By John Hogg, MD, DABR, DABVLM, RPVI, RPhS, RVT, RVS
Founder, Medical Vein Clinic
When Rebecca T. completed surgery and radiation treatment for breast cancer, she thought the hard part was behind her. Five years later, she noticed something wasn’t right. Her right arm began to swell, slowly at first, then alarmingly fast. A persistent ache turned into a deep, nagging pain. What followed was an unexpected hospital stay and a diagnosis no one had warned her about: lymphedema.
The Lymphatic System Disrupted
“Lymphedema is one of the most under-recognized complications of cancer therapy,” states Dr. Joshua Trock, Doctor of Physical Therapy and Lymphedema Specialist at Medical Vein Clinic. “It’s especially common among breast cancer survivors, particularly those who’ve had lymph nodes removed or treated with radiation.”
Lymphedema develops when the body’s natural waste disposal network, the lymphatic system, breaks down. Cancer treatments such as lymph node removal and radiation can hinder lymphatic flow, allowing fluid to accumulate and cause swelling. This often starts subtly: a sense of heaviness in the limb, a sleeve that suddenly fits tighter, or a wristwatch that feels snug.
Over time, the swelling may become more visible and persistent. Without treatment, the affected area becomes increasingly vulnerable to infections, which can escalate quickly and require hospitalization. In some cases, something as minor as a bug bite, small cut, or even dental work can trigger a full-blown infection if the immune defenses are compromised.
A Condition That Can Linger for Years
Lymphedema affects at least three million Americans. The highest incidence is observed following breast cancer surgery, particularly among those patients who undergo radiation therapy following the removal of axillary lymph nodes. Many of these individuals will develop Breast Cancer Related Lymphedema (BCRL).
BCRL is one of the most concerning and prevalent secondary complications of breast cancer treatments. “Research indicates that approximately 25% of patients develop lymphedema after breast cancer surgery. But for those who also undergo radiation therapy, the development of lymphedema increases to 38%,” according to the American Physical Therapy Association’s “Physical Therapy Journal.”
Lymphedema doesn’t always appear immediately. It can show up weeks, months, or even decades after cancer treatment. Studies estimate that up to 1 in 5 breast cancer survivors develop some form of lymphedema, often exacerbated by inflammation, weight gain, or lack of movement.
Unfortunately, the condition is often overlooked or misdiagnosed, even by well-meaning healthcare professionals. Many patients are told they’re simply “retaining water” or experiencing normal post-treatment discomfort, when in fact they are showing early signs of a progressive condition.
If left unmanaged, it can be a lifelong condition. But, caught early and treated appropriately, patients can regain comfort, reduce swelling, and avoid more serious complications.
Spotting the Early Signs
Even without swelling, contact your doctor if you experience tingling or unusual sensations in your arm after surgery. If you’re uncomfortable, request a referral to a lymphedema management specialist. Lymphedema usually begins with these symptoms:
- Tightness or heaviness in the arm or hand
- Swelling that comes and goes
- Achiness, itching, or skin changes
- Reduced flexibility or discomfort in the affected limb
- Infections often present with red, blotchy skin, fever, or chills. If you notice any of these symptoms, don’t wait. Prompt treatment can prevent serious complications.
Reducing Risk with Real-World Strategies
Patients don’t need to live in fear, but they do need to be cautious. Avoid injury to the affected limb: no aggressive yard work, no deep tissue massages on that arm, and be careful with manicures.
For individuals at risk, proactive skin care and injury prevention are crucial. Simple changes such as wearing gloves while cooking or gardening, using insect repellent, and avoiding tight jewelry can help protect vulnerable areas. Compression sleeves should be considered during air travel or physical activity.
Staying active, under your doctor’s guidance, is crucial for managing swelling. While it may seem counterintuitive, gentle exercise can actually improve fluid circulation and maintain strength and flexibility, whereas avoiding movement might worsen swelling. Keeping the blood flowing and keeping the body moving is usually a good rule of thumb for all things involving the circulatory and lymphatic systems.
Lymphedema Treatment at Medical Vein Clinic
Medical Vein Clinic in San Antonio has one of the few comprehensive lymphedema programs in Texas, recognized by the National Lymphedema
Network. Our multidisciplinary team takes a whole-patient approach to treatment, combining the latest technologies with personalized care.
Treatment plans may include:
Compression Therapy: Compression is crucial for treating lymphedema. Physical therapists use special bandages to reduce swelling, followed by
compression garments to reduce the accumulation of fluids in the arms.
Exercise Coaching: Safe movement strategies to stimulate lymphatic flow.
Skin Care Education: Preventive care to reduce the risk of infection. We are the quarterback for our patients’ overall lymphedema care. It is important to evaluate the underlying veins. The number one cause of lymphedema in this country is from many years of untreated vein disease (reflux, or venous insufficiency). In less developed countries, the leading cause is parasites. And we can treat these veins if they are abnormal. Once treated, there is less fluid leaking out in the legs, which adds to the excessive fluid that causes lymphedema. Less “fuel”, less “fire.”
Awareness Makes the Difference
Many breast cancer survivors never receive adequate education about lymphedema. Awareness is the most important step in preventing long-term complications. Any patient who has had lymph nodes removed or radiated should consider an evaluation with a certified lymphedema therapist, even if no symptoms are present.
Lymphedema may not make headlines, but it affects quality of life in very real ways. With early detection, expert care, and a proactive plan, patients can manage it effectively and keep moving forward with confidence.
About Medical Vein Clinic
Medical Vein Clinic in San Antonio specializes in venous, arterial, and lymphatic disorders and is proud to be affiliated with the National Lymphedema Network. Dr. John Hogg, MD, DABR, DABVLM, RPVI, RPhS, RVT, RVS, is a board-certified radiologist specializing in Vascular & Interventional Radiology and the CEO/Founder of Medical Vein Clinic. With over 30 years of experience, he leads a team of experts in a patient-first approach, providing advanced, compassionate care for those living with or at risk of lymphedema. To learn more, visit www.medicalveinclinic.com or call 210-622-8000 to set up an evaluation.
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