This is a poster created to find others who may have Radiation Induced Lumbar Plexopathy … Have you had Pelvic Radiation? Are you having difficulty walking? Do you have Peripheral Neuropathy? Do you have Pelvic Radiation Disease Symptoms? You may have RILP
Sharing this article that I posted on Life in a wheelchair. Chris is doing some great work in the cancer community so I wanted to share this with as many people as possible … Thanks Chris for giving me this opportunity
Thank you, thank you so much for all the support you have given me in the creation of my New Blog, it has been just amazing with over 500 views in just one day. I have also had many, many beautiful messages of support and encouragment which have really lifted me. When I started to blog I had no idea how it would go, if there would be any interest but it has spread across the world and is now read in 127 countries, truly amazing. There have been nearing 100,000 views and 272 posts. Many if you have created posts for me and I hope you continue to do so. Just email me at email@example.com to share your story. I would still love to hear from someone who has had the lymphatic lyposuction, SAPL proceedure.
I would also like to ask everyone no matter where you live to encourage your goverment to give support to Lymohoedema. It has been far to long that Lymphoedema has been ignored by goverment health programs. Everyone should have access to the treatment that they need and the garments that they need to wear. The burden should not fall to the patient, in which case many do not get the care that they need and the Lymphoedema becomes worse and worse. Please give Lymphoedema and voice, a loud voice. Lets hope that more high profile people like #Kathy Bates start to speak out instead of hiding their problem. We have become a “cyber community” of fellow lymphies who are there to connect and support each other, we are no longer alone or silent.
Feel free to share with others. It can be distributed via social media, reblogged or added to websites. Please do not change the original content and provide appropriate credit by including the author’s name and a link to this blog.
I am sure you are wondering when I was going to write again!!! I am sorry I have been rather slow at creating new posts. A few weeks ago I wrote “Sometimes Life does not go as you Expect,” which explained what had been happening in my life over the last six months. These events have really turned my life upside down but lately I have started to feel more settled and have felt the need to write again. Writing for me is a form of mindfulness that helps to keep my head a little quiet!! The last few days I have been thinking of how to approach my blogging and have decided to create another blog that embraces my new “Life in a Wheelchair”
Do not worry though as I will still continue this blog, “My Lymph Node Transplant,” as I believe it has become a wonderful resource for all those with Lymphedema, especially those who are considering surgery or who have had surgery for their Lymphedema. I love all the interaction that happens between people in the comments and the emails that I get from people. Please still continue to send me your stories so that I may post them, as by sharing our experiences we help each other. We have truly become an online community.
Just to keep you up to date with my own LNT which was now two and a half years ago. My leg is going well even though not an ideal situation in the wheelchair all day! My leg has good shape, knee and ankle bones show. I wear no compression at night and not everyday. I can go for a while without and then I wear it for a few days and it goes back to normal. Me leg is very soft, which is important, as that means fluid can be moved where fibrous tissue cannot, also still no infection which for me is a huge plus. My ankles do swell by the end of the day, due to sitting in my wheelchair, but this is Oedema rather than Lymphoedema, this swelling goes down each night. So I am happy with the results, not a cure but much better control and response to compression, MLD and elevation. This surgery is not suited to everyone but there are other options available now, lymphatic Liposuction and Lymphatic bypass. There continues to be improvement all the time as the surgeons become more experienced and document their work.
If you would like to follow my new blog then this is the link https://lifeinawheelchairblog.wordpress.com There have been a few teething problems with setting up the blog and some people have had difficulty following, I hope these are all resolved now, you do need to follow the new blog separately even though you are following this blog. I look forward to sharing my new experiences with you. Wishing you all well, Helen xx
I was very excited yesterday when I found I had been given an award for the… Sisterhood of World Bloggers… worldwide there are thousands of blogs, so it is always a great honour when someone finds my blog worthy of an award. This award was given to me by Jazzybeatchick Writes … this is a great blog which I really enjoy reading for her content, music and pictures..
With these awards there are always rules to excepting and passing the award to others… so here goes!!This is a link to Jazzybeatchicks nomination post…
1 Provide a link to and thank the blogger who nominated you for this award.
2 Answer ten questions.
3 Nominate 10-12 blogs that you find a joy to read.
4 Provide links to these nominated blogs and kindly let the recipients know they have been nominated.
5 Include the award logo within your blog post.
~~Ten questions to be answered~~
1 Your favorite colour … Red /orange
2 Your favorite animal … Dog
3 Your favorite non-alcoholic drink … Mango Juice
4 Facebook or Twitter … Facebook
5 Your favorite pattern … Swirls
6 Do you prefer getting or giving presents… oh I like both giving and getting!!
7 Your favorite number … 4
8 Your favorite day of the week … Saturday the start of the weekend!
9 Your favorite flower … Lilies
10 What is your passion? … Travel
Well as always when there are rules I am inclined to bend or break them!!! I find it impossible to pick which 10 or 12 blogs I should choose, as all the blogs I follow I enjoy, you can see these listed at the end of my posts. How ever I have decided to give this to just one post that has a special place in my heart at this time…
In this blog Mogatos says…. I never really worried or thought much about cancer … until my sister was diagnosed with breast cancer at the age of 28. At the time, I was 21 years old, naive, in college, worried about what plans I had for the weekend, and didn’t really grasp what that meant. More than ten years later, my sister is gone, my mom is gone (ovarian cancer), and I just had a prophylactic bilateral mastectomy and started the breast reconstruction process on January 22, 2013. I said NOPE to breast cancer.
I am pleased to pass this award to Mogatos so you can read this courageous women’s story…
This is an opportunity for patients who have had breast cancer treatment to be part of a clinical trial in New York … Thank you to the Lymphatic Reasearch Foundation for bringing this to my attention.
Innovative Technique Seeks to Prevent Lymphedema in Breast Cancer Patients
Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia University Medical Center is enrolling patients in clinical trial
NEW YORK (Jul 23, 2013)
A team of surgeons and members of the breast cancer program of the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center is conducting a two-year pilot study of an innovative microsurgery technique coupled with imaging technology to not only prevent lymphedema but also potentially detect and treat it early.
Lymphedema, the accumulation of lymph fluid in the arm and painful swelling due to blocked lymph drainage, occurs in up to 13 percent of breast cancer patients after sentinel node biopsy and external-beam radiation, increasing to 40 percent following complete axillary lymph node dissection (ALND) and radiation.
Lymphedema can also affect other cancer patients. Surgery and radiation after lymph node removal can cause scarring that blocks the lymph ducts, not only in the underarm but also in the legs, groin, pelvis, or neck after treatment for uterine, prostate, ovarian, or prostate cancer, as well as lymphoma and melanoma.
It can be difficult to treat lymphedema, which often requires lifelong therapy with compression garments to prevent lymphangitis (inflammation) and cellulitis in the affected limb. The condition can greatly affect quality of life for breast cancer patients and, some studies suggest, is associated with a two-to-three-fold increase in mortality in the six years following a cancer diagnosis.
The current study of the lymphatic microsurgical preventive healing approach (LYMPHA) is the first to be conducted outside of the University of Genoa in Italy, where it was developed. Dr. Sheldon M. Feldman, the principal investigator, was invited by the developers, Drs. Francesco Boccardo and Corradino Campisi, to observe their team in 2012.
The LYMPHA technique creates a bypass to restore lymphatic flow by connecting lymph vessels to a branch of the axillary vein, a pathway normally severed by node removal or blocked by tissue fibrosis resulting from radiation, says Dr. Feldman, chief of the Division of Breast Surgery and the Vivian L. Milstein Associate Professor of Clinical Surgery at NewYork-Presbyterian/Columbia University Medical Center.
Previous techniques for preserving lymphatic flow were lengthy and complex, and surgeons could not predict which patients would develop lymphedema or benefit from intervention. The LYMPHA bypass adds only 20–30 minutes to breast cancer surgery and ALND. “In addition to removing all potentially cancerous lymph nodes, we can now restore lymphatic flow and reduce the patient’s risk of developing lymphedema,” says Dr. Feldman.
Prior to ALND, a blue dye normally used to identify sentinel nodes is injected into the upper arm to map the lymphatic circulation from the arm. During the node dissection, the surgeon preserves a branch of the axillary vein and keeps a suitable length for reaching the lymphatic vessels.
The vein connection, or anastomosis, is then performed by a microvascular surgeon, using a sleeve technique in which the lymphatic vessels are inserted into the cut end of the vein to restore normal lymph flow. A mastectomy is performed at the same time as the node removal and LYMPHA procedure.
Before their surgery, study patients undergo an imaging technique known as lymphoscintigraphy, using a radiotracer such as technetium, and bioimpedance spectroscopy with a device called the L-Dex, to establish baseline lymphatic volume in the arms.
In addition to the regular follow-up visits normally scheduled after an ALND, postoperative monitoring includes physical exams for lymphedema, lymphoscintigraphy, and L-Dex bioimpedance spectroscopy to confirm that the LYMPHA bypass is open and functioning.
“We actually use the L-Dex routinely before breast cancer surgery. Then if patients need lymph node dissection, we carefully monitor them with the L-Dex. If they begin to develop increasing lymph volume in their arm, even if there’s been no external change, we know they are on their way to developing lymphedema,” says Dr. Feldman. “By using a support sleeve and seeing a physical therapist (for range-of-motion exercises), they may never experience lymphedema.”
This study is part of a comprehensive lymphedema management in the breast cancer program at NewYork-Presbyterian/Columbia encompassing education, lymphedema prevention, and, in the future, potential treatment of patients with lymphedema who have not responded to decongestive therapy, which involves wrapping of the limb and specialized massage for drainage.
The LYMPHA pilot study seeks to enroll 10 patients with confirmed nodal metastases whose veins are suitable for the bypass.
The next step would be a multicenter trial throughout the U.S. to confirm the efficacy of the LYMPHA procedure. Eventually it could become the standard of care for cancer patients needing ALND. The lymphatic-venous bypass could also potentially be used to treat patients with lymphedema that is not well controlled with decongestive therapy. The earlier treatment begins, the more likely the condition is to be reversible.
Says Dr. Feldman, “We can now help patients maintain a normal quality of life by most effectively preventing and treating lymphedema without compromising their cancer treatment. We never want to let quality of life trump the cancer treatment. We want both—we don’t want people to experience lymphedema.”
To be considered for the study, breast cancer patients needing lymph node dissection should contact Amiya Vaz at 212-305-1317 or by email at: firstname.lastname@example.org.
During surgery for various cancers Lymph nodes may be removed and radiation given. This leaves the effected limb at risk of Lymphedema. Myself I have one leg with Lymphedema and one at risk, as Lymph nodes were removed on both sides followed by radiation. I therefore treat the at risk limb with great “respect” to protect it from Lymphedema. Once Lymphedema starts that is it, there is no going back, so if there is a way to stop it starting I encourage you to use it!! I thought this article from the American Cancer Society gave very good advice, a great deal of which is important for limbs which are at risk or which have Lymphedema…taking these precautions may also stop your Lymphedema worsening.
“For people at risk of Lymphedema
At this time there are no scientific studies to show that lymphedema can be prevented. Still, most experts say following these basic steps might lower your risk of lymphedema, delay its onset, or reduce its impact.
Get regular medical check-ups.
Regular check-ups should include screening for lymphedema. If you’ve been recording measurements of the affected part of your body, this may be part of the check-up. Talk to your health care team about how often you should be checked.
After surgery and/or radiation, you will learn how the affected part of your body normally feels. Any changes in size, color, temperature, feeling, or skin condition should be reported to your doctor right away.
Try to get to and/or stay at a healthy weight.
We know that obese people are at higher risk for lymphedema. Talk to your health care team about what a healthy weight is for you, and get their advice on how to get to or stay at that weight.
It’s important to use the part of your body that’s been affected by cancer for normal, everyday activities to help you heal properly and regain strength. Using your muscles also helps the lymph fluid drain like it should.
Certain types of exercise can reduce your lymphedema risk, too, and some exercises can make lymphedema better after it starts. If you’ve had surgery or radiation treatment, ask your doctor or nurse when you can start to exercise and what type of exercises you can do. Avoiding exercise and allowing your body to get out of shape may lead to lymphedema and episodes of swelling that are sometimes called flare-ups.
But keep in mind that some kinds of exercise can increase your risk of lymphedema or make lymphedema worse if you already have it. Overuse, which can result in injury, has also been linked with the start of lymphedema in some people. Work with a well-trained fitness or health professional to design a program that’s right for you and starts at a low level of intensity and progresses slowly to avoid overuse.
Follow these tips for exercising safely:
• Use your affected body part as normally as you can. Once you are fully healed, about 4 to 6 weeks after surgery or radiation treatment, you can begin to go back to the activities you did before your surgery. But check with your doctor first.
• Exercise regularly, but try not to over-tire yourself. Before starting any exercises, talk with your doctor, nurse, or physical therapist. They can help you set goals and limits so that you can work at the level of activity that’s right for you.
• If the affected part of your body starts to ache or swell, lie down and raise it above the level of your heart.
• Avoid repetitive overuse of the affected body part. Sudden increases in how long or hard you work out might trigger or worsen lymphedema.
• Any exercise program should be started gradually, increased cautiously, and stopped if you have pain, more swelling, or other discomfort. Talk with your doctor if you have any of these problems. If they continue, ask about being referred to a lymphedema specialist.
Use of compression garments
Compression garments are fitted sleeves or stockings that can help control lymphedema. They can help prevent and reduce swelling by moving lymph fluid from the arm or leg back into the body. Careful fitting is needed and you should follow your health care professional’s advice on use and care of the garment.
Compression garments are most often used by people who already have lymphedema. But if you are at risk for lymphedema, you might want to use one to lower your risk in certain high-risk situations. For instance, lymphedema has been linked with air travel, possibly because of air pressure changes. But there are pros and cons to using a compression garment on long or frequent flights. Ask your doctor or therapist if you should be fitted for a garment to wear during air travel.
Do not use a poorly-fitting compression garment under any circumstances, as this may increase risk for lymphedema or make it worse if you already have lymphedema.
You usually do not need a compression garment to prevent lymphedema during exercise. But if you’ve noticed swelling while exercising, talk to your doctor or therapist.
Try to avoid infections, burns, and injuries.
Your body responds to infection, burn, or injury by sending extra fluid and white blood cells to the area. If lymph nodes and vessels are missing or damaged, it’s harder for your body to move this extra fluid, which can trigger or worsen lymphedema.
Some basic precautions, good hygiene and careful skin care may reduce the risk of lymphedema by helping you avoid infections, burns, and injuries. Follow these tips to help you care for the part of your body that had surgery and/or radiation:
• Keep the affected area clean. Careful skin care can help you prevent infections.
• Keep your hands, feet, and cuticles soft and moist by regularly using moisturizing lotion or cream. This will help keep your skin from chapping or cracking. Push your cuticles back with a cuticle stick while they are soft (after a bath) rather than cutting them with scissors. Try not to pick at or bite your cuticles.
• Clean and protect any openings in your skin caused by cuts, scrapes, scratches, bug bites, hangnails, or torn cuticles. See “How to care for cuts, scratches, or burns” in the section “Take care of yourself.”
• Watch for early signs of infection, like pus coming from a cut or scrape, rash, red blotches or streaks, swelling, increased heat, tenderness, chills, or fever. Call your doctor right away if you think you have an infection.
• Be extra careful when shaving, and use a clean razor on clean skin.
• Use an insect repellent to avoid bug bites when outdoors. If a bee stings you in the affected area, clean and raise the limb, put ice on the sting, and call your doctor if there are signs of infection (see above).
• Avoid activities that irritate or chap your skin.
• Protect your body, especially treated areas, from sunburn. Use a broad spectrum sunscreen that
is labeled SPF 30 or higher, and try to stay out of the sun between 10 a.m. and 4 p.m.
• Your affected limb might not sense hot or cold as well as it did in the past. Test bath water temperatures with an unaffected limb.
• Avoid extreme temperature changes, such as heat from hot tubs and saunas. If you use a heating pad or ice pack on the affected area, limit the length of time you use it until you know how your body will respond. Both heat and cold can damage tissues and can increase fluid build-up. Some doctors may advise you to stay away from all sources of extreme temperatures.
• Protect yourself against falls, fractured bones, and serious burns.
Be aware of cellulitis.
Cellulitis is an infection in the tissues just under your skin. Signs of this problem include redness, warmth, fever, pain, and flu-like symptoms. Report this urgent medical problem to your doctor right away. See the section “Take care of yourself” for ways to help prevent infection.
Cellulitis can lead to or worsen lymphedema. In fact, if it becomes a repeated problem, suppressive antibiotics may be used to keep it under control.
If your arm is affected
• Whenever possible, have your blood drawn, IVs, and shots given in your unaffected arm. Get flu shots and vaccinations in your unaffected arm or somewhere else. Let all your health care providers know that you are at risk for lymphedema.
• Wear protective gloves with sleeves when doing household chores using harsh chemical cleansers or steel wool, when gardening or doing yard work, and when working with animals that could scratch or bite.
• Wear a thimble when sewing to cut down on needle and pin pricks.
• Use oven mitts that cover your arms instead of hot pads. Be careful when frying foods, boiling liquids, and removing food from a microwave oven.
• Keep pets’ claws trimmed to avoid getting scratched.
If your legs are affected
• Always wear well-fitting, closed shoes instead of sandals or slippers. Do not go barefoot. • Keep your feet clean and dry. Wear soft protective socks (cotton or padded types).
• Dry the creases between your toes after bathing.
• Cut toenails straight across to help prevent ingrown toenails.
Try to avoid pressure or constriction.
Constriction or squeezing of the affected body part may increase the pressure in nearby blood vessels. This can lead to increased fluid and swelling (much like water building up behind a dam). Some people have linked this to the start of lymphedema. Here are some tips to help you with this:
If your arm is affected
• Wear loose jewelry, clothing, and gloves. Do not wear anything that forms a snug band around your arm or wrist. Be sure compression garments fit well and are worn properly. Clothing and compression garments should be supportive and have smooth, even compression.
• Do not use shoulder straps when carrying briefcases and purses.
• Wear a loose-fitting bra with padded straps that do not dig into your shoulder.
• Have your blood pressure taken on the unaffected arm. If both arms are affected, blood pressure can be taken on your thigh. Or, you can ask that blood pressure be measured by someone using a hand pump and stethoscope rather than using a machine; the machines often use high pressures for a longer time.
If your legs are affected
• Avoid socks, stockings, undergarments, or pants with tight elastic bands.
• Wear shoes that fit well.
• Try not to stand or sit in one place for too long (more than 30 minutes). Do not cross your legs when sitting.
• Most people with leg lymphedema benefit from wearing a compression stocking when up and walking around. A compression stocking can help squeeze the lymph fluid through the remaining vessels before it builds up. The stocking must be well fitted to apply the right pressure while avoiding too much tightness near the top of the stocking. Ask your doctor or physical therapist if you should be fitted for a compression stocking.
You can’t change the fact that you have or are at risk for lymphedema. What you can change is how you live your life – taking good care of yourself, making healthy choices, and doing what you can to make your body and your mind feel as good as possible.”
Thank you to the American Cancer Society for this information which is very helpful http://www.cancer.org/ for more information please visit their website…
I wonder if in the future Artificial Lymph nodes could be created….. Imagine the possibilities that could open up for the treatment of all types of Lymphoedema…it is good to see that research is being done in this area….
“The lymphatic research group is part of the biological sciences platform and the Brain Sciences Research Program at Sunnybrook Research Institute (SRI). Our principal investigator, Dr. Miles Johnston, has studied the lymphatic circulatory system for over 30 years.
We are investigating several issues related to the relationship between lymphatic vessels and disease, including:
The role of lymphatic injury in the generation of post-surgical lymphedema in breast cancer.
We are fully affiliated with the University of Toronto.
The loss of the lymph nodes in cancer patients may have a much more negative impact on tissue fluid balance than has been considered in the past. Available evidence suggests that the absorption of protein-free water into the capillaries of the nodes has an important role in the regulation of pressure and volume in downstream anatomical elements of the lymphatic system. The autologous transplantation of lymph nodes into the surgical resection site could facilitate the restoration of normal lymph transport in the affected limb. However, the removal of a normal lymph node could lead to donor site morbidity.
We are investigating the possibility of developing an artificial lymph node that could be implanted into the surgical resection site. We are attempting to create an implant that will stimulate new blood vessel and lymphatic vessel growth resulting in the recreation of an intact lymphatic network.
Current therapeutic measures are applied to patients with entrenched edema and the outcome is often unsatisfactory. In the case of breast cancer-related post-surgical lymphedema, the timeline of the disorder can be linked to the removal of lymph nodes. Therefore, it is likely that a higher success rate may be achieved with treatment started early (lymph node transplantation or its artificial equivalent) since the chronic sequel of events leading to lymphedema might be prevented”.... Ref.. Sunnybrook Research Institute website
I am posting a link to the latest Live Symposium from the Lymphatic Research Foundation
Dr Chang speaks from the Anderson Cancer Centre on the advances in surgery for Lymphoedema
“Video Published on May 23, 2013
David W. Chang, M.D., is a professor with tenure and the deputy department chair in the Department of Plastic Surgery, director of the Center for plastic and reconstructive surgery, and director of the The University of Texas M. D. Anderson Cancer Center in Houston, Texas. Dr. Chang specializes in complex microsurgical reconstructive surgery in cancer patients with primary clinical & research focuses in breast reconstruction and restoration of extremity defects such as lymphedema. Dr. Chang has one of the most extensive experiences in microsurgical treatment of lymphedema and is considered a world expert and a pioneer in this field. Dr. Chang has been named to Best Doctors in America every year from 2001 to 2012. Dr. Chang has over 100 publications and has been invited to lecture at over 80 symposiums and meetings both nationally and internationally and to give over 40 visiting professor lectureships in 25 countries.”LRF
Thank you to the Lymphatic Research Foundation for Creating this Video of the live symposium to allow many others to view. It includes some very interesting facts on the progress of surgery, the need for insurance cover and the difficulties of treating leg Lymphedema with surgery. It covers all types of surgery including Lymph Node Transfers, and lymphatic Venous Anastomoses.
I saw a link to the following article on Facebook today and thought it would be good to share. This is another example of the latest surgical techniques being used to combat secondary Lymphoedema.
Microsurgical lymphatic-venous anastomoses have a place in the treatment of peripheral lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonoperative treatment. Improved results can be expected with operations performed at earlier lymphedema stages. (c) 2007 Wiley-Liss, Inc. Microsurgery 2007
Tiny bypass that relieves the misery of swollen limbs
By DIANA PILKINGTON
PUBLISHED: 22:59 GMT, 8 April 2013 | UPDATED: 22:59 GMT, 8 April 2013
Daily Mail newspaper England
Lymphoedema — painful swelling in the limbs — is a common side-effect of treatment for breast cancer, but also blights the lives of thousands of men with conditions such as prostate cancer.
Stuart Elcock, 69, a retired civil servant from Buckinghamshire, underwent a new procedure for tackling it.
“In 2011 I found a lump at the top of my right leg,” said Stuart Elcock “When doctors told me I might develop lymphoedema after surgery for a tumour on my thigh, it was the least of my worries: I just wanted to get rid of the cancer.I’d been treated for testicular cancer years ago, but had more than three decades of good health after that.
Then, in 2011, I found a lump at the top of my right leg — it was a sarcoma, a rare type of cancer in the connective tissues.The doctors said it might be due to the radiotherapy I had in the Seventies.The surgeons managed to get the sarcoma out.
But over the next two months, my right leg swelled until it was about 50 per cent bigger.
I had lymphoedema, where the lymph system — a network of tiny vessels that drains tissue fluid back to the blood — doesn’t function properly.It was caused when the surgeons removed some of the lymph nodes next to my cancer.The nodes are like filters, and the surgeons took them out to check if the cancer had spread. But if they are damaged or removed, fluid can build up. My leg grew very heavy and I lost the feeling from my groin down to my knee. The skin became hard and my knee and ankle swelled.
I struggled to walk short distances and had to stop driving,showering was difficult — I couldn’t wash my feet because my knee was swollen, so my wife, Morag, had to do it. She also had to put on my shoes and socks. Other problems arose, too — the lymph system helps defend against infection, so you can get skin infections.I needed antibiotics for two bouts of cellulitis, infection of the tissue below the skin. I had numerous urinary infections, too.
My GP referred me to a lymphoedema clinic, where I was given a compression stocking, but after a few days of wearing it, the 8 inch surgery wound in my thigh opened slightly and lymph fluid started leaking. Even with lighter compression, the wound opened and the fluid soaked on to my boxer shorts.My GP referred me back to the Nuffield Orthopaedic Centre in Oxford, where I’d had my cancer surgery.
Dominic Furniss, a plastic surgeon, suggested I try a procedure he had recently learned in Japan, which would redirect the fluid away from the wound. I quickly agreed.
In April last year, I was put under general anaesthetic for six hours while the surgeons stitched some of my lymph vessels directly to my veins so the fluid could bypass damaged nodes. Over the following weeks there was a gradual improvement in the swelling in my leg; although it’s only gone down a bit, the increase in mobility is tremendous. The skin has softened and the feeling is back.I can walk the half mile from home to the shops with no trouble, and can shower, drive and put shoes and socks on unaided. The cellulitis, urinary infections and leakage are gone, and the wound has healed nicely.”
Dominic Furniss is a plastic surgeon at Oxford University Hospitals Trust and Oxford University. He says:
“More than 125,000 people in the UK are affected by lymphoedema. It’s very common in women who’ve been treated for breast cancer — about 60 per cent of sufferers whose lymph glands are treated will develop it, but you can get it after many other cancers, too, such as testicular, prostate and melanoma. There are even reports of lymphoedema in the face after radiotherapy for head and neck cancer. For someone like Stuart, who was leaking lymph fluid through his open wound, it can be very distressing.
Conventional treatment involves massage, compression and life-long skincare to prevent infections, but this doesn’t address the cause — the blockage to the outflow of lymph fluid.
This new technique — supermicrosurgery — rather than trying to force the lymphatic fluid past the blockage, we direct the lymph vessels into the veins so the fluid bypasses the obstruction. The lymphatic vessels and veins we work on are tiny — between 0.2mm and 0.8mm in diameter — so we use a microscope and super-fine instruments.
First, we make about four 1in incisions in the affected limb, and find the lymph vessels and veins just underneath the skin. We then take some of the lymph vessels and stitch one end into a vein, using nylon stitches about a fifth of the thickness of a human hair. Studies show the more vessels and veins you join, the more effective it is, so we do between six and ten, depending on time. The operation takes four to six hours.
As we only go up to 2cm deep into the tissue, the only real risk with the operation is a superficial wound infection. It leaves scars, but they aren’t very noticeable, and there’s no great risk of damage to deep structures such as nerves and tendons.
The real joy about this operation is that it’s minimally invasive, and most patients can have it done under local anaesthetic.
When Stuart came to me, he was struggling with daily tasks and his wife said he wasn’t the man he used to be. But when I saw them again a few months ago, she said: ‘You’ve given me my husband back.’ He had normal shoes on and trousers — I’d only seen him in loose-fitting elasticated ones.
This technique won’t cure very bad lymphoedema, but we can reduce the complications, make the limb feel softer, and reduce the swelling. The benefits continue accruing for about four years after the operation.We can now identify early stages of lymphoedema and even those patients who are at risk of getting it. For example, if a woman with breast cancer is to have her lymph glands removed from her armpit, we can perform this surgery before the swelling manifests. So many people survive cancer nowadays that we need to look at the complications of their treatment and improve their quality of life.
Techniques like this can help.”
The operation is available on the National Health Service in England and costs about £10,000 when carried out privately.