Question

I am 58, and I had a left mastectomy with axillary nodes removal 3 years ago. For the past 6 weeks I've had severe neck stiffness and discomfort on the left side of her neck. The doctor prescribed manipulation and muscle relaxants. About one week ago my left hand and forearm became very swollen, starting at the fingertips and going about 3/4 of the way to the elbow. No pain, just uncomfortable. Is this lymphedema?

Answer

I believe, as you do, that this is a blockage of the lymphatic system and residual scar tissue from your mastectomy that is causing the problem. For our bodies to function well, we need a lymph system to carry off wastes, toxins, proteins, viruses, bacteria, excess water, etc. from the connective tissue. The lymph system is obliged to remove these substances that cannot be carried by the venous capillaries, so we describe them as the lymph-obligatory-load (LOL).

The LOL is picked up by thin-walled, 'initial' lymph vessels that originate in the connective tissue and funnel LOL into 'collector' lymph vessels. The lymph vessels are fine, silk-like structures made of consecutive units called angions. These units function independently and shift lymph from one unit to the next through one-way valves. The larger angions have smooth muscle in their walls, which contract and squeeze the lymph to the next unit. Also, external compression forces from nearby contracting muscles, pulsating blood vessels, and body movements all help to shunt the lymph forward from one angion to the next. The massage and range of motion you were prescribed was aimed to do just that.

Lymphedema may be classified as primary or secondary. Primary lymphedema occurs if someone is born with too few lymph vessels to handle the LOL. Secondary lymphedema (your type) is caused by obstruction or obliteration of lymph vessels by surgery and/or radiation or trauma. This is usually seen after cancer surgery with lymph node dissection, radiation or both. Sometimes the edema begins immediately following surgery; however, it can occur at any time following the procedure. If left untreated, the excess protein remaining in the tissues can cause fibrosis or scarring, making it even more difficult for the lymph vessels to function.

There are many ways to treat lymphedema, depending on the amount, the extent of the surgery, and residual scarring and the time after surgery. If you haven't already, see the surgeon who did the mastectomy or your family doctor for referral.