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TRUNCAL LYMPHEDEMA
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TRUNCAL LYMPHEDEMA

Had a bi-lateral mastectomy Sept. 16th came down 2 weeks later with lymphedema on arms and spread to my chest had a contract cat scan and the results wer increased intersitial markings with patchy involvement of right lower lobe suggest underlying infection chand plus left upper lobe scarring.  How does this happen and what does it mean Please help
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Lymphedema, unfortunately, is a common complication following mastectomy, especially if you have a lymph node dissection.  It is not curable, but it is treatable and, as described in the first abstract below, the treatment can be effective.  I suggest that you discuss the treatments described with your physicians (including your surgeon) and request a referral to a medical center that is experienced in the management of lymphedema. You might want to begin your search on this problem by visiting the web-sites of the M.D. Anderson Cancer Hospital in Texas and Memorial Sloane-Kettering Hospital in New York City.  Individuals trained at these institutions may be located in your geographical area.   The second abstract describes laser therapy.  This appears to be relatively new and the effectiveness of it is yet to be determined.  The following are recommendations from Abeloff’s Textbook of Clinical Oncology.

Weight reduction and extremity elevation are important measures that decrease edema. The individual must elevate the affected extremity at night. A sling may be used for the upper extremity, and elevating the foot of the bed on 4- to 6-inch blocks is recommended for edema of the lower extremity.
Custom-fitted elastic compressive garments (sleeves or stockings) are often worn during the day to maintain limb volume. The length of the garment should match the extent of disease. A comfortable fit is essential to ensure compliance.
Intermittent pneumatic compression with multichamber pumps removes excess fluid from the involved limb and may be helpful if used early in the course of disease, before the development of fibrosclerotic tissue changes. These devices apply a sequential pattern of compression to the extremity, permitting a physiologic distal-to-proximal milking action of the lymphedematous limb  Therapy is most effective if continued at regular intervals, and compressive garments should be worn between treatments. Cardiac failure, active infection, and deep venous thrombosis are contraindications to pump therapy.
Noninvasive complex lymphedema therapy, which consists of manual lymph drainage, compressive bandaging, and physical therapy exercises, may be used with promising resultsComplex lymphedema therapy facilitates lymph drainage by recruiting collateral vessels so that the lymphedematous area can be drained into normally functioning lymphatic systems. Recent series have demonstrated therapeutic responses in compliant patients. With regard to the X-ray shadows in the right lower lobe “that suggest infection, it should first be determined if these shadows are related to the lymphedema.  If so they may respond to therapy for lymphedema and not require antibiotic therapy.  Consultation with a pulmonary specialist (pulmonologist) might be quite helpful, in this regard.






Authors Full Name Karadibak, Didem. Yavuzsen, Tugba. Saydam, Serdar.
Institution School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey. ***@****
Title Prospective trial of intensive decongestive physiotherapy for upper extremity lymphedema.
Source Journal of Surgical Oncology. 97(7):572-7, 2008 Jun 1.
Abstract BACKGROUND: The aim of this study was to evaluate the effects of kinesiophobia, quality of life, and home exercise programs on women with upper extremity lymphedema. METHODS: A total of 62 women with lymphedema after breast cancer treatments were provided a protocol of complete decongestive therapy (CDT). This protocol involved manual lymphatic drainage (MLD), compression garments, skin care, and remedial exercises. The women were taken to a 12-week therapy program once per day, 3 days per week. A home program, consisting of compression bandage exercises, skin care and walking was recommended. Absolute volume and percentage of volume of the lymphedema were compared before and after treatment. The kinesiophobia, quality of life, and home-based program were assessed before and after physiotherapy. RESULTS: Strong correlations were found between the severity of edema and fear of movement. There was a significant negative relationship among the fear of movement, quality of life, and home-based exercises program. Mean initial lymphedema volume was 925 ml, and the percentage of lymphedema was 47.1%. After decongestive physiotherapy, the lymphedema volume and percentage were 510 ml and 21.3% (P < 0.05), respectively. There was also a trend toward improvement in general well-being (P < 0.05). CONCLUSION: In upper extremity lymphedema, the use of complex physiotherapy programs (CDP) can decrease edema and fear of activity, and increase the quality of life.

Authors Full Name Kaviani, Ahmad. Fateh, Mohsen. Yousefi Nooraie, Reza. Alinagi-zadeh, Mohammad-reza. Ataie-Fashtami, Leila.
Institution Tehran University of Medical Sciences and Iranian Center for Medical Laser Research, Tehran, Iran. ***@****
Title Low-level laser therapy in management of postmastectomy lymphedema.
Source Lasers in Medical Science. 21(2):90-4, 2006 Jul.
Abstract The aim of this paper was to study the effects of low-level laser therapy (LLLT) in the treatment of postmastectomy lymphedema. Eleven women with unilateral postmastectomy lymphedema were enrolled in a double-blind controlled trial. Patients were randomly assigned to laser and sham groups and received laser or placebo irradiation (Ga-As laser device with a wavelength of 890 nm and fluence of 1.5 J/cm2) over the arm and axillary areas. Changes in patients' limb circumference, pain score, range of motion, heaviness of the affected limb, and desire to continue the treatment were measured before the treatment and at follow-up sessions (weeks 3, 9, 12, 18, and 22) and were compared to pretreatment values. Results showed that of the 11 enrolled patients, eight completed the treatment sessions. Reduction in limb circumference was detected in both groups, although it was more pronounced in the laser group up to the end of 22nd week. Desire to continue treatment at each session and baseline score in the laser group was greater than in the sham group in all sessions. Pain reduction in the laser group was more than in the sham group except for the weeks 3 and 9. No substantial differences were seen in other two parameters between the two treatment groups. In conclusion, despite our encouraging results, further studies of the effects of LLLT in management of postmastectomy lymphedema should be undertaken to determine the optimal physiological and physical parameters to obtain the most effective clinical response.

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