long-term consequences of lymphedema

I've had LE for 7 years and am very concerned about what my arm will be like "down the road". I've had recurring cellulitis (5x this year) and one doctor said it will get worse as time goes on. Anyone have any information??? Thanks, BBinB

My arm "blew up" with Taxotere. I didn't treat it at the time because I had had a bad experience with previous therapy. I hated dealing the ace wraps so I just let it go. It is now significantly and permanently swollen and fibrotic (stiff and thickened) in some areas. It definitely makes clothing a challenge but I don't regret it. The condition is much easier to live with than the treatment for it. I cannot work and function wearing a sleeve. I am a nurse and need to use my hand and wash it many times a day.
Cathy from Oregon

I've been wearing a sleeve for 7 years along with the glove. I have a Reid sleeve which I use at night occasionally. I've had three courses of treatment over the years. What I'm concerned about is the recurring cellulitis. I can't even find a website that has information about cellulitis and lymphedema that answers my questions. For me, it is very difficult dealing with on a day-to-day basis. It's been very troublesome the last 3 weeks, and I know that I can't be on antibiotics indefinitely. I'm getting more nervous that usual about it, and I wouldn't go without a sleeve for fear that it will swell even more. BBinB

Hi Barb,
I am so sorry you are having a hard time with le.
I did find losing my breasts was easier to accept than looking after LE. Mentally this has taken over my life at times.
My arm is pretty good but my hand is very hard to manage. I wear my sleeve in the daytime and wear a glove or bandage my hand in the daytime depending how it looks and i wear a swell spot to.
I have had le in my arm since 2004 and hand since 2005.
I am waiting for a new glove and sleeve from mediven and I hope it works better than what i got.
My knuckles and the top of my hand is the problem.
Bandaging DOES fix it but i don't want to keep my hand bandaged every day.
I know where Cathy is coming from as once in awhile i just chuck it for a few hours.
It doesn't seem to make a difference. It seems all i am doing is moving this fluid to a new spot.
I have stopped doing mld of and on as i don't see any difference at all.
I was bandaged from finger tip to armpit for 23 hours a day for 5 weeks and it did help.
I read somewhere if you need to do this just do it for 2 weeks and not five. I would never do it for 5 again as after 2 weeks i saw the same difference as 5 weeks made.
I think, i am not sure, it was Maryann ( forgive me if i am wrong) who was going to try a all natural way to fix or help le.I don't know if i missed her post or if she posted.
As of yet i haven't had an infection thank God but i expect i likely will.
I wish i could help you as you have been through enough already.
Thinking and praying you don't have anymore infections. bc and le hugs jinkyns

I forgot to say i don't wear anything at night if my hand is good.....if not i only bandaged my hand at night. le hugs jinky

Barb have you posted at www.lymphedemapeople.com and ask Pat. He is really up to date on lymphedema . bc and le hugs jinky

I am sorry that you are having so much problems. I had lumpectomy with node dissection back in 1997. I have been hospitalized with cellulitis in that upper arm 3 times with 2 more bouts that did not require hospitalization. The last episode I had with cellulitis they put me on a daily dose of antibiotic. I take 500 mg of VK penn 1 daily for the rest of my life. So far it has held any infection at bay. I still have to be careful and not lift with that arm , carry anything heavy, even a heavy handbag, and not to use the arm in repetitive motion for long such as painting rooms, etc. Ask your doc about the pennicilin daily. That small of a dose helps keep infection at bay and is not a large dose as to mess up your natural floras. Be Blessed Sharron in TN

Barbara,
You can be on low dose antibiotics indefinitely with no ill effects. My Mayo Clinic doc has had me taking 7 days of Keflex the first week of every month since my last serious bout of cellulitis in March of 2002, and I haven't had any trouble since I started on that regimen. No swelling, no redness, no pain.
Also, I noticed that my lymphedema improved considerably after I finished my five years on Tamoxifen. Are you taking Tamo or an aromatase inhibitor? Could be a factor.
Love,
Helene

Conservative approaches to lymphedema treatment
http://www3.interscience.wiley.com/cgi-bin/abstract/75501208/ABSTRACT?CRETRY=1&SRETRY=0
...
MODIFIABLE RISK FACTORS FOR LYMPHEDEMA IN BREAST CANCER SURVIVORS
http://cdmrp.army.mil/scripts/get_item.asp?item=abstract&log_no=BC010602&type=pu blic
...
Lymphedema Management Following Breast Cancer Therapy: Part I
http://www.bamc.amedd.army.mil/DCI/articles/dci0799r.htm
...
Lymphedema
http://apdvs.vascularweb.org/APDVS_Contribution_Pages/Curriculum/Clinical/14-Lymphedema.html
...
Performing your original search, Cellulitis from breast cancer surgery, in PubMed will retrieve 61 citations.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=817542 4&dopt=Abstract
...
Scientists find genetic key to some breast cancers
http://www.guardian.co.uk/medicine/story/0,,1963324,00.html
...
Overview of LE
http://www.cancer.gov/cancertopics/pdq/supportivecare/lymphedema/healthprofessional
...
LE Forums
http://www.lymphedemapeople.com/phpBB2/index.php?sid=0022dbd8329d887aa44dc6f4204d5386
...
Research and Resources
http://www.nhlbi.nih.gov/public/dec02/rsrchtls.htm
...
this doctor, you can use the contact info and ask a question.
Janet Grange, MD, Breast Specialist - Is the Disease in My Lymph
http://janetgrangemd.com/home/content/view/16/17/
...

Clinical practice. Cellulitis [Swartz MN N Engl J Med 2004;350:904]: This is a "Clinical Practice" review dealing with a common, but often misunderstood clinical problem.

Diagnostic Studies:

Five series using needle aspiration in 284 patients identified a pathogen in 86 (29%). S. aureus, group A or B streptococci, viridans streptococcus and E. faecalis collectively accounted for 79% of cases; most of the rest were due to gram-negative bacteria. The author notes that this diagnostic procedure is not indicated in routine care. The conclusion from the studies summarized is that antibiotic treatment should be directed against gram-positive cocci.
Bacteremia is found in only 4% and usually yields either S. aureus or group A strep. The low yield means that blood cultures are probably not cost-effective. The exception is lymphedema with cellulitis which gives a high yield of non-group A streptococci.
MRI is recommended for differentiating cellulitis from necrotizing fasciitis, but this should not delay needed surgery. Ultrasound and CT scans were felt to be of less value.
Antibiotic Treatment: Most cases are caused by streptococci or S. aureus so betalactam drugs are usually preferred. The following are suggested for IV use:

Cefazolin, 1 gm IV q6-8 hr
Nafcillin, 1-1.5 gm IV q4-6 h
Ceftriaxone, 1 gm IV/day
Cefazolin, 2 gm IV qd plus probenecid, 1 gm po/day
For MRSA or penicillin allergy: Vancomycin 1-2 gm IV/day or linezolid, 0.1 gm IV q12h
For oral therapy following betalactam IV treatment: Dicloxacillin, cephradine, cephalexin or cefadroxil.
Antibiotic Trials: Several new antibiotics have been tested in clinical trials as summarized below:

Source
#
Agents-Cure Rate

Gentry LO, Arch Intern Med 1989;149:2579 461
Ciprofloxacin – 98%
Cefotaxime – 92%
Muijsers RB, et al. Drugs 2002;62:967` 401
Moxifloxacin – 84%
Cephalexin – 84%
Graham DR, et al. Clin Infect Dis 200235:381 399
Levofloxacin – 84%
Ticarcillin – CA – 80%
Steven DL, et al. Antimicrob Agents
Chemother 2000;44:3408 819
Linezolid – 89%
Oxacillin/diclox – 86%
Stevens DL, et al COD 2002;34:1481 175
Linezolid –79%
Vancomycin – 73%

Special Clinical Settings: The following table summarizes several conditions associated with unique pathogens and provides recommendations for antibiotic treatment:

Condition
Probable pathogen
Antibiotic

Buccal cellulitis H. influenzae Preferred: Ceftriaxone
Alt: imipenem/meropenem

Diabetic foot ulcer – limb threatening and
decubitus ulcers Coliforms, P. aeruginosa, Anaerobes Preferred: Amp-sulbactam
Alt: Imipenem; clind + fluoroquinolone;
metro + fluoroquinolone or ceftriaxone

Human bite Oral anaerobes
E. corrodens, S viridans, S. aureus
Preferred: Amox-clavulanate
Alt: Penicillin + cephalosporin

Dog/cat bite P. multocida, other Pasteurella,
S. aureus, S. intermedius, N. canis, H. felix, C. canimorsus, Anaerobes Preferred: Amox-clavulanate
Alt: Moxiflox + clindamycin

Abrasion & Salt
water exposure Vibrio vulnificus Preferred: Doxy 200 mg IV, then 100 mg bid
Alt: Cefotaxime, ciprofloxacin

Abrasion & fresh
water exposure Aeromonas Preferred: Cipro IV or gentamicin & ceftazidime
Alt: Imipenem or meropenem

Occupational-butcher, fish handler, veterinarian Erysipelothrix rhusiopathiae Preferred: Amox or penicillin IV 12-20 mil units/d (bacteremia)
Alt: Ciprofloxacin, cefotaxime,
imipenem

Bacteriology According to Specific Risks: The following table summarizes special circumstances in which there is predictable pathogens according to the defined setting:

Anatomical variant
Microbiology

Periorbital cellulitis S. aureus, S. pneumoniae, Gr A strep
Buccal cellulitis S. aureus, Gr A strep
Body piercing cellulitis S. aureus, Gr A strep
Mastectomy, lumpectomy Non-gr A strep
Liposuction Gr A strep, Peptostreptococcus magnus
Postop wound (early) Gr A strep
IDU "skin popping" S. aureus, strep A, C, F, G
Perianal cellulitis Gr A strep
Crepitant cellulitis Anaerobes ± coliforms

Prophylaxis: Patients with recurrent cellulitis of the leg should have topical antifungal agents applied to fissures in interdigital spaces. Patients who have two or more episodes of cellulitis at the same site should have daily prophylaxis with oral penicillin G or amoxicillin.

Comment: This is an excellent review by one of the most revered figures in infectious disease who is an extraordinary authority on management of soft tissue infections. The one issue that was not addressed in the recommendation concerns the recent surge of cases of soft tissue infections involving methicillin-resistant S. aureus, the community-acquired strains that are often resistant only to betalactams. This strain may change the recommendations for both the importance of cultures for sensitivity tests and for antibiotic recommendations. In this report, betalactams were recommended for empiric use in virtually all cases, but these strains are often sensitive to every antibiotic but betalactams. This issue is mentioned in the controversies, but it did not influence the recommendations for empiric treatment.
By John G. Bartlett, M.D., posted 03-22-2004

http://hopkins-abxguide.org/show_pages.cfm?content=Mar-04_content.html#09_Mar
...
Erysipelas after breast cancer treatment (26 cases)
http://dermatology.cdlib.org/113/case_reports/erysipelas/masmoudi.html
...
Periorbital cellulitis with breast cancer
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=539513
...
Cellulitis syndromes unique to women
http://patients.uptodate.com/topic.asp?file=skin_inf/10762
...
Patient information: Localized breast cancer evaluation, mastectomy, and breast conserving therapy.
http://patients.uptodate.com/topic.asp?file=cancer/5798
...