LymphLink Question Corner - Archive from July 1998
Judith Casley-Smith, PhD, MD
Q: In February 1998, I had a lumpectomy with lymph node removal. When necessary, I have used acupuncture successfully for the past 15 years. I have been told not to do this anymore, but I'm not sure I understand why, since the acupuncturist washes down the area with alcohol, uses sterile needles which are then discarded and washes the area a second time after treatment. I get the feeling my doctor just doesn't believe in acupuncture and this might be the reason for his feelings on the subject. Is acupuncture really contraindicated for lymphedema patients and, if so, why?
A: This question brings another question to mind. Have you been having the acupuncture in the affected limb? If the acupuncture has been in the affected limb, then we would advise a patient to stay away from any potential needle sticks in spite of the best-intended sterile technique. If the needle stick of the acupuncture is in a remote part of the body, then the likelihood of infection to the affected limb certainly lessens, but does not completely go away. I would say acupuncture is contraindicated for lymphedema patients - certainly in the affected limb - and alternate modes of therapy should be tried before subjecting oneself to acupuncture generally when lymphedema is present. Those few patients who have tried it have reported no benefit or reduction in the lymphedema.
Q: I am very concerned. After 8 years of living with a large swollen arm and protecting it, I found out I now have a malignant tumor in my opposite breast and need more surgery including sampling of axillary lymph nodes. I was told never, ever to have needles, blood pressures, or blood drawing from the site of surgery. What other options do I have? The idea of two swollen arms is overwhelming. Please help me. My doctor told me this is nonsense.
A: Firstly, you may not get a swollen arm from the second operation. Secondly, it is essential that the tumor be removed and lymph nodes involved treated. This is to save your life. Drips can be inserted and both blood samples and blood pressures taken from one of your legs rather than the lymphedematous arm. You have every reason to be concerned, but providing certain pre-cautions are observed, the risk of further lymphedema will be lessened. You will get some post-operative swelling - this is unavoidable - but this will hopefully resolve after a few weeks. A compression sleeve worn on the lym-phe-dematous arm would help to prevent further swelling.
Q: Does anybody in your group have an understanding of the impact of medications, in particular, hormones? I have primary LE in my right leg since puberty and have been able to maintain it fairly well with a compression stocking and exercising (swimming, walking). I am only 43 years old and recently went into early menopause. My gynecologist told me that I need to start hormone replacements. I asked him if this had an impact on LE, and he did not know. Can anybody help me?
A: Unless your lymphedema worsened at times of your menstrual cycle, it would seem unlikely that H.R. therapy would affect your lymphedema. Your case is very different from that of a post-mastectomy patient where maintaining the levels of estrogen are usually not recommended. F.Y.I.: Patients with vascular disease should be monitored closely, since hormones can cause clotting.
Q: Can you please provide me with information on the use of antibiotics when an insect bite or cut occurs on the limb. How can one use insect repellant on the limb and not ruin the support garment?
A: I would use an anti-bacterial (cetrimide) preparation on minor injuries rather than an antibiotic ointment. However, if the area of inflammation increases - becomes larger, hotter and redder - then you must use antibiotics orally. Many insect repellants are in a spray (alcohol-based preparation) which dries very quickly and should not hurt a garment. (French perfume also works as a mosquito repellant and smells much nicer!) A long-sleeved or long-legged white garment over the affected area also will protect you and deter mosquito bites.
Q: I just started my CDP program and have had ongoing problems with terrible itching from the bandages. I literally have to take them off in the middle of the night because they are so irritating. What can I do? I know how important it is to keep them on. Any suggestions?
A: Are you using a "Stockinette" sleeve and proper padding under the bandages? These products can be obtained in synthetic materials which should avoid any allergic reaction. Are bandages being applied tightly enough to prevent slight movement and, therefore, skin abrasion (rubbing)? Are you moisturizing your limb before the application of the bandages? This will prevent dryness. It may be the heat of the bandage layer that is producing the irritation. Try to keep the limb as cool as possible and, if you wake up in the night, exercise it a little. Do try to keep your bandages on, or you will not get the desired reduction.
In Your Opinion:
ATTENTION CLINICIANS: The following challenging questions are in need of an answer. What is your opinion? Please send, fax or e-mail your input to nln [at] lymphnet [dot] org.
Q1: I have had lymphedema in the extremities since 1992 and now have blisters on the labia. Does anyone know how to treat this condition?
Q2: I am an attorney taking on a case where a LE patient almost lost her leg due to infection after having eight teeth pulled. NO antibiotics were prescribed by the oral surgeon. Are there any clinical studies or materials about the use of prophylactic antibiotics before oral surgery?
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