Lymphoedema is a chronic swelling of the limb, caused by a primary congenital condition, or a secondary trauma or surgery to the lymphatic structures. Lymphoedema of the arm is a common side effect of breast cancer treatment (1,2), with varying incidence depending on the type of treatment received.
Not all men and women who undergo treatment for breast cancer will develop lymphoedema, but it is important to know how to reduce the risk of developing this condition and what signs and symptoms to look out for. There is currently no cure for lymphoedema, but it is a condition that can be managed effectively if identified at an early stage.
One of the questions that I face (and which I am certain many of us do) concerns the use of alternative therapies. Iron chelation therapy, high-dose vitamin C infusions, Chinese herbs—interest in these therapies and others like them are driven by word of mouth (“a friend of a friend”), claims on websites, and patients’ own curiosity. Cancer is serious, and let’s face it—modern medicine has not (yet) found the cure.
To reduce the risk of infection in highly immunocompromised patients, prophylactic antibacterial, antifungal and antiviral agents are frequently prescribed and patients are routinely advised to reduce their risk of exposure by avoiding soil, plants and cut flowers due to the presence of Aspergillus and other moulds and Nocardia spp.
Other recommendations to limit exposures include the avoidance of water-retaining materials given their association with Pseudomonas aeruginosa, raw vegetable sprouts (Escherichia coli), undercooked eggs (Salmonella enteritidis), fresh salsa, and berries (Cyclospora etc.) among others. These recommendations do not comment on the infectious risks of medical marijuana substance now legal.
It was a call from a referring physician who wanted the patient to be transferred to our major academic center. The patient had a history of a lethal malignancy in a very advanced stage. The patient was already outside the bell curve, for she had survived far longer than expected for a malignancy with such a dismal prognosis. The patient presented with bleeding, which was alarming to the patient and family and also difficult to manage in a small town hospital. Although the patient had a do-not-resuscitate (DNR) order, it was decided that the patient would be transferred to our major academic center for further care.