59 yo obese F s/p Left modified radical mastectomy with axillary lymph node dissection and radiation therapy directed at L axillary nodes for stage III IDC 4 months ago. Presents to Surgery Clinic for 1 month history of intermittent tingling/numbess of her L arm and L UE swelling. Her wedding ring that fit her last month no longer fits. She also reports achiness, heaviness, and warmth in her L UE, along with shoulder/elbow/wrist stiffness.
Which of the following is the most effective treatment for this condition? What imaging would you recommend?
A-diuretics
B-keratolytics
C-complex PT
D-surgery
set up each as a link with answer C correct
C-complex PT-
Yes, the first-line treatment for lymphedema is complex physical therapy, which includes: manual lymphatic drainage, massage, exercise, and the use of compression stockings (at a minimum of 40 mmHg), multilayer bandaging, and/or pneumatic pumps. Other conservative therapies include encouraging patients to lose weight, to elevate the affected extremity whenever possible, and to avoid even minor trauma (Rossy 2016)
A-diuretic:
This unfortunate patient has developed lymphedema. Diuretics are not effective in treatment of this condition.
B-keratolytics-
No, topical emollients and keratolytics, such as ammonium lactate, urea, and salicylic acid, have been recommended to improve secondary epidermal changes, but alone are not the best management of lymphedema (Rossy 2016)
D-surgery
No, lymphedema often rapidly recurs after excisional surgery, such as suction-assisted removal of subcutaneous tissues. Surgical treatment is palliative, not curative, and it does not obviate the need for continued conservative therapy. Surgical treatment is not first-line for lymphedema; it is reserved for patients who continue to worsen with conservative measures or for cases in which the extremity is so large that it impairs daily activities and prevents successful conservative management (Rossy 2016)
SURGERY CASE 1