Exercised and now in pain

Yikes, Sally, that does not sound good at all!  To answer your direct question, if you were to poll women in the lymphedema forum about getting it (LE) after just one or two nodes, the answer is yes! It does happen, unfortunately, too often.  I think the statistic is from 3-17% of women with sentinel node biopsy will develop LE.  The reason the range is so wide, is that studies of LE incidence vary widely on the diagnostic criteria for when they say you have LE, and on the follow-up period built into the study. 

The sentinel node biopsy is suspected of increasing the incidence of breast LE, because the most direct lymph pathway from the armpit node clusters to the breast is by definition disrupted. SNB has reduced arm LE, but more research is needed to understand its impact on breast LE.

So--don't rule out lymphedema, and if you can get a script for LE evaluation, that would be a very prudent course.

Now, to the exercise question.  Pushups, planks, and stretching the band are wonderful resistance and core exercises, but they are also pretty risky when we're at risk for, or have LE.  There have (thankfully) been quite a few studies in recent years that demonstrate we can lower our LE risks (or flares/sudden swelling episodes) if we use strength training to develop adequate limb and trunk strength, so that picking up heavy objects in daily life won't signal the lymphatic system that there's some kind of crisis, trigger a rescue-release of lymph fluid, and cause a fluid back-up in the arm or trunk as a result. (I'm paraphrasing here..the studies really don't talk about rescue!).  So, if you've had nodes removed, to reduce your LE risk it really is important to develop the strength we need in daily life --and those Obama arms are an equally worthy goal, of course.

BUT- the crazy dilemma is that the very process of strength training can add LE risk, at least initially, because picking up a dumbbell (or doing a pushup, or stretching a resistance band) can cause that same lymphatic response.  SO..research was done to answer the question: how can we use strength training safely--to develop the needed arm/upper body strength, without inadvertently causing extra lymph to flow--a problem for those of us with nodes removed?  The answer is: use a strength training program that is slowly progressive, with training tools that allow you to measure your weight increments as you build up.  The research in question is the PAL Trial (Physical Activity and Lymphedema).

The PAL Trial concluded that there's no upper limit to the amount of weight we can lift; we just need to get there slowly, and by adding weight in very small increments (initially, one measly pound at a time). The problem with pushups, planks, and resistance bands is that it's nearly impossible to gauge each session's added resistance, much less to know that we're adding resistance in small, consistent doses.

Finding a trainer who's versed in PAL guidelines is no easy feat. But you can start by directing your trainer to the published PAL studies, and the trainer can also go to the research website (part of Univ. of Pennsylvania) and request a copy of the specific research-based strength training program that was developed from the trial results. Unfortunately, they only give that exercise program to certified personal trainers, not to us mere patients.

Here are some links:

http://www.lymphnet.org/pdfDocs/PAL_NEJM.pdf  (original PAL research, pertains to women with an LE diagnosis)

http://jama.ama-assn.org/content/early/2010/12/03/jama.2010.1837.full (follow-up research to study strength training for women at risk of LE)

http://www.lymphnet.org/pdfDocs/Weight_LE_Misconception.pdf  (Dr. Schmitz (primary researcher) responds to some unfortunate, inaccurate media hype about PAL research conclusions)

http://www.penncancer.org/physical-activity-and-lymphedema/receive-pal-intervention-materials/  (site where your trainer can request the actual exercise routine and precautions)

And finally--one of the PAL research team members, Cathy Bryan, can put on a workshop for trainers in your area. I did that in Michigan, getting sponsor help from two hospitals to help with the expenses.  You can find Cathy here:  http://cancersurvivorfitness.com/index.html

Sally and Coraleliz, I have LE after 5 nodes removed for SNB, and I am a huge believer in working out, especially strength training (but sigh...I have a long way to go before getting Obama arms...which I would dearly love to have!).  I work out with a PAL-trained trainer (he took Cathy Bryan's one-day workshop), and besides taking care to build up verrrry slowly (and start well below my pre-surgery weights), I can say that my LE has never given me any grief after working out.  I am quite aware that I am building strength, so I no longer cringe when I pick up a grocery bag with 10 lbs of flour in it, or shoulder press my 30-lb bag into the overhead bin of an airplane (about every other week).

I've dropped a ton of information here, but I do hope you can take time to take a look, and to talk about it with those you are working out with. 

Carol

Bedo, ultrasound can't diagnose lymphedema, because in lymphedema the fluid is not pooled (like it is in a seroma, which you CAN see with ultrasound). The fluid is all over among the cells in microscopic "interstitial spaces," so it doesn't show up. The medical professionals who are trained to diagnose and treat lymphedema are well-qualified lymphedema therapists. Here's how to find one near you:

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

Any doctor on your team can write you a referral for evaluation, and as Carol says, catching it early makes a world of difference to controlling it on-going.

Be well!
Binney

Hi Bedo,

I exercised throughout active treatment, so never had the "re-entry" pain.  However, I thought I would mention that I found that my pectoral muscle on the radiation side was weaker.  This was not a problem until I skied 10 miles through really thick and heavy powder last year.  I hurt on both sides afterwards, but much more on the side that had radiation.

I can't imagine how you must be hurting after 10 months of no exercise.  Back off a bit and feel better.  You will get there, but it might a month as opposed to two days.

Having said all this, I found it was my abs that protested most when I started doing crunches post surgery.  They are lazy and need to be whipped to stay in line.  But the results are worth the effort.  I have no problem lifting anything (reasonable) that comes my way.

And other than hiking long distances (trashed ankle from cycling wipe out), I can do anything that I could do pre diagnosis.  Good luck. - Claire

Move it move it move it!!

Pre-cancer I was on a competitive dragon boat team - after my lumpectomy (4cm) + removal of 2 nodes I was paddling again in 2 wks and racing in 4 wks.  I continued to train as best I could through chemo/rads and am now competing nationally on a team that consists of all breast cancer survivors.  We are 2 time Canadian Gold Medalists!   I find radiation did more 'damage' than surgery - muscles very tight and hard, not much flexibility.

Don't give up - challenge yourself always

Mine are better than Michelle's.  That is the point of lifting.  Off to bed as doing a 40 mile ride in the AM.

Hiking, biking and kayaking count and are great fun.

That's my story and I'm sticking to it.  Have a great weekend. - Claire

Yes -  it's very important to educate yourself about exercise and lymphedema.