Surgery Mon. with anxillary disection. Any last minute advice?
I go in Monday for BMX with Axillary dissection. I hope I don't get lymphadema. Any last minute advice to avoid it? Pam
Comments
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Pamela, one strategy is to make sure no one has you doing any exercises or stretches above shoulder level, for at least one week following your surgery. A random-controlled trial led by Jacquelyn Todd had two groups of patients: all with axillary dissection, and half followed the traditional program of immediate post-surgery shoulder mobilty exercises (like 'wall walking'), and the other half waited 7 days before starting these exercises. The 'immediate' group had 2.7 times the incidence of LE by the end of one year, compared to the group that delayed exercises. Both groups has the same physical outcome at the end of that year, in terms of shoulder and arm mobility, so they demonstrated that waiting the week reduces LE incidence without impairing physical function.
So--now the best standard of care is to have us wait seven days after surgery before doing shoulder mobility exercises. Other studies have shown that we most certainly do need to do those exercises, so don't ignore them--just wait the week. Unfortunately, not all breast surgeons are up to date on these findings, and neither are all physical therapists. So you may have to argue a bit on this one. Here's a link to the study abstract, in case you need to pass it along: http://www.physiotherapyjournal.com/article/S0031-9406(08)00113-2/abstract
This study, along with one by Torres Lacomba, was mentioned in several presentations at the recent National Lymphedema Network research conference. Both support the need to do stretching and mobility work after mx, especially mx coupled with node dissection, but that we need to do it smartly.
I would also add that if you can, get a referral now for pre-surgery baseline arm measures, both arms--so if you have early LE symptoms, you can have an accurate way to measure if swelling is occurring compared to before surgery. We don't want you to get LE, but if you do, we want it to be diagnosed at the earliest possible moment so you can get early treatment for the best possible outcome. Baseline arm measures help that goal. They should be taken by a qualified LE therapist who takes them all the time. There's quite a technique to doing them well and accurately.
Others may come along with more suggestions--how very smart of you to ask about this before hand!!
Best of luck for an uneventful and speedy recovery!
Carol
(edited to correct an error) -
Carol's advice is very good. =
Really take it easy at first ... you want to minimize extra load on your lymphatics that exercise brings. skip the housework and cooking, and if you have little kids, try to get someone to help out at home.
Bring a poncho or button down short sleeve or sleeveless shirt to wear home from the hospital so you don't have to lift your arms up. You're going to have a bunch of surgical drains, and if your very petite or large, you might want to order an appropriately-sized post-surgical bra (the kind with attachments for the drains).
I've heard rumor that some hospitals actually have LE therapists visit patients in the hospital to give education etc., but you need to request them. Lots of LE therapists have a long waiting list, so even if you can't see a LE therapist for baseline measurements done before your surgery or be seen while in the hospital, perhaps one of your docs (if not your surgeon maybe your MO) will write a referral to a LE therapist for AFTER your surgery for education.
Are you having unilateral or bilateral ALND? Presumably the docs & nurses known not to do BPs/IVs/blood draws on the ALND side. I have a question for one of the experts on the board, if a woman is having a BMX and unilateral ALND, is it safe to have post-surgical BPs, IVs etc on the non-ALND side?
best wishes for an uneventful surgery and speedy recovery. KS1
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Thank you Carol and KS1! Pam
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I have a question about LE prevention, too. I did not find these forums till after my surgery. Not one of the docs or nurses I had seen during the whole thing ever mentioned LE, in fact I had never heard of it till I found my way here and started reading. There seems to be some conflicting advice i.e. some say elevate the arm, others say don't raise it above shoulder level (a moot point for me as my arm still won't go anywhere near that high 2 weeks after surgery). When I was in the hospital they told me not to use that arm for BP readings, etc. and the doc said not to stretch it or lift anything heavy. I just naturally took that to mean they didn't want anything pulling on my arm while the incision/stitches were fresh. At 13 days post-op, my surgeon checked the incision and pronounced it all healed, and said I could go back to my normal activities and start doing stretching exercises. Basically he said "do whatever you want as long as it doesn't hurt." Well now after reading here it seems those recommendations are more about preventing LE than worrying about popping out some stitches. Just no one ever said. Anyway my question is, no one seems to ever say, for how long do you take these precautions? Is it OK to raise my arm as far as it will go now? OK to start lifting weights again? How long before it's OK to have BP taken in that arm? A month? Or what? Appreciate any clarification....
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KS1,
I am not an expert but I did have a bmx with AND on one side only. My port is on that side and that is where I have BP, injections etc as was recommended by my pt and mo. I wear a medic alert bracelet on the AND side so it is never touched.
Caryn -
Pam, how did your surgery go? How are you feeling? Hope everything went smoothly.
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Jennie, My surgery went well. It was better than I expected. I can't straighten my left arm where I had the left axillary dissection. Is that normal six days after surgery?
Pam -
So glad the surgery went well. I am not sure how common it is not to be able to straighten your arm, but I had difficulty doing so. The reason in my case was "cording" (AKA axillary web syndrome). Ask your surgeon when you see her/him. In the meantime, you might want to check out the stepup-speakout website link:
http://www.stepup-speakout.org/Cording_and_Axillary_Web_Syndrome.htm
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I don't have anywhere near full use of my arm yet, 3 weeks out, and still have a great deal of pain in the armpit area, and overly sensitive skin on the upper arm. I don't know if all that is normal, none of my docs will say how long it takes, they just say everyone is different. I must admit I'm a bit put out by all of this, I honestly thought beforehand that I'd be back to normal in a few weeks. The incision itself is healing just fine, no problem, no pain. It's just the armpit thing. Aggravating because none of them warned me ahead of time! Too bad I didn't find this place till after, I would have had a much better idea what to expect. Oh well, better late than never!
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