Lymphedema?
I am hoping someone experienced with lymphedema can help me. I had a BMX a year ago. My cancer was on the right and I had 3 lymph nodes (negative) removed on the right side.
After a couple months, I noticed swelling of my left hand and arm. I immediately called my breast surgeon's office and was referred to a lymphedema therapist. I was diagnosed with lymphedema of my left arm, even though I had no lymph nodes removed from that side. After a lot of trial and error, I was finally fitted with a one piece garment which I wore almost every day for the past year.
My son, an orthopedic surgeon (who has no experience with lymphedema issues) tells me that he is not totally convinced that I really have lymphedema. The swelling is very minor. I was told by a new lymphedema therapist that there is now about 1 centimeter difference between my left and right arm and hand. She too, does not seem 100% sure that I have lymphedema. The swelling has significantly decreased over the past year. Is it possible that my body has figured out a way to compensate for the extra fluid? Or that the swelling was caused by something else all along?
My question is, as it is time to order new, expensive garments, how can I be sure that I really need them? I have asked on several occasions if there is a Dr. that I can go to to get a definite diagnosis. No one seems to be able to give me an answer. Everyone just says to go to a lymphedema therapist. I have been told to offer my right arm for blood pressure, blood work, IV's, etc. (the side nodes were removed). I am obviously putting this arm at risk, maybe unnecessarily, if I don't have lymphedema on the left side to begin with.
Not sure what to do. I am hoping some of the knowledgeable people on this board can offer some help. Would appreciate any information.
Thanks
Comments
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jarris, did you have chemo? An interesting study published in the last year or so found that women who had taxane-based chemo often had swelling that resolved within about a year. That your swelling is on the side opposite your node removal does raise the question of another explanation besides LE, although it certainly is possible to have LE develop after prophylactic mastectomy...several members here have had that experience. That said, those I can think of also have LE on their cancer and/or node removal side.
LE therapists, if well qualified, should be able to consider all of your circumstances and be pretty accurate in diagnosis. You could seek imagine --lymphoscintigraphy--which literally maps your lymphatic vessels in the areas examined. But I don't know how widespread the technology is, nor do I have a clue about insurance coverage.
Another perspective is that LE swelling can largely resolve over time, if you're lucky, but it doesn't mean you no longer have LE--just that your LE has receded to a latent, or stage 0 state. That's where I am, with very rare visible swelling in my arm. But I still feel the LE. I get heaviness feelings, often a burning sensation, and my arm aches, aches, aches when I've over-done activity, or when there's a storm brewing, or when I'm in the mountains. Does your arm feel like your personal barometer? These kinds of sensations do signal LE.
I wonder if you've just had the good fortune that much of your swelling resolved. If so, it's sure important to remind yourself that you do have LE, because the sensations would be telling you that you do have diminished lymphatic capacity, and that leaves you at risk of infection after a cut, burn etc. and (in my case) I worry that it's a set-up for more advanced LE later. So I wear my compression sleeve and gauntlet when doing risky activity, such as weightlifting in the gym, kayaking, during air travel, and anytime I'm using my arm for heavy or repetitive work.
My guess is that you need garments to be able to use them at minimum preventatively. If you need custom, that can be a financial killer, but I'm also guessing that you're at particular risk of LE, even if your swelling for some reason had nothing to do with LE. The kind of swelling you experienced after mx-only seems to me to suggest some kind of lymphatic insufficiency.
But I'm no doctor, and unfortunately as you've discovered, LE keeps us all guessing. Sigh.
Good luck deciding what to do!
Carol
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Carol, thank you for your response. I did have chemo. 4 treatments of TC. That is very interesting. I hadn't heard anything about taxane based chemo and having swelling that resolves.
As far as experienced LE therapists, the first one that I was referred to was very young and hadn't been working very long. The more experienced one that I saw a few weeks ago seemed very knowledgeable and was the one that told me that she wasn't totally convinced that I had LE. It seems this is all more of a guessing game than I realized in the beginning.
I think I will follow your advice and continue to wear the garments when doing any risky activity or if I notice an increase in the swelling. Last year when I first noticed the swelling, it always seemed to get worse when the weather was extremely warm. We have only had a few days of higher temperatures so far this year (I'm in Ohio). I'm kind of anxious to see if I notice an increase in the swelling during the humid summer months.
Also, I have never noticed any heaviness or aching in my left arm. The only symptom I've had is the swelling.
Thanks again for your response. It helps to hear from someone who has been dealing with this problem.
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jarris, I'm Ohio born and bred, although for DH job reasons I've defected to Michigan. So that means I'm well acquainted with Ohio's hot, humid summers. Most of us have worse LE in summer, so get ready.
Here's a link to an abstract of the study that suggests taxane-based chemo may provoke temporary swelling: http://www.ncbi.nlm.nih.gov/pubmed/23494582
Perhaps your son has library access to the full study. If not and you're interested, PM me and we can exchange emails, and I'll send it to you.
I really hope that your swelling has moved on and you're in prevent-and-protect mode instead of having to deal with constant puffiness!
Carol
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