Monday, June 27, 2011

Why lymphedema now?

Three years post-surgery, I’m back to wearing a compression stocking this week with the sudden onset of lymphedema in my left foot and ankle. It’s a mild case and so far hasn’t seriously interfered with running, but it’s not something I take lightly.

The pooling of fluid in the affected limb is a common side-effect of lymphadenectomy, which is the surgery I had in 2008 to remove all of the lymph nodes in my left inguinal crease. I bought a compression garment then for swelling that never occurred. I’ve noticed since that my ankle and foot will sometime swell on days when I spend a lot of time on my feet, but it quickly resolves. Not so this time.

I was told by my radiation oncologist back when I was being treated that I should be extra careful with my leg. Wounds heal more slowly and are more prone to infection when local lymphatic drainage is impaired. I haven’t done anything stupid to hurt myself since, although I did scramble down a scree slope in the John Day canyon several days ago. It’s not likely but still possible that I strained a ligament or two. It apparently doesn’t take much to interfere with the new pathways that develop in the leg to compensate for the serious disruption of the lymphatic system caused by my surgery. Sometimes lymphedema just happens for no good reason.

While the lymphatic system is one of the least understood organ systems in the body, it is known that lymph fluid is pumped out of the limbs mostly by the action of the muscles. This is why inactivity is the worst thing for lymphedema; it’s hard to get fluid out once it’s accumulated. In my case, the strategy is for the compression stocking to help move excess fluid up to the thoracic duct and eventually back into the bloodstream. It’s not like I’m suddenly generating more lymph fluid than before, so it’s my hope that the transport capacity of the lymph pathways can be ramped up again.

I have separate appointments tomorrow with both my clinical oncologist and my surgeon, so they may be able to offer some insight on this subject. The main event, however, will be outpatient surgery for another subcutaneous metastasis on my upper left arm. This is met #11. I had a skin check with my dermatologist last week, and she didn’t notice anything else suspicious. Nothing ever seems to go completely to plan, but I’m hopeful this will be a simple In-N-Out Surgery (hold the burger and fries). After that, my summer truly begins.

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