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Dr Margulies blood pressure

Lymphedema can be a problem worse than a cold rain in spring. Lymphedema is swelling of the arm that can occur after breast cancer surgery and is akin to your kitchen sink sponge soaked with water.

Traditionally, women who have had lymph nodes removed from their armpit, what is known medically as the axilla and the procedure an Axillary Lymph Node Dissection, were at a 40% risk for developing lymphedema.

However, today, most women have a Sentinel Lymph Node Biopsy as opposed to a full Axillary Lymph Node Dissection, and the risk of lymphedema is only 8%. You would need to ask your surgeon which procedure you had, a Sentinel Lymph Node Biopsy or a full Axillary Lymph Node Dissection, before you know what your risk of lymphedema is.

How can you prevent lymphedema? The two biggest risk factors for lymphedema are infection in the arm and obesity.

The first step is to eat a healthy diet, exercise and get your weight down to a body mass index (BMI) less than 25. The second step is to protect your arm from infection. When you are gardening or walking in the woods, wear a long sleeve shirt, because scratches from plants and bites from insects can lead to infection, which can lead to lymphedema.

What about having a blood draw at your doctor’s office? The risk of infection from the blood draw is extremely low as most doctors’ offices and laboratories use a sterile technique and have an extremely low infection rate. As such, it probably is OK to have a blood draw from your affected arm, but try to use the other arm, if possible. The same goes for having an IV placed for a medical procedure, in that you should try to use your other arm, as an indwelling catheter has an increased risk, albeit a small risk, of infection.

Will having your blood pressure done on your arm cause lymphedema? No. Don’t worry about having someone take your blood pressure in the affected arm, although again, prudence may dictate that you use the other arm for blood pressure measurement.

Lastly, as we live in East Tennessee, many of us get allergy shots, and quite often those shots go in both arms. As someone who has had a Sentinel Lymph Node Biopsy (for a melanoma), I only receive those shots in my unaffected arm. Why? Again, it’s a very low risk of infection, but allergy shots do, intentionally, cause an inflammatory reaction, and so I suppose the risk of lymphedema is real. I just play it safe and get the allergy shots in my “good” arm.

Sometimes in medicine we do not know the exact answer, but we have to practice our art and do what seems to be the right thing to do until medical science teaches us otherwise.

Some other cautions to preventing lymphedema include maintaining a healthy weight (BMI <25) and reducing the risk of infection in the affected arm.

May you live long and prosper.

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