question about wrist surgery and lymphadema
Hi all I hope everyone is well. I'm writing because I'm considering having wrist surgery for a broken wrist it's actually the same side as my lumpectomyme and my sentinel node biopsy from my surgery 12 years ago. I am concerned about the surgery because I think they do a nerve block and some sort of tourniquet on the right arm and I'm wondering if anyone has an experience with this and I think I never if they developed lymphedema. I have never had lymphedema and I would like to do everything possible to avoid it. Any advice would be greatly appreciated thank you
Comments
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Mom- oh my, a difficult choice - but it would be hard to avoid surgery for a broken bone. You can require that the nerve block and any IVs be on the other arm or your ankle. I always specify ankle for blood draws & IVs, and calf for blood pressure during any surgery. Not sure about the tourniquet. Do they need that to stop the blood flow to the surgical site?
Hopefully someone else will be along who has more experience with this - maybe Binney. Below is a link you can look at that may have some useful ideas.
https://www.stepup-speakout.org/
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Hi, just had surgery for wrist 1 month ago. Wasn't aware of the tourniquet used during surgery. Now experiencing lymphedema for the first time since dx 15+ years ago. The facility had my health history, but went through with surgery anyway. Be careful and trust no one. Good luck, hope all goes well.
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Oh Naomi - so sorry to hear this.
I actually write all over my arm with a magic marker "no sticks, no BP" before surgery.
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Naomi I'm so sorry to hear this but thank you for sharing it. I too have had no problem with lymphedema I only had a sentinel node biopsy I'm not sure if you had more than that or just that. Because it's my right arm and my breast cancer was on my right side I'm honestly not sure what they can do to mitigate this risk if anything. I was made aware by a colleague of the tourniquet and that's what made me start to think that maybe this was a great idea for me. However I'm not quite sure what the alternatives are I'm trying to get some information from the doctor but you know how they like to just go ahead and do surgery and not really think about all the other implications. Thanks again for sharing if you've any more information that you think might be helpful I love to hear it thanks.
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Thanks minus I'm actually not sure how they will be able to avoid my right arm given that it's my right wrist so the nerves would have to be blocked on that side I am really careful about blood pressure and injections on my right side and have had no problems over the last 12 years. The bone is broken in such a way that it would heal on its own but it won't be perfect and I could have some residual pain. But I'm saying to think that pain might be better than developing lymphedema if that's even a remote possibility.
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momand2kids, The problem is if you don't repair the fracture you can loose the function/use of your hand. Do they have to use screws? Why aren't you having general anesthesia? I wouldn't have a nerve block. I had one after surgery and it did nothing for the pain.
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well this surgeon does it out patient did you have wrist surgery with general? i thik it is commonly done with a nerve block
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it is a slightly displaced break it will heal on its own but not perfectly they would use scews if i do surgery
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It's worth asking about general anesthesia though, given your BC history. I definitely would be asking that myself and actually making sure that's what I was getting. You need a working right hand and both a poorly healed fracture and lymphedema won't help that at all.
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momand2, it just doesn't ever seem fair when life happens on top of our bc history, forcing these sorts of decisions. I'm so sorry! For sure you'll want to talk all this through with your surgeon and be sure s/he is someone who is either already aware of lymphedema and the potential risk, or willing to listen and learn. Some of the women here have had carpal tunnel surgery with the use of a tourniquet, but they made sure the surgeon was with them on using it as briefly as possible.
If not having the surgery could result in increased or chronic pain, that's a very good reason to go ahead with the surgery. Our bodies respond to pain by rushing lymph fluid to the site (for instance, no doubt you noticed some swelling when you broke your wrist). That response can overwhelm a compromised lymph system, triggering lymphedema. So anything you do to reduce or eliminate pain will help control lymph build-up and lower your risk of developing lymphedema. That includes making extra sure that your post-surgical pain is controlled.
Since your arm is at risk for lymphedema, it is also at somewhat extra risk for infection, so prophylactic antibiotic use before surgery is another topic to discuss with your surgeon.
Please keep us posted, momand2.
Gentle hugs,
Binney -
thank you everyone. Such helpful info. The surgeon basically said I could do either way. With surgery he could”make it perfect” without it will certainly heal on its own. He said some people experience some residual pain but not all. We just don’t know. Truth is is I don’t want surgery. Because of BC and because I do feel like I have been healing well. But I know I have to do due diligence so I am after a second opinion. Feeling some time pressure as it starts to heal and could make surgery more complex but o am not ready to commit. I also don’t think this ortho does general anesthesia, which I also don’t want because I text badly to it. But I greatly appreciate your advice. Really helps me think critically.
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momand2kids, My Mom fell on the ice and had a wrist fracture. They used screws and it was done as an outpatient procedure with light general anesthesia. My mother in law fell and had a non-displaced wrist fracture. They used a splint to stabilize the fracture and to keep it immobilized while healing. Because of her age they did not want to put a cast on it. After about 6-weeks she started therapy to regain the use of her wrist/hand. Don't wait too long or they won't be able to get it realigned. My Mom regained the use of her wrist/hand, but my MIL wasn't compliant with keeping her wrist immobilized so she lost function.
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I already had LE when I broke my wrist in 3 places. Ortho said he guessed I didn’t want surgery. Smart doc!! I didn’t want it, he put a cast on it. It’s healed, doesn’t give me any grief, unless I put a lot of pressure on it. And that could be arthritis too.
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When I broke my arm (fortunately the arm at the least risk for LE), they decided to immobilize with a splint & sling for 6 weeks instead of cast or surgery It meant lots of PT afterwards to regain range of motion, but the bone healed well & no residual issues.
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Hi everyone thank you so much for your answers to my questions and for sharing your experiences. I did talk to the doctors office to let them know about this concern. They didn't have any experience with it but the PA was good enough to check with one of the surgeons and they talked about how there was very little data that supported the idea that someone might get lymphedema from the surgery. I also spoke to my oncologist and she said there is a risk it is low but it's still a risk. And that's my concern. Every time there's a small risk for me I seem to always fall on the side of the small risk. I had a little risk of getting breast cancer I got it ,I had a low risk of getting thyroid cancer I got it, at a low risk of getting melanoma I got it. So I'm not feeling really confident about this surgery. I just read the after notes from the doctors visit on Wednesday and it talks about a very slight malunion as a possibility. And because he was sort of either or on surgery I think I'm more inclined to go without surgery. I am feels much better I'm happy to spend six weeks in a cast if I need to win more weeks in a splint in PT I just really don't want to take any risk related to lymphedema. So that's where I am today I'm still considering second opinions having a few of my doctor friends read the doctors notes and see what they think. And I will have to decide within the next week before things start to really heal. But again thanks so much your advice and your experiences was so helpful to me I really appreciate it.
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momand2kids sounds like you are in a good place then! And I hear you about all the low/no risk things--like you, very low risk of BC and here I am; same with the melanoma! I hope I don't follow you w/ the thyroid
Also I lived in the South End a few years ago, loved Boston.
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thank you for sharing your surgery story. I am 10 years Cancer Free and I had lymphedema from my initial surgery. I have it under control and have not worn a sleeve in many years just a slight difference in my arm.
my question is I have a torn rotator cuff in that arm and have put off surgery for 5 years. I am at the point where I don’t think I can put it off. We’re you able to get your lymphedema under control?
thank yo -
This is an interesting thread to me as I am undergoing revision surgery tomorrow to hopefully fix a neuroma in my left foob. Unfortunately to get to it my PS has to remove my implant. I had a lymphatic draining massage yesterday, and my left arm (cancer side) and hand do swell just a small amount. I asked my therapist if during surgery I have to have a blood pressure cuff and IV (that one is a given), which on which side? She suggested the IV on the side where the lymph nodes were removed, blood pressure cuff on the other. Theory being less risk with the needle stick than the pressure changes with the blood pressure cuff. I will let you all know how this works out. The surgery is outpatient of course (insert eye roll)
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Rah, please do post an update. I have a procedure scheduled in a couple of months and am already wondering about cuff and IV placement while in a lymphedema sleeve.
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Oh Rah - it's probably too late, but for others:
Any subsequent surgeries - I've had the BP cuff on my leg. I've had the IV for anesthesia on the other ankle. I've never had any push back, except anesthesia people who don't know how to insert a line in the ankle. I just have them call the head surgical nurse. It works out fine and is well out of the docs ways.
Do let us know how it goes.
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Hersheykiss (love that name) and Minus Two (ditto) things went really well. Outpatient of course haha
They were very proactive on the lymphedema. The nurse that was preparing my IV asked me if I had any swelling issues due to my past surgery. They put a pink band on my left wrist so everyone would know to leave that arm alone. My IV and my blood pressure were performed on my right arm. I hope Hershey that you receive the same quality care as I did. Upright and going this morning although whew I am sore from the liposuction more than the foob repair!
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hi all
I did not have surgery. Did 5 weeks in cast and now am in physical therapy. Still hurts but not as much. I can do more and PT says I will heal fine. Will go back to dr for final X-ray in December but things look good. Thanks for your advice.
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Rah, I'm happy that surgery went well for you. Your team sounds top notch. Wishing you a very speedy recovery!
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Thanks for the well wishes Hershey! Improving every day
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