Dr. Roach: Avoiding IVs helps avert lymphedema in those with risk factors

Dear Dr. Roach: I had breast cancer in my right breast when I was 45. I had a lumpectomy, underwent radiation treatments and had seven lymph nodes removed. My breast doctor told me not to use my right arm for any injections, IVs or blood pressure checks. He also advised me to use an elastic pressure arm band when traveling by plane.

I am now 81 and still follow the same regimen. My breast doctor retired years ago, but my primary doctor told me I can now use my right arm for injections. What is your opinion?

— A.M.

Dear A.M.: I was taught what your breast surgeon told you. The goal is to prevent swelling in the arm, called lymphedema, which can happen after receiving treatment for breast cancer. There are several risk factors for breast-cancer-associated lymphedema, including invasive cancer; lymph node dissection/removal; radiation and others, like being obese or a history of infection. Men and women with breast cancer are at such a high risk for developing lymphedema that we consider them “stage 0 lymphedema.”

For those with no risk factors, blood pressure readings and blood draws did not increase the risk of developing lymphedema in a recent study. However, even though there may not be much risk, my opinion is that people with breast cancer and risk factors for developing lymphedema should continue to avoid IVs, blood draws and blood pressure readings if possible. It is not onerous to avoid them, and prevention is so much better than treatment.

You, on the other hand, have at least two risk factors, so I more strongly recommend you continue what you are doing. However, I would be cautious about the elastic pressure arm band. Incorrectly placed compression might increase the risk of developing lymphedema. A breast expert or expert in managing lymphedema could help answer that, but since you have done well for 36 years, I think you should keep doing what you are doing.

Dear Dr. Roach: I am a 76-year-old male who recently had an MRI that revealed a slightly torn tendon in my shoulder. My doctor suggested that I see an orthopedist for further treatment. When I asked if he could recommend one, he said that I should “do some research” and select one myself. I was really disturbed by this. Should I have been?

— Anon.

Dear Anon.: Ideally, your doctor would have knowledge about the specialists available to you and recommend one who has expertise with this kind of shoulder problem. (For some kinds of doctors, matching personalities and philosophies is important, too.)

In the best situation, your primary care doctor’s office would even help you get a timely appointment. I can understand why you would be disappointed that your doctor couldn’t help you navigate this complex system.

I do have to say that, from the standpoint of a primary care doctor, it is increasingly difficult to maintain that expertise. Health care systems constantly change, and some of the specialists who your doctor would like to refer you to might be unavailable for insurance reasons. In addition, a doctor who is new to the area hasn’t had time to build up the relationships necessary to know which specialist is best for the medical issues that are at hand.

Still, I understand why you feel that way. At the very least, your doctor could have helped you search.

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