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Tuesday, April 16, 2013
Q: Three days ago, there appeared an unexplained wet spot at the inside of my husband’s sock, and also near the cuff of his slacks. It happened again during the next two days. We consulted his doctor, who diagnosed it as a leaking lymph node, and said he had no way of treating it, but increased the furosemide my husband is taking from every other day to a daily dose, hoping to decrease the swelling in his legs.
In the past, my husband has battled non-Hodgkin’s lymphoma, and also a blood clot in the “leaking” leg. Both legs have been swollen and tight to the touch for a year or even longer. Interestingly, the cardiologist’s comment was: “Don’t worry about it, it’s only cosmetic.” There seems to be no problem with his heart or lungs.
What do you think?
A: It sounds to me as though your husband has lymphedema. Lymphedema is a swelling in an extremity (but usually leg or legs) that doesn’t improve much even after sleeping. Lymphedema has many causes, including cancer, surgery and blood clots, but many people have lymphedema with no known cause. In the case of cancer, it does not necessarily mean that the cancer has come back, but most cancer physicians would carefully evaluate for recurrence.
I think what is happening is that the skin has been so tight for so long that the integrity of the skin is breaking down, and the lymph fluid is literally leaking through the skin. It’s not a lymph node that is leaking. A lymph node is a localized organ of the lymphatic system, where white blood cells congregate. In this case, the whole lymphatic system, which should be returning fluid to the circulation, isn’t working properly, so the fluid is backing up. I had one patient who literally lost liters of fluid from his legs.
Unfortunately, many physicians are not so well-educated about lymphedema. Diuretics like furosemide can help for a day or two, but they are not effective in the long term. One effective treatment is manual lymphatic drainage (MLD). A trained therapist massages the affected limb to drain the fluid back into the circulation. Unfortunately, this generally can’t be done with the skin so broken down, so frequent leg elevation (above the heart, at least three times a day for at least 30 minutes each time) may be necessary until the skin heals and MLD can start. Support stockings, effective for people with occasional leg swelling, are sometimes useful, especially if his are custom-fitted and -made.
Your husband’s cancer doctor is more likely to have resources available to help than his cardiologist.
Q: How often does a 76-year-old man need a colonoscopy? I had one in 2008 and am due again in 2013. I had part of my colon taken out due to cancerous polyps. What are the chances I have cancer now? Last time, the doctor said I was clean.
A: Colonoscopies are recommended for men and women every 10 years between the ages of 50 and 70, as long as everything is completely normal. If things aren’t completely normal, your gastroenterologist will give you a recommended follow-up. For people with non-cancerous polyps, the follow-up depends on the type of polyp, and may be anywhere from three to 10 years. After cancer, you should have a colonoscopy after one year, with follow-up exams every three to five years after that.
Dr. Keith Roach’s column runs
in Tuesday’s Extra.
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