› Forums › General Melanoma Community › Axillary LND and pain management
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JC.
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- July 26, 2012 at 12:45 am
Just curious for those of you who've had an axillary LND, what was your pain like following the procedure? Narcotics? How long? Recovery time? Inconvenience level?
Just curious for those of you who've had an axillary LND, what was your pain like following the procedure? Narcotics? How long? Recovery time? Inconvenience level?
I have an 87 y.o. father who has melanoma in the right axillary lymph nodes. He had one node cherry picked maybe 8 months ago, but now others are growing. It's his cane arm and I'm worried about pain, lymphedema, and compromised quality of life. He has experienced severe personality changes while on narcotics (although he doesn't believe his family when we say that). He has limited mobility and limited tolerance for being inconvenienced. I'm not sure how well he'd do with stripping drains. We have an appointment tomorrow with a surgical oncologist that originally suggested the LND which we refused as only one node was enlarged at that time. I'm trying to balance quality of life with keeping things in check. My father has 3 other types of cancer but all are stable except for this melanoma. I understand where this can all go, but leaving this alone is most likely the option my father will choose. I'm just trying to consider all options from nothing to minimally invasive to a complete LND. My Dad will look to me for guidance on this one and I want to feel more comfortable than I do right now with my choice. Any input would be appreciated.
Janner
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- July 26, 2012 at 2:08 am
Hi Janner,
I had a CLND under my left arm, 42 nodes plus 3 sentinels before the clnd. I had the surgery back in late Nov 2010, and I am still numb under the arm, but getting some sensation back at times. The worst part for me by a mile was the drain and stripping the drain, mine had to stay in for nearly 4 weeks, and it was pretty terrible. The pain for me wasn't that bad, actually had more pain with my original WLE on my chest and when they took 3 sentinels from under my right and left arm. The pain was easily managed with tylenol 3 for a short time, but many of my nerves were cut so maybe that was somewhat of a blessing for pain purposes? I have no lymphedema and try to stay very active, just threw 200 bales of hay the other day. I get sore at times but not too bad. Oh yeah, another tough thing for me was getting mobility back in my arm since I couldn't lift it for 3-4 weeks, very tough to lift at first but then it comes back, I had some physical therapy. I am now 38 so I am sure recovery would be different for your father.
Hope this helps and feel free to ask if you have anymore ?. Best of luck!
Dave
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- July 26, 2012 at 2:08 am
Hi Janner,
I had a CLND under my left arm, 42 nodes plus 3 sentinels before the clnd. I had the surgery back in late Nov 2010, and I am still numb under the arm, but getting some sensation back at times. The worst part for me by a mile was the drain and stripping the drain, mine had to stay in for nearly 4 weeks, and it was pretty terrible. The pain for me wasn't that bad, actually had more pain with my original WLE on my chest and when they took 3 sentinels from under my right and left arm. The pain was easily managed with tylenol 3 for a short time, but many of my nerves were cut so maybe that was somewhat of a blessing for pain purposes? I have no lymphedema and try to stay very active, just threw 200 bales of hay the other day. I get sore at times but not too bad. Oh yeah, another tough thing for me was getting mobility back in my arm since I couldn't lift it for 3-4 weeks, very tough to lift at first but then it comes back, I had some physical therapy. I am now 38 so I am sure recovery would be different for your father.
Hope this helps and feel free to ask if you have anymore ?. Best of luck!
Dave
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- July 26, 2012 at 2:08 am
Hi Janner,
I had a CLND under my left arm, 42 nodes plus 3 sentinels before the clnd. I had the surgery back in late Nov 2010, and I am still numb under the arm, but getting some sensation back at times. The worst part for me by a mile was the drain and stripping the drain, mine had to stay in for nearly 4 weeks, and it was pretty terrible. The pain for me wasn't that bad, actually had more pain with my original WLE on my chest and when they took 3 sentinels from under my right and left arm. The pain was easily managed with tylenol 3 for a short time, but many of my nerves were cut so maybe that was somewhat of a blessing for pain purposes? I have no lymphedema and try to stay very active, just threw 200 bales of hay the other day. I get sore at times but not too bad. Oh yeah, another tough thing for me was getting mobility back in my arm since I couldn't lift it for 3-4 weeks, very tough to lift at first but then it comes back, I had some physical therapy. I am now 38 so I am sure recovery would be different for your father.
Hope this helps and feel free to ask if you have anymore ?. Best of luck!
Dave
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- July 26, 2012 at 2:23 am
Janner, sorry to hear your father is facing this.
I had right axillary LND in June 2011 after sentinel node biopsy (2 removed) found MM in one. The LND removed a futher 16 nodes, so not as complete a dissection as some. I developed quite a persistent seroma, went on for about 6 weeks and it was a real nuisance, had it drained every couple of days until it went. Having the drain in for the first week wasn't too bad, and it was removed without any problem at the end of that week (although in hindsight it perhaps should have stayed in longer given the seroma developing). I don't recall a huge amount of pain, like Dave I think my SNB caused more exquisite pain just in the area where they went in. I managed on regular painkillers (ibuprofen, panadol) after the first couple of days (had a PCA while in hospital).
I have not had lymphodema, but did get some advice on massage techniques which I used when I had the seroma and there was some threat that lymphodema might develop. I also wear a specially fitted compression sleeve whenever I fly.
In terms of recovery, the first six months or so, I had quite a bit of residual swelling around the axilla and out to my back below the shoulder-blade. I had quite a numb area in my tricep region but that is now feeling pretty normal. If I touch the underarm to back area, it still now feels a bit puffy and slightly tender to touch.
My arm was pretty weak in the early stages but now feels fairly normal, and I find if I use it and exercise sensibly it actually feels better than if I do nothing at all. The time I perhaps notice some continuing slight weakness the most is when I pick up my nearly 2-yr old son who weighs 14kg, I can't support him with that arm alone for very long!
All in all it was pretty manageable for me but then I was only 41 at the time. I think it could be quite different for an older person.
Regards,
Allison
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- July 26, 2012 at 2:23 am
Janner, sorry to hear your father is facing this.
I had right axillary LND in June 2011 after sentinel node biopsy (2 removed) found MM in one. The LND removed a futher 16 nodes, so not as complete a dissection as some. I developed quite a persistent seroma, went on for about 6 weeks and it was a real nuisance, had it drained every couple of days until it went. Having the drain in for the first week wasn't too bad, and it was removed without any problem at the end of that week (although in hindsight it perhaps should have stayed in longer given the seroma developing). I don't recall a huge amount of pain, like Dave I think my SNB caused more exquisite pain just in the area where they went in. I managed on regular painkillers (ibuprofen, panadol) after the first couple of days (had a PCA while in hospital).
I have not had lymphodema, but did get some advice on massage techniques which I used when I had the seroma and there was some threat that lymphodema might develop. I also wear a specially fitted compression sleeve whenever I fly.
In terms of recovery, the first six months or so, I had quite a bit of residual swelling around the axilla and out to my back below the shoulder-blade. I had quite a numb area in my tricep region but that is now feeling pretty normal. If I touch the underarm to back area, it still now feels a bit puffy and slightly tender to touch.
My arm was pretty weak in the early stages but now feels fairly normal, and I find if I use it and exercise sensibly it actually feels better than if I do nothing at all. The time I perhaps notice some continuing slight weakness the most is when I pick up my nearly 2-yr old son who weighs 14kg, I can't support him with that arm alone for very long!
All in all it was pretty manageable for me but then I was only 41 at the time. I think it could be quite different for an older person.
Regards,
Allison
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- July 26, 2012 at 2:23 am
Janner, sorry to hear your father is facing this.
I had right axillary LND in June 2011 after sentinel node biopsy (2 removed) found MM in one. The LND removed a futher 16 nodes, so not as complete a dissection as some. I developed quite a persistent seroma, went on for about 6 weeks and it was a real nuisance, had it drained every couple of days until it went. Having the drain in for the first week wasn't too bad, and it was removed without any problem at the end of that week (although in hindsight it perhaps should have stayed in longer given the seroma developing). I don't recall a huge amount of pain, like Dave I think my SNB caused more exquisite pain just in the area where they went in. I managed on regular painkillers (ibuprofen, panadol) after the first couple of days (had a PCA while in hospital).
I have not had lymphodema, but did get some advice on massage techniques which I used when I had the seroma and there was some threat that lymphodema might develop. I also wear a specially fitted compression sleeve whenever I fly.
In terms of recovery, the first six months or so, I had quite a bit of residual swelling around the axilla and out to my back below the shoulder-blade. I had quite a numb area in my tricep region but that is now feeling pretty normal. If I touch the underarm to back area, it still now feels a bit puffy and slightly tender to touch.
My arm was pretty weak in the early stages but now feels fairly normal, and I find if I use it and exercise sensibly it actually feels better than if I do nothing at all. The time I perhaps notice some continuing slight weakness the most is when I pick up my nearly 2-yr old son who weighs 14kg, I can't support him with that arm alone for very long!
All in all it was pretty manageable for me but then I was only 41 at the time. I think it could be quite different for an older person.
Regards,
Allison
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- July 26, 2012 at 2:52 am
Sorry about your dad Janner. I had 4 nodes removed initially and that was a piece of cake. Very little pain, no drugs required. The CLND was not terribly painful but the drains were very inconvient. I never hit the mark for draining and after 25 days finally after 25 days got the drains pulled. I too developed a Saroma which burst, not nice but not the end of the world. I also ended up with so permanent nerve damage (2+ years down the road now). It's nothing I can't deal this but I just know it's there.
The first 4 days after the CLND I was uncomfortable (pain level maybe a 5), after that it was down to a 2 or so.
Hope this helps
Mary
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- July 26, 2012 at 2:52 am
Sorry about your dad Janner. I had 4 nodes removed initially and that was a piece of cake. Very little pain, no drugs required. The CLND was not terribly painful but the drains were very inconvient. I never hit the mark for draining and after 25 days finally after 25 days got the drains pulled. I too developed a Saroma which burst, not nice but not the end of the world. I also ended up with so permanent nerve damage (2+ years down the road now). It's nothing I can't deal this but I just know it's there.
The first 4 days after the CLND I was uncomfortable (pain level maybe a 5), after that it was down to a 2 or so.
Hope this helps
Mary
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- July 26, 2012 at 2:52 am
Sorry about your dad Janner. I had 4 nodes removed initially and that was a piece of cake. Very little pain, no drugs required. The CLND was not terribly painful but the drains were very inconvient. I never hit the mark for draining and after 25 days finally after 25 days got the drains pulled. I too developed a Saroma which burst, not nice but not the end of the world. I also ended up with so permanent nerve damage (2+ years down the road now). It's nothing I can't deal this but I just know it's there.
The first 4 days after the CLND I was uncomfortable (pain level maybe a 5), after that it was down to a 2 or so.
Hope this helps
Mary
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- July 26, 2012 at 2:53 am
Janner,
I had my axillary LND 3.5 years ago and I really don't remember the pain afterword being very bad. The pain from my excision was much worse. The drain was gross and I had to strip it all the time and it stayed in at least 3 weeks. I started out having other people strip it and then I ended up just doing it myself. I was using my arm with full range of motion and without much pain other than aching in my armpit area. I haven't had any lymphedema either. I did however start having issues recently with pain and range of motion. I really don't know for sure if it's related or if I injured it weeding the garden or doing something else. I probably haven't been much help. I was 40 when I had my surgery that's a lot different than 87. I have a 95 year old grandmother that I would absolutely say no way to this surgery on, but she's got a few more years on her than your dad. Sorry you are going through all this. Take care.
Amy S. in Michigan
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- July 26, 2012 at 2:53 am
Janner,
I had my axillary LND 3.5 years ago and I really don't remember the pain afterword being very bad. The pain from my excision was much worse. The drain was gross and I had to strip it all the time and it stayed in at least 3 weeks. I started out having other people strip it and then I ended up just doing it myself. I was using my arm with full range of motion and without much pain other than aching in my armpit area. I haven't had any lymphedema either. I did however start having issues recently with pain and range of motion. I really don't know for sure if it's related or if I injured it weeding the garden or doing something else. I probably haven't been much help. I was 40 when I had my surgery that's a lot different than 87. I have a 95 year old grandmother that I would absolutely say no way to this surgery on, but she's got a few more years on her than your dad. Sorry you are going through all this. Take care.
Amy S. in Michigan
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- July 26, 2012 at 2:53 am
Janner,
I had my axillary LND 3.5 years ago and I really don't remember the pain afterword being very bad. The pain from my excision was much worse. The drain was gross and I had to strip it all the time and it stayed in at least 3 weeks. I started out having other people strip it and then I ended up just doing it myself. I was using my arm with full range of motion and without much pain other than aching in my armpit area. I haven't had any lymphedema either. I did however start having issues recently with pain and range of motion. I really don't know for sure if it's related or if I injured it weeding the garden or doing something else. I probably haven't been much help. I was 40 when I had my surgery that's a lot different than 87. I have a 95 year old grandmother that I would absolutely say no way to this surgery on, but she's got a few more years on her than your dad. Sorry you are going through all this. Take care.
Amy S. in Michigan
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- July 26, 2012 at 7:01 pm
Thanks for the input. It's now been discovered he has sub-q intransits so we won't be pursuing the LND — moot point now as the disease is no longer confined to the basin. So far, it has been slow growing and we'll continue to hope that will be the case. For now, he's choosing quality of life until something grows large enough to be an issue for him.
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- July 26, 2012 at 7:01 pm
Thanks for the input. It's now been discovered he has sub-q intransits so we won't be pursuing the LND — moot point now as the disease is no longer confined to the basin. So far, it has been slow growing and we'll continue to hope that will be the case. For now, he's choosing quality of life until something grows large enough to be an issue for him.
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- July 26, 2012 at 7:01 pm
Thanks for the input. It's now been discovered he has sub-q intransits so we won't be pursuing the LND — moot point now as the disease is no longer confined to the basin. So far, it has been slow growing and we'll continue to hope that will be the case. For now, he's choosing quality of life until something grows large enough to be an issue for him.
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- July 26, 2012 at 7:09 pm
Just wondering, is this a recurrence of a past lesion that was removed and has now recurred? From how long ago, what stage at the time?
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- July 26, 2012 at 7:26 pm
Originally at least stage II (2.22mm) 6 years ago at age 81. Opted not to do the SNB because even then, he wouldn't have had the LND if it were positive. Only did the WLE. Melanoma discovered in local lymph basin maybe 1.5 years ago. One lymph node "cherry picked" 14 months ago to slow down disease. His case isn't typical with no SNB/LND – but it was his choice.
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- July 26, 2012 at 7:26 pm
Originally at least stage II (2.22mm) 6 years ago at age 81. Opted not to do the SNB because even then, he wouldn't have had the LND if it were positive. Only did the WLE. Melanoma discovered in local lymph basin maybe 1.5 years ago. One lymph node "cherry picked" 14 months ago to slow down disease. His case isn't typical with no SNB/LND – but it was his choice.
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- July 26, 2012 at 8:34 pm
Actually, I don't think so. I think prognosis is still better for younger individuals. It's been a long time since I looked at all those stats, though. As we age, there are probably a lot more things that might compromise the immune system so older individuals may not be able to fight melanoma as easily as they could when younger.
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- July 26, 2012 at 8:34 pm
Actually, I don't think so. I think prognosis is still better for younger individuals. It's been a long time since I looked at all those stats, though. As we age, there are probably a lot more things that might compromise the immune system so older individuals may not be able to fight melanoma as easily as they could when younger.
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- July 27, 2012 at 3:15 pm
Fighting means preventing melanoma in the first place. The body has mutated cells all the time and for the vast majority – the body gets rid of these cells and cancer isn't an issue. This is the point in maintaining a strong immune system, letting the body do what it does best. This is why people with compromised immune systems may develop melanoma at a much higher rate than people without. (People who have had an organ transplant where their immune systems are suppressed to prevent organ rejection are at much higher risk for melanoma). As we get to be more elderly, we don't have the strong immune system in place to fight off everything. From the common cold to the more sinister cancer, the elderly are more susecptible.
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- July 27, 2012 at 3:15 pm
Fighting means preventing melanoma in the first place. The body has mutated cells all the time and for the vast majority – the body gets rid of these cells and cancer isn't an issue. This is the point in maintaining a strong immune system, letting the body do what it does best. This is why people with compromised immune systems may develop melanoma at a much higher rate than people without. (People who have had an organ transplant where their immune systems are suppressed to prevent organ rejection are at much higher risk for melanoma). As we get to be more elderly, we don't have the strong immune system in place to fight off everything. From the common cold to the more sinister cancer, the elderly are more susecptible.
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- July 27, 2012 at 3:21 pm
And, maybe this too if this makes any sense – correct me if I'm way off base here: Let's say someone has an early melanoma diagnosed and they get excision surgery. There are 3 options of what happened, we just don't know: 1) All the melanoma was excised in the biopsy/surgery, and it was contained & localized and no stray cells migrated somewhere else in the body or 2) There were some cells that traveled either through lymphatic channels or bloodstream, and have strayed elsewhere in the body. Could be dormant for # of years, and then recur later as metastatic disease or 3) There were some cells that traveled elsewhere in the body but the patient never knows it or realizes it because the body's immune system took care of those stray cells before they could cause trouble.
If this is somewhat accurate, then even for people who have already had melanoma, the immune system's ability to fight still may be of importance.
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- July 27, 2012 at 3:21 pm
And, maybe this too if this makes any sense – correct me if I'm way off base here: Let's say someone has an early melanoma diagnosed and they get excision surgery. There are 3 options of what happened, we just don't know: 1) All the melanoma was excised in the biopsy/surgery, and it was contained & localized and no stray cells migrated somewhere else in the body or 2) There were some cells that traveled either through lymphatic channels or bloodstream, and have strayed elsewhere in the body. Could be dormant for # of years, and then recur later as metastatic disease or 3) There were some cells that traveled elsewhere in the body but the patient never knows it or realizes it because the body's immune system took care of those stray cells before they could cause trouble.
If this is somewhat accurate, then even for people who have already had melanoma, the immune system's ability to fight still may be of importance.
-
- July 27, 2012 at 3:21 pm
And, maybe this too if this makes any sense – correct me if I'm way off base here: Let's say someone has an early melanoma diagnosed and they get excision surgery. There are 3 options of what happened, we just don't know: 1) All the melanoma was excised in the biopsy/surgery, and it was contained & localized and no stray cells migrated somewhere else in the body or 2) There were some cells that traveled either through lymphatic channels or bloodstream, and have strayed elsewhere in the body. Could be dormant for # of years, and then recur later as metastatic disease or 3) There were some cells that traveled elsewhere in the body but the patient never knows it or realizes it because the body's immune system took care of those stray cells before they could cause trouble.
If this is somewhat accurate, then even for people who have already had melanoma, the immune system's ability to fight still may be of importance.
-
- July 27, 2012 at 3:15 pm
Fighting means preventing melanoma in the first place. The body has mutated cells all the time and for the vast majority – the body gets rid of these cells and cancer isn't an issue. This is the point in maintaining a strong immune system, letting the body do what it does best. This is why people with compromised immune systems may develop melanoma at a much higher rate than people without. (People who have had an organ transplant where their immune systems are suppressed to prevent organ rejection are at much higher risk for melanoma). As we get to be more elderly, we don't have the strong immune system in place to fight off everything. From the common cold to the more sinister cancer, the elderly are more susecptible.
-
- July 26, 2012 at 8:34 pm
Actually, I don't think so. I think prognosis is still better for younger individuals. It's been a long time since I looked at all those stats, though. As we age, there are probably a lot more things that might compromise the immune system so older individuals may not be able to fight melanoma as easily as they could when younger.
-
- July 26, 2012 at 7:26 pm
Originally at least stage II (2.22mm) 6 years ago at age 81. Opted not to do the SNB because even then, he wouldn't have had the LND if it were positive. Only did the WLE. Melanoma discovered in local lymph basin maybe 1.5 years ago. One lymph node "cherry picked" 14 months ago to slow down disease. His case isn't typical with no SNB/LND – but it was his choice.
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- July 27, 2012 at 12:29 am
Janner,
I don't have any information for you, but I wanted to let you know that you're in my prayers. You always go out of your way to help others on this board…I hope some of these answers will help you for a change. Good luck with everything!
Tricia
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- July 27, 2012 at 12:29 am
Janner,
I don't have any information for you, but I wanted to let you know that you're in my prayers. You always go out of your way to help others on this board…I hope some of these answers will help you for a change. Good luck with everything!
Tricia
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- July 27, 2012 at 12:29 am
Janner,
I don't have any information for you, but I wanted to let you know that you're in my prayers. You always go out of your way to help others on this board…I hope some of these answers will help you for a change. Good luck with everything!
Tricia
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- July 27, 2012 at 2:13 pm
Sorry to hear about your dad.
I had all the left axillary lymph nodes removed in January 2011. I didn't find the post surgical pain to be all that bad. Some nerves had been severed to help with pain control and that definitely helped. I was prescribed oxycodone for pain and only took it at night for the first two nights. By the time I had my follow up visit with the surgeon, which was 2 weeks after the surgery, my pain level was negligible, though I still had some work to do to regain mobility in my left arm. He would definitely be inconvenienced, since his surgery will involve his cane arm. It won't hurt to get some input about his predicament from a lymphedema specialist/therapist. I know you're not supposed to lift heavy things with the affected arm but I'm not sure about supporting yourself with a cane.
The worst part of the surgery for me was the damned drain. When that was finally removed it was a huge relief.
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- July 27, 2012 at 2:13 pm
Sorry to hear about your dad.
I had all the left axillary lymph nodes removed in January 2011. I didn't find the post surgical pain to be all that bad. Some nerves had been severed to help with pain control and that definitely helped. I was prescribed oxycodone for pain and only took it at night for the first two nights. By the time I had my follow up visit with the surgeon, which was 2 weeks after the surgery, my pain level was negligible, though I still had some work to do to regain mobility in my left arm. He would definitely be inconvenienced, since his surgery will involve his cane arm. It won't hurt to get some input about his predicament from a lymphedema specialist/therapist. I know you're not supposed to lift heavy things with the affected arm but I'm not sure about supporting yourself with a cane.
The worst part of the surgery for me was the damned drain. When that was finally removed it was a huge relief.
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- July 27, 2012 at 2:13 pm
Sorry to hear about your dad.
I had all the left axillary lymph nodes removed in January 2011. I didn't find the post surgical pain to be all that bad. Some nerves had been severed to help with pain control and that definitely helped. I was prescribed oxycodone for pain and only took it at night for the first two nights. By the time I had my follow up visit with the surgeon, which was 2 weeks after the surgery, my pain level was negligible, though I still had some work to do to regain mobility in my left arm. He would definitely be inconvenienced, since his surgery will involve his cane arm. It won't hurt to get some input about his predicament from a lymphedema specialist/therapist. I know you're not supposed to lift heavy things with the affected arm but I'm not sure about supporting yourself with a cane.
The worst part of the surgery for me was the damned drain. When that was finally removed it was a huge relief.
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