat this yourself!!! Proper professional treatment is essential to getting control of lymphedema and preventing its progression. Treatment can be expensive and inconvenient, but this condition is life long, potentially disfiguring, disabling and possibly life-threatening (if you get an infection known as cellulitis) so professional evaluation and treatment as soon as possible is essential.
1) Get evaluated promptly by your doctor to rule out other causes for the swelling in your hand/arm, and get a referral to see a well-trained lymphedema therapist;2) Drink plenty of fluids -- staying well hydrated helps dilute lymph fluid and keep it moving freely
;
3) Elevate the swollen arm or hand as much as possible during the day and on pillows at night; support the arm well so that it doesn't tire;4) Several times a day pause and do some deep breathing -- this helps stimulate the largest lymph vessels in your body;
5) Raise hands over head as high as is comfortable for you, three times a day, and pump fists 20 times;6) Call for medical help immediately if you have severe pain, redness, fever or feel ill;
7) You can try mild compression gloves by either Sammons Preston or Isotoner® Fingerless Therapeutic Gloves if your hands and/or fingers are swollen until your appointment with your lymphedema therapist. Be sure to bring them along to your appointment;8) Do NOT use ACE wraps or any other wraps without the advice of your lymphedema therapist after your evaluation and your treatment plan is scheduled.
Hope this helps and please let us know how you're doing
Kira
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Kira,
I thank you for responding so quickly. I am calling my onc this morning and see if I can get a referral asap. I would still like to know if the symptoms that I listed (skin sensitivity, bruised feeling) can be a symptom of lyphedema (or a sign of the beginnings of a flare up)?
Thanks!
Trish
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Trish, women report aching, fullness and I found in my hand, it hurt to grasp things. Symptoms are very important, and some researchers put more stock in them than measurements
Kira
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Kira,
Thank you again for your help. My husband says that my hand looks better today, but definately still swollen. Can LE resolve itself for a few months and then flare up again? I have had the sensitive skin on this arm before (different parts of the arm), but if there was swelling, it was not noticable as it is now.
Trish
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Trish, Lymphedema can definitely flare and spontaneously resolve--this is called Stage 1 lymphedema, there is also a latent stage--stage 0, where there is no swelling, but the drainage is abnormal, then there's stage 2 where things become irreversible.
You want to catch it early, as lymphedema is a disease of inflammation and if you catch it early, you can halt the progression.
Here's a brief lymphnotes article on the stages:
http://www.lymphnotes.com/article.php/id/474/
A much longer position paper on them:
http://www.avonfoundation.org/programs-and-events/lymphedema-information.html
The National Lymphedema Network is advocating early treatment and diagnosis:
http://www.lymphnet.org/lymphedemaFAQs/positionPapers.htm
On stepupspeakout, Mei Fu describes the symptoms of lymphedema:
http://www.stepup-speakout.org/What_%20is%20_Lymphedema.htmWHAT IS LYMPHEDEMA?
LYMPHEDEMA (LIMF-eh-DEE-ma) following breast cancer treatment is an abnormal accumulation of lymph fluid in the affected arm, hand, fingers, wrist, elbow, shoulder, neck, breast, chest area, or any combination of these areas. The word "affected" means the same body side on which you received breast surgery or radiation. The excess fluid build-up leads to persistent swelling and other distressing symptoms, including pain, heaviness, firmness, tightness, and numbness.
Lymphedema usually develops slowly over time but it can also develop soon after surgery or radiation or even years later after breast cancer treatment. Not everyone who has been treated for breast cancer will develop lymphedema, but many will.During surgery for breast cancer, the doctor usually removes part or the whole breast and at least one of the lymph nodes and some connected lymph vessels from the underarm or chest area to see if the cancer has spread. This changes the flow of lymph fluid in your affected body side and leads to the excess fluid build-up. Radiation can also affect the flow of lymph fluid in your affected body side in a similar way.
Please call your doctor if you notice the following symptoms as they may indicate an early onset of lymphedema:
Your affected arm, hand, or breast feels full or heavy.
Skin in your affected arm or body side feels tight or firm.
Swelling in the affected body side (including breast, hand, fingers, elbow, shoulder, neck, breast, or chest area).
Less movement or flexibility in your affected hand, fingers, wrist or arm.ONSET OF LYMPHEDEMA
Onset of lymphedema following breast cancer treatment can be gradual or sudden. It is still not fully understood why some patients are more prone to fluid build-up than others even with similarity in surgical treatment, numbers of lymph nodes removed, and radiotherapy. Noticeable swelling is often absent during the initial development of lymphedema, but patients may report feelings of tightness and heaviness. With gradual onset, lymphedema typically occurs two to five years after treatment, but it can also happen as many as 15 to 30 years later.
With sudden onset, swelling develops rapidly, usually within 24 hours and often individuals are able to identify the triggers, such as air travel, infection, or injuries (e.g., cuts, insect bites, pinpricks, burns). Usually, immediate administration of antibiotics can clear the infection, while elevation of the limb helps to reduce the swelling. To reduce the risk of injury-triggered lymphedema, it is important to treat cuts, insect bites, pinpricks, or burns immediately with antibiotic cream to prevent infections.
It is also important to follow appropriate risk reduction behaviors.
Way too much information, right?
Kira
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Trish, yes, early LE often resolves and then reappears. There can be as much as 30% more fluid in the tissues than is normal before any swelling is visible or measurable, and the symptoms of that fluid buildup include tenderness, aching, heaviness, a stretched feeling -- or just "feeling funny."
If you elevate your arm, do some deep breathing, and stay well hydrated it may well resolve again, but you still need to see a therapist because early treatment makes it much easier to treat and helps slow or prevent progression.
Keep us posted! Warm hugs,
BinneyOops, Kira and I were posting at the same time!
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Binney--
But yours is so much easier to read.
Kira
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Kira & Binney,
Thank you so much for your quick responses! I have an appointment with a therapist on Wednesday morning (7:30 am!) to get evaluated. The therapist I'm seeing is a member of the National Lymphedema Network and a certified Lymphedema therapist. Wish me luck and I will keep you both posted.
Trish
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Kira/Binney,
I had my appt with the pt this morning and the concensus is stage 0 LE. He did MLD and I can see my tendons now! He taped my arm/hand and I go back on Friday to see if it worked and if so, will go over exercises and other things to reduce my risk.
Thank you for all your help and will update as I go.
Trish
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Trish, as someone with LE of the hand--I'm always checking out the tendons and veins the the "puff" areas between the knuckles.
It's so great that you got good treatment, and so quickly!
Perhaps some compression to wear as needed--a glove and sleeve for flying and repetitive arm movements.
Once you have LE, it's recommended that you wear a sleeve and glove (no gauntlet with hand swelling, because you don't want swollen fingers) with flying.
Great news! Not that you have LE, but that you caught it so early and have been so proactive about your care.
Kira
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