Lymphedema, the build up of fluid that causes swelling in the
upper extremity, develops when lymph vessels are damaged or removed, often
following a lumpectomy. According to Lesli Bell, PT, Timberlane Physical
Therapy, lumpectomy patients are often considered “the lucky ones.”
Lumpectomy patients undergo treatments often considered more
conservative than a mastectomy, according to Bell.
“I think there is a big disservice being given to lumpectomy
patients because they are considered the ones who did not have to have a
mastectomy,” Bell told O&P Business News. “They are
the ones who received conservative treatment, such as a biopsy and radiation,
or some sort of small lumpectomy.”
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The problem with that assessment, according to Bell, is that the
patients who undergo a lumpectomy still have their breast tissue, which leaves
the door open for painful swelling.
“It’s a big issue,” she said. “Unfortunately, we
have not been measuring or documenting the experiences of lumpectomy
patients.”
Because the primary drainage nodes are removed from the breast, there is
no pump system in place and no muscles in the breast to actually pump fluid.
Lymphedema becomes a chronic problem for the patient when congestion in these
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initial swelling begins. The swelling usually begins post-operation or
post-radiation. Those are the two most significant events that create an edema
problem. But if we treat patients at that point, this stretch-out will not
happen to these vessels that lead to a chronic problem.”
Bell compared the standard of care with that of people who have varicose
veins. Without treatment for lymphedema patients, the swelling and pain will
only increase.
“When we see patients with varicose veins, we tell them to use
compressions because it will only get worse,” she said. “This is the
same concept we would use following surgery.”
According to a 2008 study conducted by the National Naval Medical Center
and the National Institute of Health, and in collaboration with the University
of Michigan-Flint and George Mason University, early detection and management
can prevent lymphedema from progressing to a painful condition. The 4-year
study, which assessed 196 breast cancer patients, suggested that when detected
in its earliest stages, lymphedema could be treated with a more conservative
compression sleeve.
“This is an opportunity for fitters to move into a different realm
where they are assisting lymphedema patients in the reduction of symptoms and
halting the development of chronic problems,” Bell said. “They are
the ones that will fit the patient with appropriate compressions or cosmetic
pieces that will improve patients’ quality of life. They should not
underestimate the parts that they play.” — by Anthony Calabro
Disclosure:Bell does not have any
relevant disclosures.
For more information:
N.L. Stout Gergich, PT, MPT, CLT-LANA, L. Pfalzer, PT, MA, PhD, C.
McGarvey, PT, DPT, MS, B. Springer, PT, PhD, OCS, SCS, L. H. Gerber, MD, P.
Soballe, MD. Preoperative Assessment Enables the Early Diagnosis and
Successful Treatment of Lymphedema. Cancer.? 2008; 112;809-819.
