How to respond to lymphedema emergencies?


Question from Kris: Thanks so much for sharing your expertise with us tonight. Can you talk a bit about lymphedema emergencies and how/when to respond?
Answers - Nicole Stout Great question!
Kathryn Schmitz There was a woman advocate survivor with lymphedema at the conference in Australia who regularly developed cellulitis and finds herself talking to doctors to try to get a prescription for antibiotics in remote areas of Australia. It's a difficult situation for her. Her response has been to have a script for antibiotics on her person at all times. That's one issue: having cellulitis and needing antibiotics immediately. I think it's inexcusable for physicians not to have that available to their patients if they have recurring cellulitis.
Nicole Stout I think we should define what an infection looks like for those who have never had one: rapid exacerbation of swelling in their arm, redness to the tissue, it will be warm to the touch, and it's typically painful. If a patient's limb or chest wall exhibits these signs they should proceed directly to get medical attention, because a cellulitic infection can first of all bring on lymphedema in someone who's never had lymphedema before. And secondly, it will spread very rapidly as the protein-rich fluid is a culture for bacteria. So I agree with Dr. Schmitz’s comments – patients need to recognize and respond quickly. If they're familiar with infections, if they've had recurrent infections, they should have access to antibiotics. Because Murphy's Law is that Friday night, 10pm, the redness and pain starts in their limb and having access to antibiotics prevents them the trip to the emergency room. It enables them to treat without having a seriously exacerbating situation.
Jennifer Sabol, M.D., F.A.C.S. One thing I would add is that, while sometimes you can get a pink tinge to a swollen limb, patients that have true cellulitis generally feel overall ill. They have a general sense of fever, chills, aches – much like they have the flu and the onset is fairly rapid. I agree it's never at a convenient time. So I encourage a lot of my patients if they're traveling outside of the area to simply fill a prescription and take it with them if they've had recurring episodes.

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, 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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