LymphLink Question Corner - Archived from July 2000
Bonnie B. Lasinski, MA, PT
Q: My mother is having blood pressure taken from her legs, but she needs to know: what the BP should read; whether she should be lying down or sitting up; should it be taken above or below the knee? She is getting opposition to this from a few nurses at her doctor's office. Also, will blood taken from her feet rather than her arm react any differently? Any help you can give her on this would be greatly appreciated.
A: Lying down is probably more comfortable, with the cuff on the thigh above the knee and the stethoscope behind the knee, taking the reading. No, the blood from a vein in the foot should not react differently to any tests they wish to do.
Q: I have just been diagnosed with shingles (very painful) and they are spreading toward my lymphedema side. I have been managing my LE for two years, but I m frightened that this could aggravate the LE. I am treating with w/Famvir and patience. The clinic analyzing the shingles did not seem knowledgeable about a possible impact on LE. Can you help me with this?
A: I have treated several patients who developed shingles either before or after CLT treatment, often on the trunk on the lymphedematous side. In some patients, the inflammation did worsen the swelling temporarily, but with a bit of extra care, this swelling was resolved. Those who were maintaining good reduction prior to the shingles found that they were able to continue this, or regain their reduction fairly quickly as the shingles resolved. Prevention of secondary infection is the most important thing for you now. I would recommend applying antibiotic ointment to any lesions that are open and oozing to help prevent this. Monitor your skin very carefully. If there is any sign of even a local infection, consult with your physician about starting systemic antibiotics to avoid a local infection from progressing rapidly into a more serious systemic infection.
Q: I have secondary LE in my right arm post-mastectomy and radiation. I've been through the Vodder treatment and have several different garments, including a Reid Sleeve. Lately I have developed pain above my elbow. Sometimes when I move it, the pain feels like a bruise, but it is not bruised. Is it normal to have such pain? I have had LE since 1997.
A: You do not mention what type of work you do that might cause this. Have you done any unusual activity lately? Pain is not normal and is a sign that something is wrong. It can be as simple as muscle ache from overuse, or as complicated as bursitis/tendonitis, or nerve compression perhaps from a Reid Sleeve that you are tightening too much near the elbow area. For problems like this, you have to be a good detective. Try to think about your daily activities and even how you sleep at night. For example, I had a heavy patient w/a similar complaint. Finally, she realized she was leaning heavily on her arm on the metal strip of the car door, to position herself in her car seat (she was short and stout). As soon as she padded the car door with foam, the pain went away. That simple. Yet, sometimes pain is a sign of something more serious and I would recommend that you see your doctor for a check-up. Perhaps your compression garments don't fit properly. Consult with an experienced fitter/lymphedema therapist who can advise you.
Q: I had a lumpectomy and node dissection 8-1/2 years ago and developed LE within a year of my surgery. I am very diligent in my self-care, i.e., self-MLD, compression sleeve every day, bandaging every night, professional MLD once a year. One question that no one has been able to answer for me is how pregnancy affects LE. One doctor told me that I shouldn't wear a sleeve OR bandage during pregnancy, while MLD therapists tell me I shouldn't alter my routine at all. (FYI: I m not pregnant right now.) I d really like to understand what will happen: can the LE become worse, and how best to continue treatment during pregnancy? Thanks!
A: There is no documented scientific evidence anywhere stating that compression garments should not be worn during pregnancy, or that MLD is contraindicated during pregnancy. Of course, modifications in the abdominal breathing/abdominal clearance would be made during pregnancy. In fact, for lymphedema of the legs, it is essential to maintain compression during pregnancy, to avoid worsening of the swelling from abdominal pressure on the great veins. There is an increase in total blood volume during pregnancy to support the fetus. This should not have a direct effect on the lymphedema in your upper extremity. My suggestion would be to continue to follow your usual lymphedema management program, including wearing your compression garments and bandaging at night if that has been your routine. I know that you are not pregnant now, but I hope that this information will allay your fears about your lymphedema worsening during pregnancy. You can safely continue to do your self-care program, perhaps with some modifications, if you do become pregnant.
Q: I have primary LE in both feet. I am currently trying to lose weight and a friend suggested that I try jogging instead of walking (I've been walking on a treadmill at home for 30 min/three times a week). I told him that I am not supposed to run because I have LE (I read in a book that if you run or jump it can cause the LE to worsen). He thought that the circulation would actually help my legs. Which is true?
A: First of all, congratulations on being proactive in your personal weight loss program. In terms of aerobic activity to burn calories, walking at a pace of 4 miles per hour (fifteen minute miles) for at least 45 minutes daily will help you lose weight safely, while tightening and toning your body. Daily, brisk walking will burn calories nicely. Exercising 3x/week for only 30 minutes may not be enough for you to lose weight. It is not necessary to jog, although jogging is not "contraindicated" if you have LE. Each individual reacts differently to different activity levels. I have had some patients who did well jogging, despite their lower extremity lymphedema, although I must say that none of them was overweight and they were runners before they developed lymphedema.
The idea that better circulation will help the LE in your legs is not entirely true. Remember, the problem with LE is that there is not enough lymph transport capacity for the normal amount of lymph fluid that is produced. When you exercise, the muscles need more blood to supply them with oxygen. With the extra blood, comes the extra lymph fluid. That is the problem with LE and "too much exercise": there is extra lymph to transport in a system that is already overloaded.
Only you can discover where your "overload" point is in relation to exercise. My suggestion would be to increase your activity level slowly so that you can monitor its effect on your legs/feet. I hope that you have properly fitted compression garments to wear, which will assist your "muscle pump" to move the extra lymph fluid that is produced during the exercise. Good luck and here's to a healthier, trimmer you in 2000!
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