Mom’s arm swells ‘beyond belief ’
Dear Dr. Roach: My 90-year-old mother has been a warrior over the years with her health. She had lung cancer and had her lung removed; had breast cancer and had her left breast removed; and had colon cancer and had a little of her colon removed.
She has been cancer-free for almost 10 years. About a year ago, she had carpal tunnel surgery on her left wrist because she was in so much pain. It took months for her to recover from it, but finally she did feel better.
She had bloodwork about a month and a half ago, and her left hand and arm swelled up beyond belief. The only medication she has been on is furosemide. My mother prefers home remedies, such as vinegar for arthritis.
She is still out and about to lunch and dinner, and shopping, and just recently gave up driving. She’s very active, but is about 70 pounds overweight.
She started seeing a new doctor because hers retired, and he took her off the water pill and suggested massage therapy, which she starts next week. Is there anything else my mom can do to relieve the pressure and pain in her enormous arm and hand?
M.M. The most likely cause for the swelling in her hand and arm is lymphedema. People (almost always women) with breast cancer are at high risk for lymphedema due to the damage from the cancer, surgery, radiation or some combination. Women who are very overweight are at particularly high risk.
I am concerned that the reason it came on years after the breast cancer treatment was the surgery on the carpal tunnel. (However, even a blood draw from the arm on the side of the cancer can cause it. People with breast cancer should get blood draws and blood pressures drawn from the other side.)
Furosemide (Lasix) is not an effective treatment for lymphedema, but I regret to say I see it used frequently. It sounds like her new doctor is more up-to-date, as current treatment usually involves manual lymphatic drainage, which massages the fluid from the fingers, hands, forearm and arm toward the chest, literally squeezing the fluid out of the loose tissues and back into the lymphatics, where it can be returned to the circulation.
Trained therapists perform this, and can train the patient (or sometimes a family member) to do the massage themselves. Compression garments are often worn during the day. Dear Dr. Roach: I have been advised to take a blood thinner for atrial fibrillation. I currently eat or take garlic, Ginkgo biloba, cinnamon, turmeric, aspirin, vitamin E, omega-3, ginger, blueberries and onions. Since these are all blood thinners, are they sufficient to prevent a stroke? I am diabetic with an irregular heartbeat.
Anon. All the diet and supplements you discuss have some effect on preventing blood clots. However, in someone with atrial fibrillation, there is not enough evidence that they are adequate to prevent the stroke risk associated with atrial fibrillation, which can be as high as five per cent per year.
However, if you do take a prescription anticoagulant, such as warfarin or a newer agent, your doctor should be aware of all of these issues so that you can get a safe amount of anticoagulation.
It can be very difficult to balance the risk of clotting and stroke from not enough anticoagulation, with the risk of major bleeding from too much.
Turmeric and aspirin are the ones I would be most concerned about using in combination with prescription medicine. While some people benefit, that decision must be individualized with many factors about you.