Surgery Side Effects

Bilateral mastectomies were a must for me. The impact was minimal. I am a strong woman. I am not defined by my breasts. Life and love win. Cancer lost. I have a rather large laceration from melanoma surgery on the upper part of my leg. It is about 8 inches in length and 3 inches or so, wide. Its depth is about 1/2 inch to 3/4 inch, and the rather large muscle shows clearly. It was much too large to be closed with stitches. I chose to devise my own measures to conceal it rather than have more surgery involved in disguising it. I merely wear knee length shorts when exercising, longer-length styled trunks when swimming. The viewing of the wound does not bother or cause concern to me or my immediate family in the least.

The range of reported lymphedema in patient who undergo pelvic lymph node dissection is between 5-30%. However, it is important to note that the range varies widely based on several factors such as the tools to measure lymphedema or the medical comorbidities of the patient such as obesity, diabetes, hypertension, and cardiovascular disease. The range of reported lymphedema in patient who undergo pelvic lymph node dissection is between 5-30%. However, it is important to note that the range varies widely based on several factors such as the tools to measure lymphedema or the medical comorbidities of the patient such as obesity, diabetes, hypertension, and cardiovascular disease.

Cording, also described as axillary web syndrome, can occur after axillary surgery such as full axillary dissection, sentinel node biopsy and after excision of masses from the axillary tail of the breast. It presents as a visible and palpable cord of subcutaneous tissue running from the axilla to the elbow.

It is thought to be a superficial thrombophlebitis (inflammation of the superficial veins), a variant of Mondor's disease (superficial thrombophlebitis of the breast). http://www.ncbi.nlm.nih.gov/pubmed/21987036

Other authors describe it as an inflammation of the lymphatics in the upper arm.

Cording generally resolves in about 12 weeks. Anti-inflammatory drugs can help, as can massage, range of motion exercises, and physical therapy.

Adhesions is a term used for intra-abdominal scarring from prior surgery or infection. Cording, also described as axillary web syndrome, can occur after axillary surgery such as full axillary dissection, sentinel node biopsy and after excision of masses from the axillary tail of the breast. It presents as a visible and palpable cord of subcutaneous tissue running from the axilla to the elbow.

It is thought to be a superficial thrombophlebitis (inflammation of the superficial veins), a variant of Mondor's disease (superficial thrombophlebitis of the breast). http://www.ncbi.nlm.nih.gov/pubmed/21987036

Other authors describe it as an inflammation of the lymphatics in the upper arm.

Cording generally resolves in about 12 weeks. Anti-inflammatory drugs can help, as can massage, range of motion exercises, and physical therapy.

Adhesions is a term used for intra-abdominal scarring from prior surgery or infection.

I love this question and I hope you do not mind a long answer.
After my mastectomy, I was very confused about the surgery itself. As a veterinarian, I wanted the gory details but really was not getting any. I did not understand where the expander was in relation to my muscle and chest wall and I also developed a large hard mass in my arm pit that my doctor did not seem to be able to explain. It was extremely uncomfortable and I had to keep my arm raised to minimize the discomfort. Communication was very poor with my surgeon and staff at this point. My drain was also pulled, to my surprise and I was given the pathology report on my way out the door. At a previous visit, my surgeon told me that he had gotten everything and the 3 sentinel nodes taken were clean. I read the report in tears on my way home. The report stated that the original mass (IDC) was nonviable scar tissue but it also reported another small mass, invasive lobular carcinoma, not previously detected, with 0 margin of clean tissue on the chest wall side of the tumor. Not good. It also reported that 11 nodes were taken, not just the 3 sentinel nodes. Fortunately, they were all clean. The real concern was the lack of clear margins. My understanding at that point was that radiation would be necessary but also not possible without removing the expander. I had no one to talk to and the weekend to survive until I could get more information. I was a mess. I saw my surgeon the following Monday and he allayed my concerns about the free margins (which were confirmed by my oncologist). The next day, however, I was in the ER with a 104 fever and an infection.

During my post surgical complications, I knew I could not continue healing at my best in my current state of mind. I was unhappy with the poor communication I was having with my surgeon and his staff and I just did not trust the conflicting information I had been getting. I was seriously considering changing surgeons/hospitals. I knew, at this point, that I could not change my surgeon and how he interacted with me nor could I change the culture of the hospital and staff. The only change I could create was in myself and how I chose to engage. With the help of author Caroline Myss, (Defy Gravity), I meditated and focused on reinventing my relationship with my surgeon (and my life). I surrendered to the situation and flipped my state of mind from one of fear and anger to love and trust. It required daily/hourly effort (or remembering) initially, but the benifits were so powerful and freeing, it literally had a momentum and staying power of its own. Simply put, a choice. I love this question and I hope you do not mind a long answer.
After my mastectomy, I was very confused about the surgery itself. As a veterinarian, I wanted the gory details but really was not getting any. I did not understand where the expander was in relation to my muscle and chest wall and I also developed a large hard mass in my arm pit that my doctor did not seem to be able to explain. It was extremely uncomfortable and I had to keep my arm raised to minimize the discomfort. Communication was very poor with my surgeon and staff at this point. My drain was also pulled, to my surprise and I was given the pathology report on my way out the door. At a previous visit, my surgeon told me that he had gotten everything and the 3 sentinel nodes taken were clean. I read the report in tears on my way home. The report stated that the original mass (IDC) was nonviable scar tissue but it also reported another small mass, invasive lobular carcinoma, not previously detected, with 0 margin of clean tissue on the chest wall side of the tumor. Not good. It also reported that 11 nodes were taken, not just the 3 sentinel nodes. Fortunately, they were all clean. The real concern was the lack of clear margins. My understanding at that point was that radiation would be necessary but also not possible without removing the expander. I had no one to talk to and the weekend to survive until I could get more information. I was a mess. I saw my surgeon the following Monday and he allayed my concerns about the free margins (which were confirmed by my oncologist). The next day, however, I was in the ER with a 104 fever and an infection.

During my post surgical complications, I knew I could not continue healing at my best in my current state of mind. I was unhappy with the poor communication I was having with my surgeon and his staff and I just did not trust the conflicting information I had been getting. I was seriously considering changing surgeons/hospitals. I knew, at this point, that I could not change my surgeon and how he interacted with me nor could I change the culture of the hospital and staff. The only change I could create was in myself and how I chose to engage. With the help of author Caroline Myss, (Defy Gravity), I meditated and focused on reinventing my relationship with my surgeon (and my life). I surrendered to the situation and flipped my state of mind from one of fear and anger to love and trust. It required daily/hourly effort (or remembering) initially, but the benifits were so powerful and freeing, it literally had a momentum and staying power of its own. Simply put, a choice.

After my mastectomy, I had a drain for 10 days. It was pulled even though I was producing alot of fluid. 3 days later, I had a check up with the surgeon and everything seemed fine. The next day, however, I did not feel well. Feverish and exhauted all day. I took my temperature around 4 PM to see that I had a fever of 104. I called my doctor's nurse and went to the ER. Initially the concern was that I had MRSA (Methacillin Resistant Staph. A.) and was put on Bactrim just in case. Fortunately it was just the friendly neighborhood Staph. A. and responded to treatment. I was on Bactrim for almost 3 weeks, at which point I developed an allergic reaction to it (generalized rash and itchiness) so I was put on clindamycin for 3 weeks. The concern was that the Staph might harbor in the expander since there is no circulation to foreign material in the body, and that we would not be able to get rid of the infection without removing the expander, which meant delaying reconstruction for a minimum of 6 months then starting over. I was very fortunate that my infection was eliminated and I had my reconstruction 15 weeks after the mastectomy. After my mastectomy, I had a drain for 10 days. It was pulled even though I was producing alot of fluid. 3 days later, I had a check up with the surgeon and everything seemed fine. The next day, however, I did not feel well. Feverish and exhauted all day. I took my temperature around 4 PM to see that I had a fever of 104. I called my doctor's nurse and went to the ER. Initially the concern was that I had MRSA (Methacillin Resistant Staph. A.) and was put on Bactrim just in case. Fortunately it was just the friendly neighborhood Staph. A. and responded to treatment. I was on Bactrim for almost 3 weeks, at which point I developed an allergic reaction to it (generalized rash and itchiness) so I was put on clindamycin for 3 weeks. The concern was that the Staph might harbor in the expander since there is no circulation to foreign material in the body, and that we would not be able to get rid of the infection without removing the expander, which meant delaying reconstruction for a minimum of 6 months then starting over. I was very fortunate that my infection was eliminated and I had my reconstruction 15 weeks after the mastectomy.

There are exercises developed by lymphedema experts specifically to decongest the swollen limb. They tend to combine stretching protocols with decongestion protocols utilizing the "muscle pump", that is, causing the major arm and leg muscles to slowly expand and contract and squeezing the skin against a compression garment or bandaging. There are a number of videos available demonstrating these specialized exercises.

Our favorite is the Video "Remedial Exercises For the Upper Extremities" by Klose Norton Training & Consulting is available for $34.95 + $5.00 s&h for NLN members, $39.95 + $5.00 s&h for non-members from:
National Lymphedema Network
1611 Telegraph Avenue, Suite 1111
Oakland, CA 94612-2138

Edema Exercises for Patients with Arm (Leg) Lymphedema by Dr. Vodder School in Austria

Focus on Healing through Movement & Dance by Sherry Lebed Davis which you can order thru the NLN 1-800-541-3259 $28.00 + 5.50 s/h for members, 32.95 + 5.50 s/h for non-members. Or you can order it from the producer, Enhancement Inc.1-800-366-6038 for 29.75 + 3.00 s/h.

Arm Exercises Video by Dr. Vodder School - North America, 2000.

Dr. Judith Casley-Smith, 94 Cambridge Terrace, Malvern SA 5061, Australia, E-mail: casley@enternet.com.au, includes swimming exercises for lymphedema in her book, "Exercises for Patients with Lymphedema of the Arm and a Guide to Self-Massage and Hydrotherapy". She also has one for the legs. You receive it when you order her "Exercise Video" for both arms and legs. Price for overseas including postage & insurance is Economy $60, Air $65. She asks that payment be in a personal check in your own currency on you own band, but please add $15 for conversion.

There are exercise routines described in some of the lymphedema books, but I favor the videos since the demonstrations are more understandable than the dry words and static sketches or photos.

Joe Zuther had an excellent article in his January 6, 2011 blog called "Decongestive and Breathing Exercises for Lymphedema."
There are so many benefits to exercise, especially for those with lymphedema. Exercise helps maintain a healthy weight, increases range of motion, and muscle contractions are a good way to keep the lymphatic fluid flowing throughout your body. If you are starting an exercise program or returning to exercise, there are some precautions to take to make sure you can continue to exercise while managing the lymphedema.

1. Always wear a compression garment while exercising. If you don't have one, call your hospital and get fitted for one. Also, Invest in a well-fitted bra, a tight bra can restrict the flow of fluid

2. Start with either exercise bands (don't wrap them around your hands) or light weights.

3. Alternate an upper body exercise with a lower body exercise. By alternating between the upper and lower body, you give the opposite body parts time to rest and time for fluid to move out of the affected area. For example, do bicep curls, then leg raises.

4. Listen to your body. Don't fatigue or strain the affected area, don't work through the pain. Stop if you feel tightness or swelling in the affected area. Start slow and work up to your former level of fitness.

My bonus tip for you: When I have a client with lymphedema, I will have them stop in between sets and massage themselves. I have them put their arm overhead and gently press (almost like petting) the area to aide in moving the fluid.

Let me know how you make out!!

For more information on exercise and cancer, go to http://www.movingonfromcancer.com

The side effects from the oophorectomy have not been bad. They include hot flashes and weight gain. Not the greatest side effects to deal with but certainly manageable. I currently take Effexor XR (an anti-depressant) to treat the hot flashes, however I am in the process of weaning from that medication as my hot flashes aren't terrible and I'd rather be free from anti-depressants. Weight gain is weight gain. Healthy eating and exercise helps with that. I also experience achy joints but I think that's attributed to the aromatase inhibitor I take and not menopause.
Choosing to have an oophorectomy at my age (35 at the time) was quite difficult because I hadn't fully accepted not being able to have anymore biological children. But knowing that removing my ovaries was going to help keep my estrogen levels low and hopefully my cancer at bay made it an easier decision. The side effects from the oophorectomy have not been bad. They include hot flashes and weight gain. Not the greatest side effects to deal with but certainly manageable. I currently take Effexor XR (an anti-depressant) to treat the hot flashes, however I am in the process of weaning from that medication as my hot flashes aren't terrible and I'd rather be free from anti-depressants. Weight gain is weight gain. Healthy eating and exercise helps with that. I also experience achy joints but I think that's attributed to the aromatase inhibitor I take and not menopause.
Choosing to have an oophorectomy at my age (35 at the time) was quite difficult because I hadn't fully accepted not being able to have anymore biological children. But knowing that removing my ovaries was going to help keep my estrogen levels low and hopefully my cancer at bay made it an easier decision.

I've had lymphatic massage and a compression garments for my left arm to help with my lymphedema. »Interestingly enough, it was my osteopath who started loosening some on my arm and pectoral muscles that did the best job of all. I was an inch bigger in the upper arm before I saw him a few times and after a few weeks both arms were back to the exact same size. Now I wear my compression garment only for airflight. What a relief and do I need to tell you it's not very sexy during summer time! LOL Typically using lymphatic massage or compresion garments. Garments are offered FREE through http://crickettsanswerforcancer.com
Yes. I said FREE! :) Good luck!

By far the best result and state of the art today involves Nipple Sparing Mastectomy(NSM) and immediate reconstruction with DIEP or other Perforator flaps. For an optimal outcome, it is crucial to have a breast surgeon well trained in NSM and the right plastic surgeon. Ideally a one stage mastectomy and reconstruction can be done. Typically the breast would have a faint scar on the under surface of the breast. The DIEP donor site should be the same as a cosmetic tummy tuck. If the abdomen is not a good option, skin and fat can be obtained from the posterior thigh leaving a scar concealed in the fold beneath the buttock. This is my most recent innovation and is called the PAP flap. By far the best result and state of the art today involves Nipple Sparing Mastectomy(NSM) and immediate reconstruction with DIEP or other Perforator flaps. For an optimal outcome, it is crucial to have a breast surgeon well trained in NSM and the right plastic surgeon. Ideally a one stage mastectomy and reconstruction can be done. Typically the breast would have a faint scar on the under surface of the breast. The DIEP donor site should be the same as a cosmetic tummy tuck. If the abdomen is not a good option, skin and fat can be obtained from the posterior thigh leaving a scar concealed in the fold beneath the buttock. This is my most recent innovation and is called the PAP flap.

Dr Attai, Thanks for your answer. Having already tried Gabapenten and several similar drugs, and physical therapy, and acupuncture, I would be interested in what the "other treatments" were. Also I should have been a little more specific with my question. I really wanted to know if SURGICAL repair was possible. There are several types of pain that can occur after axillary / underarm surgery either performed with lumpectomy or mastectomy. The most common situation is numbness of the upper inner arm, armpit area, and the side of the chest wall. This is related to cutting or injury to the intercostobrachial nerve, which runs from the chest wall to the arm and provides for sensation. However cutting the entire or at least part of the nerve is part of most axillary dissection surgeries, and often the nerve is not one large "trunk", but several small branches that cannot be seen. Damage to this nerve is less common with a sentinel node biopsy but can still occur. Some women will experience a hypersensitivity in the first few weeks or months after the surgery in which even the slightest touch to the skin will result in severe pain. This usually resolves within a few weeks to a few months at the most. The numbness may gradually resolve or at least improve over time but every patient is different and this is not predictable.

In a few cases, severe persistent pain will occur. This is not common, but when it is present, it can be very difficult to treat. Gabapentin (neurontin) is sometimes used, along with physical therapy, acupuncture, and other treatments.

I had diep flap reconstruction on 11/15. Unfortunately flap on rt side failed, so I have an implant on the rt and the flap on the left. I like the appearance and the feel of the flap versus the implant. The implant has really been causing a lot of trouble for me, and I may just have it taken out.. Make sure you really do your homework on this. It was a grueling 15 hour surgery for me. I also needed a blood transfusion after.

I don't regret my choice, but it is a little disappointing to go through all of that and not have optimal results. Good luck with everything. So sorry to hear of your troubles with tissue expanders. Unfortunately 30% of the women we perform DIEP flaps for have had failed attempts at implant/expander reconstruction. It is possible that the infection could be treated and then later re-try an implant but it may very well happen again. The benefit of the DIEP is that no implants are use and the risk for infection is minimal. It also preserves the muscles of your tummy wall while producing a natural, soft, warm breast that is meant to last a lifetime. (We don't perform TRAM flaps any longer since the DIEP preserves the muscle)

James E. Craigie, M.D.

I didn't have infection after reconstruction but I was put on antibiotic for 20 days form the day of the surgery and forward to prevent any infection from settling in. Since with chemo I landed twice in hospotal for long stays because of infection, that was judged to be the best prevention possible. Also, a year later, when I finished second chemo tx i had the nipple graff that caused an infection. Again received 20 days (two full course) of antibiotic to fend it off and prevent implant from being infected. Now, 3 months later, I don't have an infection and didn't have to get my implant removed. I didn't have an infection but I am concerned because I see this is an unanswered question. I'm afraid I have more questions than answers.

Are you on antibiotics for an infection? Does it look like there is an infection.... are you running a fever?

The thing with those expanders is they can be uncomfortable (particularly as they get "overfilled"). Mine appeared to have a weird shape.

How long ago did you have the surgery and what is your surgeon saying?

More questions than answers but I think I wanted to let you know I am listening.

AnneMarie

This is a fair question. I do not usually recommend that people seek information about treatments on their own without consulting directly with a specialist to discuss treatment options for their individual care. Quite basically, what’s good or might work for one person may not be the case for another. Furthermore, I cannot say that there is much in the way of substantially novel approaches to managing depression or anxiety, as the mainstays of treatment consist of psychopharmacology or medication management which have been used for several decades.

That being said, there may be, and certainly is, ongoing refinements to and studies of the efficacy of the psychological therapies as well as establishment and evolution of varying approaches in the field; as well as continual research and development of drugs in the rapidly expanding and burgeoning field of psychopharmacology in which there continues to be refinement of the neurotransmitter receptor profiles, delivery systems, and formulations, in existing classes of medications – mainly the antidepressants which, you should know, are generally the first-line treatment for both depressive and many anxiety disorders, despite the potentially deceptive name – to achieve better tolerability (based on modifications to the molecule), ease of dosing (e.g. long-acting/ extended release versions) and administration (e.g. liquid or transdermal formulations for people who have difficulty with swallowing pills or cannot absorb them when taken by mouth) – all factors which are potentially important particularly for an individual with cancer who might, at a given point in the course of the illness, face a host of obstacles to quality of life including medication administration that may be eased with these options – as well as exploration of other targets for novel classes of drugs that no longer need directly involve the neurotransmitter systems.

There are also other major classes of both ‘biological’ – or what some might call “somatic” – approaches and other ‘non-medical’ interventions. With respect to the latter, these may include alternative therapies which, likewise, include approaches involving chemical consumption – such as herbal therapies – and those that do not – such as the variety of holistic and mind-body approaches. While such alternative approaches are not novel, per se, as they have typically existed for a long time, often long predating modern/ Western medical approaches, they are actively being studied to corroborate their efficacy. Particularly with respect to the holistic/ mind-body approaches, these may appeal to patients with medical illness as they would not necessarily subsume active effort or additional extrinsic compounds which may have the potential only to add to the burdensome medical list and potential risk of side effects to a condition which is already physically trying in its own right, and they may be most conducive to welcome measures of conserving, harnessing, and healing. But herbal therapies are also an area of active research with respect to both psychiatric conditions, including depression and anxiety, and cancer treatments. However, it must again be stressed that, for this reason, consultation with your oncologist and a psychiatrist is essential and is the most optimal source for information about the approaches being sought. Many herbal supplements also run the risk of side effects and deleterious drug interactions, like pharmaceuticals, compounded by the lack of careful standardization in their composition since they are not subject to the same restrictions by the Food and Drug Administration as prescription drugs. With respect to the former, a major field is that of the brain stimulation therapies. Traditionally, this included ECT – electroconvulsive therapy or what has commonly come to be known as “shock” therapy – still actually a highly effective approach which has had the misfortune of stigma through association in the popular media which has conveyed it as a less than humane treatment, and as a byproduct of it having withstood the test of time from its early days when, indeed, the approach was much cruder than the way it is currently conducted with refinements making it quite tolerable However, this is another approach that would not likely be pursued in a patient who has newly emergent depressive or anxiety symptoms in the context of grappling with cancer diagnosis and treatment. It is not that it subsumes potential logistical and medical complications in a patient with active medical comorbidity – as it may, indeed, be conducted safely, if necessary, as it is typically used and effective, for patients with a psychiatric condition that is of long-standing or has not responded well to other treatment approaches – but, rather, that many patients who experience depression or anxiety in the setting of cancer may not require such an approach. Their symptoms might be related simply to a normative adjustment process, or to transitory struggles with adapting to a dramatic life change. But even if a patient’s depression could benefit from a somatic approach, if you will, a first trial of an antidepressant medication will often be effective for someone who may not have experienced such symptoms in their past.

However, I mention the brain stimulation therapies not just because they continue to be a most fruitful field of study, and represent some of the most recent developments in treatment, in psychiatry but I think they represent a potentially appealing approach for people with cancer or other chronic medical conditions. Some of the approaches, such as Vagal Nerve Stimulation, or Cranial Electric Stimulation, have developed since ECT, have been around for a while, and have ultimately had less than appealing results. A more novel procedure, Deep Brain Stimulation – wherein an electrode is implanted in an area of the brain that is below the surface or “cortex” so must be accessed surgically – originally developed, to my awareness, for treating Parkinson’s Disease, is now being studied in a variety of medical conditions, including OCD and Depression. This invasive technique is not the one I would highlight, however. The most recent approach developed as been TMS or Transcranial Magnetic Stimulation. I am mentioning this both in response to the question and to indicate that it is potentially attractive as a very non-invasive and well-tolerated approach – a probe that generates a magnetic field on the surface of the brain to produce current that may either stimulate or inhibit certain areas of the brain – has been shown to be effective, and is FDA approved, for treating depression. It is quite feasibly better tolerated than psychiatric medication. Furthermore, there is evidence for is effectiveness as a treatment for pain, which many cancer patients do experience, (though studies in cancer pain are less robust and the treatment would be delivered with different settings and sites). For someone with cancer, with recent surgery possibly limiting one’s oral intake, this could perhaps be interesting to consider, at least hypothetically. That being said, it is fairly new, and the gains achieved in research were modest and inconsistent. Typically, one’s oral intake has been advanced at least to baseline following an operation before being discharged from the hospital, so that issue will likely be moot. It also does entail repeated frequent, albeit brief, visits for a period of a few weeks to receive the treatment each session, and this may not be feasible for someone who also has a grueling chemotherapy or radiation therapy schedule, or, even when an active phase of treatment is complete and such an intervention may be more doable, who still has a host of medical appointments to make and deferred or changing social issues that need attention. Finally, I will add that a related but newer brain stimulation technique, Transcranial Direct Current Stimulation -- involving direct electrical current, rather than a magnetic field -- may also have a similar good tolerability profile and be easily manpulated and performed, and is being studied as an intervention in both psychiatry, including depression amongst other disorders, as well as pain.

This is part of the reason why, with all of this, there is still no replacement for the mainstay approaches of psychopharmacology and/ or psychotherapy, at least to be considered first, and there is really no substitute, and no better resource that I can recommend for reviewing the current approaches to treatment of anxiety and depression, than going straight to the source – a psychiatrist. This is a fair question. I do not usually recommend that people seek information about treatments on their own without consulting directly with a specialist to discuss treatment options for their individual care. Quite basically, what’s good or might work for one person may not be the case for another. Furthermore, I cannot say that there is much in the way of substantially novel approaches to managing depression or anxiety, as the mainstays of treatment consist of psychopharmacology or medication management which have been used for several decades.

That being said, there may be, and certainly is, ongoing refinements to and studies of the efficacy of the psychological therapies as well as establishment and evolution of varying approaches in the field; as well as continual research and development of drugs in the rapidly expanding and burgeoning field of psychopharmacology in which there continues to be refinement of the neurotransmitter receptor profiles, delivery systems, and formulations, in existing classes of medications – mainly the antidepressants which, you should know, are generally the first-line treatment for both depressive and many anxiety disorders, despite the potentially deceptive name – to achieve better tolerability (based on modifications to the molecule), ease of dosing (e.g. long-acting/ extended release versions) and administration (e.g. liquid or transdermal formulations for people who have difficulty with swallowing pills or cannot absorb them when taken by mouth) – all factors which are potentially important particularly for an individual with cancer who might, at a given point in the course of the illness, face a host of obstacles to quality of life including medication administration that may be eased with these options – as well as exploration of other targets for novel classes of drugs that no longer need directly involve the neurotransmitter systems.

There are also other major classes of both ‘biological’ – or what some might call “somatic” – approaches and other ‘non-medical’ interventions. With respect to the latter, these may include alternative therapies which, likewise, include approaches involving chemical consumption – such as herbal therapies – and those that do not – such as the variety of holistic and mind-body approaches. While such alternative approaches are not novel, per se, as they have typically existed for a long time, often long predating modern/ Western medical approaches, they are actively being studied to corroborate their efficacy. Particularly with respect to the holistic/ mind-body approaches, these may appeal to patients with medical illness as they would not necessarily subsume active effort or additional extrinsic compounds which may have the potential only to add to the burdensome medical list and potential risk of side effects to a condition which is already physically trying in its own right, and they may be most conducive to welcome measures of conserving, harnessing, and healing. But herbal therapies are also an area of active research with respect to both psychiatric conditions, including depression and anxiety, and cancer treatments. However, it must again be stressed that, for this reason, consultation with your oncologist and a psychiatrist is essential and is the most optimal source for information about the approaches being sought. Many herbal supplements also run the risk of side effects and deleterious drug interactions, like pharmaceuticals, compounded by the lack of careful standardization in their composition since they are not subject to the same restrictions by the Food and Drug Administration as prescription drugs. With respect to the former, a major field is that of the brain stimulation therapies. Traditionally, this included ECT – electroconvulsive therapy or what has commonly come to be known as “shock” therapy – still actually a highly effective approach which has had the misfortune of stigma through association in the popular media which has conveyed it as a less than humane treatment, and as a byproduct of it having withstood the test of time from its early days when, indeed, the approach was much cruder than the way it is currently conducted with refinements making it quite tolerable However, this is another approach that would not likely be pursued in a patient who has newly emergent depressive or anxiety symptoms in the context of grappling with cancer diagnosis and treatment. It is not that it subsumes potential logistical and medical complications in a patient with active medical comorbidity – as it may, indeed, be conducted safely, if necessary, as it is typically used and effective, for patients with a psychiatric condition that is of long-standing or has not responded well to other treatment approaches – but, rather, that many patients who experience depression or anxiety in the setting of cancer may not require such an approach. Their symptoms might be related simply to a normative adjustment process, or to transitory struggles with adapting to a dramatic life change. But even if a patient’s depression could benefit from a somatic approach, if you will, a first trial of an antidepressant medication will often be effective for someone who may not have experienced such symptoms in their past.

However, I mention the brain stimulation therapies not just because they continue to be a most fruitful field of study, and represent some of the most recent developments in treatment, in psychiatry but I think they represent a potentially appealing approach for people with cancer or other chronic medical conditions. Some of the approaches, such as Vagal Nerve Stimulation, or Cranial Electric Stimulation, have developed since ECT, have been around for a while, and have ultimately had less than appealing results. A more novel procedure, Deep Brain Stimulation – wherein an electrode is implanted in an area of the brain that is below the surface or “cortex” so must be accessed surgically – originally developed, to my awareness, for treating Parkinson’s Disease, is now being studied in a variety of medical conditions, including OCD and Depression. This invasive technique is not the one I would highlight, however. The most recent approach developed as been TMS or Transcranial Magnetic Stimulation. I am mentioning this both in response to the question and to indicate that it is potentially attractive as a very non-invasive and well-tolerated approach – a probe that generates a magnetic field on the surface of the brain to produce current that may either stimulate or inhibit certain areas of the brain – has been shown to be effective, and is FDA approved, for treating depression. It is quite feasibly better tolerated than psychiatric medication. Furthermore, there is evidence for is effectiveness as a treatment for pain, which many cancer patients do experience, (though studies in cancer pain are less robust and the treatment would be delivered with different settings and sites). For someone with cancer, with recent surgery possibly limiting one’s oral intake, this could perhaps be interesting to consider, at least hypothetically. That being said, it is fairly new, and the gains achieved in research were modest and inconsistent. Typically, one’s oral intake has been advanced at least to baseline following an operation before being discharged from the hospital, so that issue will likely be moot. It also does entail repeated frequent, albeit brief, visits for a period of a few weeks to receive the treatment each session, and this may not be feasible for someone who also has a grueling chemotherapy or radiation therapy schedule, or, even when an active phase of treatment is complete and such an intervention may be more doable, who still has a host of medical appointments to make and deferred or changing social issues that need attention. Finally, I will add that a related but newer brain stimulation technique, Transcranial Direct Current Stimulation -- involving direct electrical current, rather than a magnetic field -- may also have a similar good tolerability profile and be easily manpulated and performed, and is being studied as an intervention in both psychiatry, including depression amongst other disorders, as well as pain.

This is part of the reason why, with all of this, there is still no replacement for the mainstay approaches of psychopharmacology and/ or psychotherapy, at least to be considered first, and there is really no substitute, and no better resource that I can recommend for reviewing the current approaches to treatment of anxiety and depression, than going straight to the source – a psychiatrist.

Sentinel node dissection reduces the rate of upper limb lymphedema, but the following breast irradiation brings with it an increased rate of breast lymphedema, which is more difficult to manage because of the absence of a muscle pump to aid in the draining of affected areas, the difficulty in providing compression, and the severe risk of recurrent infection (delayed breast cellulitis). Currently, there is no cure for lymphedema.
Lymphedema can be treated in several ways. Mild lymphedema can be treated by elevating the affected limb and the use of compression bandages. More severe lymphedema requires additional wrapping and is treated by lymphedema specialists. Exercise is also part of both prevention and treatment of lymphedema. Fortunately, lymphedema is less common due to the use of sentinel lymph node biopsy, which reduces the risk of lymphedema developing.

Watch a video about lymphedema and lymphedema treatment. http://www.cancerquest.org/lymphedema-introduction
Read about lymphedema treatment. http://www.cancerquest.org/treatment-for-lymphedema

Do you think that could be related to scar tissue stretching? I have used cocoa butter, and I hear that shea butter may help as well - to dissolve scar tissue internally. Might help. Do you think that could be related to scar tissue stretching? I have used cocoa butter, and I hear that shea butter may help as well - to dissolve scar tissue internally. Might help.

Pain can occur after lumpectomy due to fluid collection, scar tissue as well nerve involvement. The pain does usually resolve over time. Everyone is different and it depends how extensive the surgery was and how long your body takes to reabsorb the fluid and scar tissue. If the pain is caused by nerve involvement this might take longer to recover from. Pain can occur after lumpectomy due to fluid collection, scar tissue as well nerve involvement. The pain does usually resolve over time. Everyone is different and it depends how extensive the surgery was and how long your body takes to reabsorb the fluid and scar tissue. If the pain is caused by nerve involvement this might take longer to recover from.

Great question!

In fact, I've posted on my blog about this very topic:
http://breast-cancer-reconstruction.blogspot.com/2008/11/avoiding-denervation-of-abdominal.html

The DIEP flap procedure preserves all the abdominal muscle. However, preserving all the muscle won't matter if all the motor nerves supplying it have been cut during the surgery. A muscle without a healthy nerve supply will lose it's tone, strength and function.

If the DIEP surgeon does not take great care to identify and preserve motor nerves supplying the abdominal muscle then the benefits of the DIEP can be lost: the abdominal muscle can become weak, lose its tone, and the risk of abdominal bulging or even hernia increases. Occasionally a nerve has to be cut because it interferes with the blood supply of the flap (eg travels between 2 necessary perforators). In these instances the nerve should be repaired at the end of the procedure. Typically, damage to 1 motor nerve will not cause any issues long term; it's damage to multiple nerves that leads to muscle problems.

I hope that helps.

Dr C
http://www.PRMA-enhance.com Great question!

In fact, I've posted on my blog about this very topic:
http://breast-cancer-reconstruction.blogspot.com/2008/11/avoiding-denervation-of-abdominal.html

The DIEP flap procedure preserves all the abdominal muscle. However, preserving all the muscle won't matter if all the motor nerves supplying it have been cut during the surgery. A muscle without a healthy nerve supply will lose it's tone, strength and function.

If the DIEP surgeon does not take great care to identify and preserve motor nerves supplying the abdominal muscle then the benefits of the DIEP can be lost: the abdominal muscle can become weak, lose its tone, and the risk of abdominal bulging or even hernia increases. Occasionally a nerve has to be cut because it interferes with the blood supply of the flap (eg travels between 2 necessary perforators). In these instances the nerve should be repaired at the end of the procedure. Typically, damage to 1 motor nerve will not cause any issues long term; it's damage to multiple nerves that leads to muscle problems.

I hope that helps.

Dr C
http://www.PRMA-enhance.com