Guaranteed way to prevent lymphedema?
Meet the Experts
Kathryn Schmitz, Ph.D., M.P.H., F.A.C.S.M. is assistant professor in the Division of Clinical Epidemiology at the University of Pennsylvania and adjunct associate professor in the Division of Epidemiology at the University of Minnesota.
Nicole Stout Gergich M.P.T., C.L.T.-L.A.N.A. is a physical therapist and lymphedema specialist at the Breast Care Center at the National Naval Medical Center. She is also the president of the Oncology Section of the American Physical Therapy Association, and has previously served on the Medical Advisory Board and research committee for the National Lymphedema Network.
Jennifer Sabol, M.D., F.A.C.S. is a breast surgeon who directs the newly developed Breast Care Center at Lankenau Hospital in Wynnewood, Pa. Among her many interests, Dr. Sabol spearheads several research initiatives to advance the care for women with breast cancer and improve methods of breast cancer detection and treatment.
Question from Doris: Is there any 100%-positive way to prevent lymphedema?
- Answers —Nicole Gergich, M.P.T., C.L.T.-L.A.N.A. : I think the more appropriate way of looking at lymphedema is looking at it in terms of risk reduction. I think that we familiarize ourselves and our patients with how they can reduce their risk of first developing lymphedema. But secondly, if they have lymphedema, how they can reduce their risk of seeing that condition advance? There are excellent evidence based guidelines that have been offered by the National Lymphedema Network, that focus on reducing risk through skin care, prevention of infection, and just taking care of the arm with activity.
- Jennifer Sabol, M.D., F.A.C.S.: We get a lot of questions from other primary care providers about when it's safe to do things like blood pressure, putting IVs in someone's arm, etc., and there are some perceptions that if the arm hasn't swelled after 1 or 2 years, that it's safe to do these normal medical procedures. I think a lot of patients would like to know your opinion on that.
- Nicole Gergich, M.P.T., C.L.T.-L.A.N.A. : Again, if we look at the literature, it is surprisingly scant in these areas. Venipuncture is one thing; actually dropping an IV is another thing; glucose-monitoring finger sticks is another thing. So 3 forms of skin puncture, just as an example. We don't have the evidence to say one is safer or more detrimental than the other. We do advocate for their patients to keep their skin integrity maintained, so it stands to reason we'd avoid those things on an affected or at-risk limb to avoid an infection. Again, it's a mechanism of risk reduction. However, what we need to understand to answer Dr. Sabol's question is that once the lymphatics have been damaged or removed, they never regrow, so that patient remains at risk for life. So I don't think that we can say that in a period of time that it is safe for us to undertake activities that we know may increase the patient's risk.
On Wednesday, April 16, 2008, our Ask-the-Expert Online Conference was called Preventing and Treating Arm Lymphedema. Kathryn Schmitz, Ph.D., M.P.H., F.A.C.S.M.,Nicole Stout Gergich, M.P.T. C.L.T.-L.A.N.A., and moderator Jennifer Sabol, M.D., F.A.S.C. answered your questions about ways to prevent and manage lymphedema.
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