This next week I will visit with Jean-Paul Belgrado, PT, a leading Belgian researcher from the Universite Libre de Bruxelles who has specialized in the field of lymphedema for over 30 years.
He has specialized in mapping the lymph system with the use of lymphoscintigraphy. In his lab, he uses a specialized colloidal protein with a radioactive dye and he injects this into the back of the hand and then watches as the lymph system does its job pumping the lymph fluid to the heart. He projects this on a screen overhead and then they determine where the possible obstructions are with the lymph system in patients with lymphedema. This then enables the physical therapists to reroute the lymphedema around the areas of compromise and have more successful outcomes for their patients.
I am excited to see his lab and their hands-on techniques. Currently this technology is not available in the US, but we know that approximately 20 percent of patients who have surgical interventions for breast cancer will get lymphedema. What we want to know is why do the other 80 percent have no side effects from their surgical interventions, because then this will help us determine how to prevent these side effects for the other 20 percent.
Here are some of the possible reasons why lymphedema can happen after breast cancer:
Surgical Intervention: What type of breast cancer surgery did they have? Was there an axillary resection with lymph nodes removed? Or was it only a sentinel lymph node? If there was an axillary dissection performed, was the sheath of the axillary vein compromised when the nodes were removed? Where are the scar lines located? Are there multiple scars lines blocking the fluid flow patterns?
Chemotherapy: It has been evidenced that certain drug interventions produce an inflammatory response and this increases the possibly of lymphedema. A physician in the EU has recently documented a list of meds that have been noted to increase this level of edema and we are awaiting his research data to be published.
Radiotherapy: Research indicates that with radiation of the breast tissue and the axillary region you can compromise the fluid movement patterns of the lymph system. All patients who have had radiation need to have an evaluation to determine skin integrity and scarring in the area of radiation and surrounding tissue because this can block the lymphatic flow watershed patterns.
Scar tissue: The scar lines are significant in how the pattern of fluid can move. If they are restricted, thick, hard and immobile then back flow of the fluid can occur around and behind the scar lines.
Genetic: There appears to be familial patterns due to genetics towards developing edema.
Physical Activity: What is your level of physical activity at work, home and in you community life? There must be a balance in your activity level, where you are activating the muscle pump, but not increasing the level so high, with such repetitive activities, that you create an inflammation.
Body Mass Index: The level of obesity present affects the amount of fluid that might occur. The higher the BMI the greater the likelihood of edema that can occur especially if over 30 percent.
The above list needs to be considered and looked at to determine if you are at risk for lymphedema. Because of this, all breast cancer patients should have a base line examination with a physical therapist trained in this type of care, as soon as their drains are removed or 12-14 days after surgery so that lymphedema issues can be prevented and cared for early on if they are at risk.
Sheree DiBiase, PT, and her staff can be reached at Lake City Physical Therapy (208) 667-1988 or in the Spokane Valley office at (509) 891-2623 for a baseline evaluation, prevention and a complete care program after breast cancer surgery. She has a specialization in breast cancer care, and has trained at Stanford University in lymphedema. Don’t wait, you are in charge of your own health care. Come and see us so we can help you stay well.