NSU Horizons Fall 2007

Having a mastectomy can result in complicated issues for victims of breast cancer. Some of these issues are the fear of a life-threatening disease, the loss of the breast, and the potential for severe and painful swelling of the arm near the surgery site. Limbs can become markedly larger than normal, which not only can be physically uncomfortable, but also can result in a self- image crisis, according to Harvey N. Mayrovitz, Ph.D., principal investigator and leader of a team of Nova Southeastern University medical doctors and research- ers from the College of Medical Sciences that are studying the predictability and treatment of the condi- tion known as lymphedema. Dawn Brown-Cross, Ed.D., a physical therapist in the College of Allied Health and Nursing, and Ezella “Zee” Washington, second- year medical student in the College of Osteopathic Medicine (COM), collect- ed data for the initial series of studies. The first studies were of premenopausal and postmenopausal women who were examined using data obtained by Doppler blood flow measurements, skin temperature, arm volume, and tissue water levels at a specific site on the arm. Hormone levels also were monitored using saliva samples. Mayrovitz, a COM physiology pro- fessor, said lymphedema, a condition that can strike women up to several years following a lymphectomy or mas- tectomy, is a common problem. “We have a general interest in the problem of lymphedema, or swelling of the limbs,” Mayrovitz said. “Often it occurs with some frequency in women who have had a mastectomy, lymphectomy, or radiation … and it develops in about 25 percent of the women who undergo this treatment.” Although a quarter of women with this medical history may develop the problem, they may not see the symptoms for quite some time. “In some women, it won’t occur for years after their surgery,” Mayrovitz explains. “Generally speaking, in the first year following such surgery, 50 percent of the women who will get the lymphedema get it.” In addition to the discomfort excess swelling can cause, the body image problems of being self-conscious, and clothing not fitting properly, other conditions also happen. “You have to remember that for a woman that just had a mastectomy, which is very, very debilitating psychologically, to now have to deal with this swelling on top of it, it’s quite a blow,” Washington said. “When you have an arm that is significantly larger than the other, you have to change your clothing, you need to wear long sleeves; and in Florida, that is hard to do, so it can significantly change a woman’s life.” And it hurts. “It can get painful, depending upon the severity. You are taking a portion of the body that you can only expand to a certain level before it starts pressing on muscles and nerves,” she said, adding that she is looking forward to the time when Mayrovitz is able to target patients at risk for the condition because “if they knew they were at higher risk, they could have lymphatic treatment done prior to and after surgery.” This would include massage. There are other implications of the swelling, accord- ing to Mayrovitz. “The limitations on range of motion can be severe. These women can’t put their wedding rings on; they can’t put their watches on. There are many complications or bad things that occur with this,” Mayrovitz said, adding that women don’t always seek therapy when swell- ing occurs, and, if it is left alone, it will get worse. Mayrovitz and his team wish to accomplish several things with the studies. They would like to deter- mine if the condition can be predicted in certain patients. They would also like to devise treatments for women who may develop the problem that could be administered prior to the initial surgery and further develop treatments already in place for those who are suffering. Ahead of everything else on the agenda is figuring out who has the potential to develop lymphedema in the first place. In an effort to find a predicting factor, Mayrovitz et al. began with a study that measured the amount of water in a woman’s arm tissue during various times in her monthly menstrual cycle. They wondered if this data could provide an early indicator to the edema problem. “We were looking at the normal state of what happens through a menstrual cycle in terms of water retention, and we did it because there’s no scientific evidence of water retention, although women do complain about it,” said Brown-Cross. “We really just wanted to investigate it and ask questions—Did it happen? Can we measure it?— Which hadn’t been done.” While the initial studies of healthy young women yielded no significant predictions of edema in arms, Brown-Cross said “it may be just because of age that the premenopausal women would have faster blood velocity … we did find, as we expected, that estrogen levels are lower in the postmenopausal women, but it wasn’t significantly different.” The full results of this initial 22 horizons Harvey N. Mayrovitz, Ph.D.