Judy Oakley, a 66-year-old breast cancer survivor, was enjoying a months-long absence of any signs of disease when she noticed unusual swelling in her left arm. A trip to her Novant Health doctor confirmed that she had a new condition to deal with – lymphedema.
Lymphedema is a common side effect of breast cancer treatment. When a patient’s lymph nodes are removed as part of cancer treatment, the body can no longer properly drain fluids, which can lead to painful swelling in the arms or legs. (Edema is the medical term for swelling.) Older breast cancer patients are particularly susceptible and have been infrequently studied.
If left untreated, symptoms may eventually sideline patients, as it causes their arms or legs to swell to the point of immobility. But because Judy knew the signs and symptoms, she insisted on a referral to a specialist right away. Since then, she has been working with a physical therapist to offset any severe symptoms.
Patients can live with lymphedema by staying active and engaging in physical therapy to alleviate swelling, according to Patricia Monroe, a physical therapist at Novant Health Martinat Rehabilitation Center in Kernersville.
“A lot of times, with active exercise, you see the swelling start to disappear,” Monroe said.
A new routine
Oakley believes that educating herself prevented her lymphedema symptoms from worsening. She read all the material given to her when she was first diagnosed with cancer. “Listen to what your specialist tells you to do, because I’m sure that’s why I haven’t had a whole lot of trouble.”
Since her diagnosis, Oakley has had to adjust to a series of lifestyle changes, which she calls “an inconvenience, to say the least. It’s one more thing you have to tend to.” Beyond the physical factors, the emotional effects are an added challenge: “It’s a constant reminder that you’re a cancer patient.”
Oakley has undergone a series of treatments since her breast cancer diagnosis: in 2007, a bilateral mastectomy, followed by chemotherapy; radiation in 2008; and reconstruction surgery in 2010. When her cancer returned in 2015, she had radiation to treat two metastasized tumors on her spine.
“I’ll be in treatment for the rest of my natural life,” she said. “But I think it’s amazing that I’m still here, and functioning as well as I am.”
Older women at higher risk
Doctors need to pay more attention to patient symptoms that may be caused by lymphedema, according to Dr. Judy Hopkins of Novant Health Oncology Specialists in Kernersville.
Hopkins has been studying cancer for over 30 years. Her recently published research linked lymphedema to breast cancer treatment and noted, in some cases, that doctors have dismissed older patients’ complaints that could be linked to the condition. Doctors need to be more aware that women with cancer who are 65 and older are at high risk for developing conditions like lymphedema, according to her research.
One key finding was that women report multiple symptoms happening post-mastectomy and post-lumpectomy. “Physicians underestimate how significant patients’ complaints are,” she said.
Her research found that 75 percent of elderly women undergoing standard therapy for breast cancer experience “potentially debilitating” conditions.
“I am much more likely now when patients complain,” she said, “to refer them to physical or occupational therapy to help them maintain their high quality of life.”
Physical therapy, specialists are vital
With early intervention, the right specialists (Certified Lymphedema Therapists, or CLTs) and physical or occupational therapy, lymphedema can be managed.
Lymphatic fluid can be removed through skin stretching and muscle pumping. These exercises alleviate swelling and promote drainage because they help stretch the skin over large clusters of lymph nodes. The movement also activates the muscles beneath the vessels to help move the fluid through. Other therapy methods for managing lymphedema include Manual Lymphatic Drainage (MLD) massages, compression bandages and abdominal breathing.
Monroe works with lymphedema patients and said finding a CLT is key. “It completely changes the picture,” she said. “The sooner you get treatment, the better the outcome.” While Monroe works with patients in the clinic, she also teaches them how to manage the condition on their own at home. “Knowledge is power and being educated about lymphedema helps patients to make good decisions and stay in control.”
Oakley diligently keeps up with her exercises every day, wears a compression sleeve on her arm and visits Monroe for weekly treatment. While lymphedema remains an occasional nuisance, the swelling is under control and Oakley continues enjoying her favorite activities, like gardening.
The most important step you can take? Educate yourself, she said. “You can make good decisions if you know what you’re dealing with. And the right decisions include finding a lymphedema therapist.”
Oakley’s improvements are great news to Monroe, who loves celebrating her patients’ successes. Her patients don’t always know it, but she feels a close connection to their journey to recovery. Monroe lost her mother to cancer just five months after a diagnosis, and she realized that helping cancer patients was her calling once she started rounding at the hospital.
“Oncology patients are my great loves,” she said. “It just fit, and it’s the people I connect with.”
For more information on cancer care at Novant Health, click here.
(Photo: Patricia Monroe, a physical therapist at Novant Health Martinat Rehabilitation Center in Kernersville has worked with breast cancer survivor Judy Oakley to manage lymphedema, a common side effect of breast cancer treatment.)