Saturday, February 8, 2014

The Reconstruction Era – Part 10














https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqgzg-PZzB9tVaoqFHXpOfkCYyIcZVbT4WIUYgX04QDPjQKNl_MPxQaroUgwjTE_Wm-LjNvngb1PR_3xHyJOj07GXmgzbK6JlyKx77RJKQq26StE8vZDmVzr-wRW6w8xqdSQ1BaHF7Fv0/s1600/What+is+lymph.png
From the first moment my wife
discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…“It appears that the next event is breast reconstruction!”


Strangely, there doesn’t SEEM to be much to comment on – except the elusiveness of lymphedema.

On occasion, the area around my wife’s right implant swells. This is the side where the lymph nodes were removed, so while it’s not surprising, how it comes and goes is puzzling.

I did a bit of research (now THERE’S a big surprise!) and found out that there’s nothing out there that’s helpful…

The two subjects – lymphedema and breast reconstruction after mastectomy – are well-covered. But no one seems to have done any research into intermittent lymphedema. “About 7% of women who have had lymph nodes removed will develop some swelling of the arm after surgery, which is usually mild and goes away. Transient or temporary lymphedema can also show up years after surgery. It can be caused by infection or other reasons. This lymphedema is of more concern because it may become permanent. Most women who develop permanent lymphedema do so within 4 years of their breast cancer treatment, but it can also appear many years after surgery…Most women don’t get lymphedema. The majority of women who develop arm lymphedema do so within 4 years of breast cancer treatment. Lymphedema is likely to be permanent, and only a few women will have temporary lymphedema.” (http://www.bccancer.bc.ca/PPI/TypesofCancer/Breast/Rehabilitation/default.htm)

While the MECHANISM of lymphedema is well understood: transport of lymph from an extremity back into the lymphatic system is interrupted the cause of extended lymphedema is virtually unstudied. The interruption of transport has many causes such as injury, infection, disease, or actual removal as in breast cancer surgery.

What is called “temporary lymphedema” when it is disconnected from an immediate injury, is not understood at all. Lymphedema itself is the subject of numerous mythic treatments ranging from taking diuretic pulls (believing that lymphedema is called by water retention); using benzopyrones (which poison the liver) to making ultrasound work NOT as a diagnostic tool but as a special usage that might be likened to the use of “laetrile” during the 1930s through the 1970s: snake oil pure and simple!

Why this craziness?

Because lymphedema – which only happens in 7% of breast cancer mastectomy and axillary dissection patients – doesn’t happen to EVERYONE and so is fairly low on the research grant list.

For those it does happen to – the options are few, though one has held out some sense of promise: lymphatic venous anastomosis. Keep an eye on the Breast Cancer Research RIGHT NOW! posts for the latest news.




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