Truncal lymphedema
hi ladies,
I'm new to this thread. Do any of you suffer from Truncal lymphedema or know what it is? I had BMx on jan 29 and for the past probably 2-3 weeks have been unable to sleep more than 2 hours due to back pain... Specifically across my shoulder blades but also at times lower back pain. I have some swelling on my cancer side right below my breast that travels to my back and ends around the bottom of my rib cage. I've mentioned this to the bs and ps and they think it's due to how I'm sitting etc.... I need relief!!! Please, if you have any similar experiences please post!!! Thanks.
Comments
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Mommyathome, truncal LE is sure possible. Here's a link to a site that explains it, including symptoms and treatment: http://stepup-speakout.org/breast_chest_trunckal_...
Be sure to explore the rest of the stepup site, because you'll find an unbelievable wealth of excellent information on all things regarding lymphedema.
To find out if your symptoms are from LE, it's important to get a professional evaluation from someone who specializes in lymphedema evaluation and treatment. Here's how to find a qualified person (and any of your care team can make a referral: http://stepup-speakout.org/Finding_a_Qualified_Ly...
And if the bs and ps don't seem to have a clue about lymphedema (not that rare, regrettably), you can print this and give it to them: http://stepup-speakout.org/essential%20informat%2...
In the meantime, you may find it helpful to try wearing something that provides a lot of compression to your trunk. A shapewear camisole might work, or you can find a compression T shirt made by UnderArmour, in many sporting goods stores. They make them in long and short sleeve versions. If you want a short-sleeve shirt, we generally find that the men's versions work better, because the women's short-sleeve shirts have cap sleeves that tend to cut into the axilla. The general guideline is to get a size smaller than you usually would wear (even smaller if using a men's size), and wear it inside out so the seams don't bug your sensitive areas.
Swelling from not sitting right...that's a new one and a pretty poor response to your symptoms. Good luck, and do post more questions here. Lots of us have truncal LE!
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Carol57,
Well I called my bs this morning. She's still not concerned. I was like well I'm not sleeping. At all... Something has to be done. She said they wouldn't even look at lymphedema til 1 year post BMx never mind 5 weeks out. She told me to stay off the Internet. She said she can have me do physical therapy. I told her the ps set that up I went yesterday for first time. She's going to give me ambien to help me sleep but said its only for limited time!!! As if I'm looking to stay on drugs! So hopefully at least I'll sleep and physical therapy twice a week will help. Thanks for your response!!
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Mommyathome, one good study that I know of showed that early swelling can be diagnosed as LE but turn out to be just extended post-surgical swelling, especially if the patient had taxane-based chemo. But other studies show that treating early swelling with compression as soon as possible can keep LE from progressing. So, I guess it's a pick-your-study choice, and you're not the first person who's posted here to say that the surgeons don't consider LE during the first year.
I can tell you that I was aware of my LE within a few months of my surgery and had it diagnosed at about four months. I started with compression then and I have a very mild case of it now. I've never had to wrap, and I control my truncal LE with compression garments. Rarely do I need to do manual lymph drainage (a very light-touch massage we learn from our LE therapists), although in the beginning I was doing it religiously. My experience is that I started working on it early, and my LE improved and has stayed mild ever since (knock wood). Maybe that's just a coincidence, and it was going to retreat anyway, but I have a hard time believing that.
Some women here have had trouble with tissue expanders causing some swelling, and when they got their exchanges things improved. Studies (there's one for every topic) suggest that getting immediate recon like you did lowers your LE risk, and I saw one study that suggested implants are associated with better LE risk reduction than the flap surgeries. Maybe you've got something going on with the TEs and the PT can help you figure that out. But I'd say to keep LE in mind and don't be shy about pushing back to ask for a formal evaluation from a qualified LE therapist.
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Thanks carol57,
My mom was diagnosed w breast cancer 6 years ago and had a lumpectomy, removed numerous lymph nodes and ended up w lymphedema. She has to wear a sleeve from sun up to sundown or her arm swells. I like to b proactive. I see something wrong or different I need to know y and what's going on. I'll do the wait and see thing for awhile. The pt I go to isn't certified lymphedema. So if it doesn't improve I may switch and maybe pt will see what I see and say something. My bs is prescribing the ambien so I am just do hopeful for a full nights sleep!! I can't function w 2 hours of sleep and 4 kids 3, 7, 9, 11. I need more rest!!!!
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Mommy - Another truncal LE person here. I second Carol's advice to go over Step Up Speak Out website (SUSO) to learn all you can about LE. Knowledge is power. LE can present itself far earlier than a year, and with young children at home you want to be pro-active so that if you have LE, you catch it early when management is easier. Interesting that your mom has LE - we've discussed in various LE threads before how many of us have other relatives with LE. I would think that's an extra warning sign for you.
Like Carol, I was also aware of my LE symptoms early on, but my surgeon dismissed my concerns. Unfortunately, too many surgeons are not well-trained about LE and tend to dismiss patient's concerns. As Carol says, keep pushing. And you really should get an evaluation by a qualified lymphedema therapist. Unfortunately, PTs who are not aware or trained in LE management can inadvertently trigger LE or make LE worse simply because they are not aware of the signs and symptoms. By reading through the SUSO site, you'll be aware of what to look for as your therapy progresses. You also have a head start on knowledge given your mom's experiences.
Five weeks out is still early, so your swelling could well be normal post-surgical swelling. I hope so. But it's always good to be aware of LE so you can recognize the signs and symptoms.
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I was under the care of my plastic surgeon when I began to suspect LE, and he just did not want to hear about that explanation for my 'prolonged post-surgical swelling.' I admire and respect this doctor for many reasons, so I decided to write him a letter explaining my worries and asking him to refer me for a formal LE evaluation so I could put my mind at ease.
My letter was short, very respectful and polite, but also pointed. I faxed it to his office, and that very evening he called me to apologize for discounting the LE explanation, and he wrote the referral the next morning.
I think sometimes we're trapped into unsatisfactory conversations with out physicians and surgeons because time in the exam room is so limited. There are so many other topics to cover, many of them emotionally charged given the underlying foundation of BC as the continuing thread for our visits. I took my time composing my letter, and I do believe that my surgeon responded well to it in part because we were not face to face, so he had time to reflect instead of giving an immediate response.
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Thank you ladies! I too respect my bs as I have been going to her since 2008 when my mom was diagnosed but I feel her assistant is shrugging this off. They haven't even seen the swelling I'm talking about. She tells me over the phone it can't be due to the BMx. I go to my pt on Monday. I've only seen her once I'm going to tell her my concerns about lymphedema and tell her it may be best if I go to a therapist that has training w lymphedema. My mom went to this office so were familiar w some of the staff but the therapist trained in lymphedema is no longer at this site, they have a therapist two towns over from me affiliated w this group. When I registered they actually asked if I had lymphedema... I said no and she said ok if u did I'd send u to the other site... Might be better to go there now in case. And like you said, y wait til it progresses. Even if it's not "full blown lymphedema" the trained therapist may be able to help with the swelling. I just feel like they are dismissing me. There is something wrong when I had a BMx on my BREAST 5 weeks ago and it's my BACK that's causing me the most pain!!!
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It would be wise to not wait until it becomes "full-blown lymphedema". Prolonged swelling is accompanied by tissue changes which make subsequent treatment more difficult. A recent study found that early treatment by manual lymph drainage may even be able to prevent lymphedema. The experiment group was given manual lymph drainage from 2 days after breast surgery for six months, and had no swelling, while the control group had 10% excess lymph fluid at that same time. [Ref. Efficacy of manual lymphatic drainage in preventing secondary lymphedema after breast cancer surgery", Zimmermann A, Wozniewski M, Szklarska, A. Lipowicz, A. Szuba A. Lymphology 2012;45:103-112]
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What should I do if my bs and ps don't see this as related to the surgery... And won't consider lymphedema?
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Try your PCP. Any doctor can write a scrip for a LE therapist (LET). All the scrip has to say is "Lymphedema - Evaluate and Treat." I get all my LE scrips from my PCP. My PCP is great - she freely admits she knows little about LE, but is willing to learn. I've given her lots of info about it. She knows I know a lot about LE and will write a scrip whenever I need to see a LET. At this point all I do is call the office and she'll write a scrip to fax over directly to the LET's office.
Make an appointment with your PCP about your back pain. Once there, you can explain your recent surgery and that you're aware of the possibility of LE, and that you'd like to have an evaluation with a LET. You may have to give your PCP a bit of an education about LE at first if he/she is not familiar with it. I printed out a lot of material from SUSO to give my PCP. Once I did that, she understood the necessity for early intervention.
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It would be interesting to know if your swelling is less after you get up and increases throughout the day.
It would be best to try the smaller size compression cami/tee trick and see if your pain minimizes, It may be a good indicator as to what is going on. With truncal LE I feel tingling, fullness, stinging slightly like a bee, a feeling like I have a rubbery boiled egg stuck at the back of my armpit, but it vanishes with the UNDERAMOUR men's compression tee or cami.
Stick to your guns until you are satisfied. My doc laughed at me and said that I would NEVER get LE. You might not but it is wise to be educated.
I find it interesting that you had surgery jan 29 but the pain didn't set in until 2-3 weeks later. That tells me you were doing ok and then something changed. Your so smart to be proactive.I hope you don't have to join our swell club but if you do we are the gang you want to get to know.
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Hugz4u and natsfan,
Thanks. The feeling I get is soreness, sometimes on a scale 0-10 it's a 2-3 but sometimes it's a 8-9. It's intense and keeps me from sleeping. It feels like someone is using a metal rake and raking the inside of my back at times.. Sometimes it feels like a muscular ache. It's across my shoulders mainly but I also get the lower back pain. At night when I am sitting it feels like restless leg syndrome or whatever that's called. I just can't get comfortable and want to crawl out of my skin!! I feel like if I could get this back pain in check I'd be ok...this pain is killing me. I'm taking 800 mg of Motrin 3 times a day and 2 extra strength Tylenol. This pain is beyond that medicine.
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Hi Mommyathome,
I had truncal lymphadema. No one at the cancer center recognized it ( kind of scary as I had cords all down my trunk). My PCP hooked me up with a great LE therapist. It took 3 months of treatment plus lots of compression garments. Assets or underarmor- wore them for work.
It started with tingling and pain on my side and back. Keep going until someone helps you. Most PT's don't know anything about this (and neither did my radiologist and Oncologist!)
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Mommy - whether it's LE or not, one of your doctors should be taking your pain seriously. If your BS and PS are not helpful or are in denial, try your PCP. Someone needs to help you get to the root of this.
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Thanks ladies! I feel I'm getting more support from you than my medical team! My family just doesn't understand how uncomfortable it is either and just says it will take time,, you just had the surgery 5 weeks ago. It's frustrating to say the least!!!
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With the Truncal lymphedema what's the best position for sleeping?
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Well if I end up on my LE side I sometimes wake up with that pinching feeling I described before in my upper trunk. This morn I had it but as soon as I got moving it went away. I try not to sleep on LE side but man I flip like a fish at night and unless I put a pillow behind my back and lay on my side I end up all over the place. It even happens with the pillow but keeps me in position for a few hours.
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Hugz4u,
Gosh everything just seems so much harder!! Even sleeping is ridiculous! You know most surgeries after a few months you're pretty much back to your old self... Not with a BMx!!! It's a very long process that totally changes how and if you do the things you used! Man, the things I took for granted!!!!
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hi everyone. I'm looking for help here. I have sore muscles right under both tissue expanders and to the bottom of my ribs. At first I thought I pulled muscles. But now I feel a hard cord on my prophylactic side (not the cancer side where nodes were removed). The cord goes from my ribs down about 6 inches over my stomach. Is this truncal lymphadema? Also the center of my back feels like its out and I can't get it to "pop" back in. I am trying to get into the lymphadema pt specialist soon. I was educated and received therapy for my arm that had nodes removed but nothing for the trunk and nothing for the prophylactic side. I had no idea you could get cords in the stomach
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Hello, live_deliciously,
Cording like your describing is called Mondor's Syndrome and is similar to Axillary Web Syndrome (AWS). It's fairly common, can be painful--but it's not lymphedema. Here's information about AWS, which may give you some idea of treatment and healing for Mondor's as well:
http://www.stepup-speakout.org/Cording_and_Axillar...
I'm not sure about the back issue you're describing, but hopefully you'll get answers to all of this soon when you're able to get a PT appointment.
Please let us know what you discover.
Hugs,
Binney -
Hi
binney. Many thanks for your reply. I've been very physically active lately and don't know if the cord has been there or just started. I didn't know you could get them in your torso but guess it comes from the reconstruction. I'll report back once i see the p.t. thanks again.
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