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Swelling in the arm can signal lymphedema

First there was the breast cancer diagnosis. Then a year and a half after all the testing, surgery and chemotherapy was over, Sherry Churly learned she had yet another health hurdle to overcome: lymphedema.

It’s one of the chronic, sometimes “underemphasized” complications of breast cancer surgery that many patients don’t learn about until they’re already suffering from symptoms that include swelling, pain and in more serious cases, infection of the arm, said breast cancer surgeon Dr. Robert DerHagopian, medical director of the Baptist Health Breast Center.

But lymphedema isn’t limited to breast cancer — or women.

The primary form of lymphedema can be manifested at birth (called lymphedema praecox) and appears at the onset of puberty or later; lymphederma tarda, a rare form, sets in after age 35.

Secondary lymphedema is the most pervasive type.

“Certain surgeries, such as surgery for melanoma or breast, gynecological, head and neck, prostate or testicular, bladder or colon cancer, all of which currently require removal of lymph nodes, put patients at risk of developing secondary lymphedema,” according to the National Lymphedema Network.

The risk is higher with the higher number of lymph nodes removed and if the patient received radiation therapy. The condition can also be caused by damage to the lymph nodes or vessels from burns and other trauma.

In lymphodema, “there’s a problem with the mechanical transport of lymph fluid that can cause the lymphatic system, which eliminates toxins and bacteria from the body, to stop functioning normally,” said Maria Josette Mullins, director of Rehabilitative Services at Memorial Hospital Pembroke. This accumulation of protein-rich fluid may form — primarily in the arms, hands, feet, legs, face or chest — and lead to abnormal swelling that doesn’t go away on its own.

In more serious cases, it impacts a patient’s mobility and quality of life.

Lymphedema “is recognized all over the world as a hidden epidemic” impacting 300 million people, said Dr. John M. MacDonald, of the University of Miami’s Department of Dermatology and secretariat of the World Alliance for Wound and Lymphedema Care.

The condition can show up right away or years later.

“Sometimes the condition is latent and something can activate it, like a cut, an insect’s bite or the altitude on a plane,” said Ana María Mendieta, a lymphatic therapist and director of the Midas Touch Institute in Miami.

At first, “many patients are not aware of what is happening to them,” Mendieta said. “That can go on for a period of time until the lymphatic system is so filled up with fluid that it is unable to drain on its own.”

Mary Crosswell, a physical therapist certified in lymphedema treatment at South Miami Hospital, said what often alerts women “is that their bra becomes too tight in the affected shoulder, they feel a heaviness and they’re swollen around their shoulder and under their armpit.”

Churly, 55, said that when she first started feeling a heaviness in her arm, “I didn’t connect it to the breast cancer surgery.”

“The inside of my arm got bright red and was very hot,” said Churly, of Miramar, whose arm became infected. “In the acute stages, it was very painful. I could feel the heat more inside my arm than outside. It felt like I was burning from the inside out.”

Swelling in the arm can signal lymphedema

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