Q: I recently ran across an article that mentioned the medication "Daflon" in the treatment of lymphedema. I am always searching for new information and have never heard of this. Can you tell me a little about this medication and how it is used?
A: Daflon has been used for varicose veins and other conditions, and is available in many countries. It works much the same way as the benzopyrones, i.e. by enhancing the macrophage activity and increasing the numbers (this has been well established in experimental models).
Daflon has been successfully tested in clinical trials for the treatment of lymph-edema, but optimal dosages are still undecided. At this point in the trials, the higher dose has been more successful. (Pecking [France]; Ciucci [Argentina]) We think that probably the dose should be at least 2gm per day, but 900mg taken cautiously should help. I suggest you contact Servier Laboratories, the manufacturer, directly for further info. Director of Research, Institut de Recherches Internationales Servier (I.R.I.S.) 6, Place des Pleiades - 92415 Courbevoie Cedex FRANCE. Tel: (33 1) 46 41 60 00. email: firstname.lastname@example.org.
Judith R. Casley-Smith; email@example.com
Q: I am looking for injection information. I am the Director of Employee Health, Infection Control, at Riverview Hospital in Noblesville, Indiana. I have a volunteer who underwent a double mastectomy in 1993. She stated she had never had any difficulty with lymphedema and had blood drawn from both arms on several occasions. I gave her an intradermal TB skin test and when she returned for the reading there was a little lymph pocket. She is eligible for the Hepatitis B vaccine but I do not know where to give it. I hesitate to give it in the deltoid, and the gluteus is contraindicated. I'm open to suggestions.
A: The risk/benefit of a hepatitis vaccination has to be weighed against the lymphedema risk. If she is at high risk for exposure to Hep B, it is certainly a more life-threatening consid-eration than lymphedema exacerbation. Otherwise, it may be contraindicated. Since the absolute answer to this question has yet to be identified, I would ask the Center for Disease Control (CDC) in Atlanta about alternate bodily sites for immunization.
Q: I have had bilateral mastectomies, modified radical on the left side. I will be starting a program with a personal trainer soon to increase my upper body strength. The program includes diet recommendations. None of my doctors have a clue on limiting protein intake to avoid lymphedema. Is there a recommended number of grams?
A: Although lymphedema is a high protein edema, that has nothing to do with your dietary protein. The protein in lymphedema is from the lymphatic fluid, which comes from the blood. Restricting your dietary protein will have no bearing on whether you develop lymphedema or not. A well-balanced diet is best for anyone, with balance between protein, carbs (grains, starches), veggies and fruits. You need to be concerned about how much stress you place on your upper body. Overdoing exercise can bring on swelling, as the muscles need oxygen to do their work, and oxygen comes from the blood. With the extra blood, comes the extra water. Your lymphatic drainage is impaired from your surgery. You must be careful to find the balance in activity that does not overload your lymph drainage and cause swelling. It would be wise to consult a lymphedema therapist who could measure your arms for a baseline, to compare if you think that you are getting into trouble. If you don't know what is "normal" for you, you won't know when you are "swollen". The therapist can also advise you on pacing your training activities, and whether you should wear a compression sleeve and glove while exercising for extra compressive support. The NLN has a list of therapists/treatment centers. Check their website www.lymphnet.org/findTreatment.htm or call the 800 number. Good luck.
Q: My 76-year-old mother had a modified radical mastectomy (left side) last October, and swelling began a month later. She then had another mastectomy (right side) in December, and swelling began a couple of weeks ago. Lymph nodes in both arms were negative. Otherwise, she is healthy and active.
About a month ago, her left arm started turning red, but no pain or sensitivity, no fever, no elevated white count, blood clot has been ruled out by ultrasound. It has been treated for the past month as an infection (4 different antibiotics), but did not respond. The lymphedema is moderate to severe, and she has massage therapy daily, without any improvement. She has not been given a compression sleeve, yet. She was dismissed from a 3-day hospital stay today after several doctors conferred and could not figure out what is causing the redness. Any suggestions?
A: I have had a few patients who have had a chronically red extremity, that has not been infected. Usually, redness is a sign of infection or of chronic inflammation. I am concerned that your mother has had a number of "massage therapy treatments" with no improvement in the lymphedema. You do not say what type of "massage" treatment your mom received. Was it CDT - combined decongestive therapy? If treatment was appropriate, your mom should have had some reduction in the lymphedema.
I see that a blood clot was ruled out. Has active cancer been ruled out? She could also be having a "sympathetic" nervous system response, if there is compression of the sympathetic nervous chain in the midline of her trunk from scar tissue or radiation fibrosis. Have any of the doctors considered that?
It would just be helpful for you to know, so that you would not worry that it is an infection.
If you have other questions after reading these comments, e-mail me directly and I will try to answer: firstname.lastname@example.org.
Bonnie Lasinski is the Director of Physical Therapy, Lymphedema Therapy, Woodbury, NY, and an active member of the NLN Medical Advisory Committee.
Please address questions to: Editor c/o NLN, 116 New Montgomery Street, Suite 235, San Francisco, CA 94105 or e-mail: email@example.com. Deadline for submissions is first day of the month prior to publication.