Lymph Node Removal and Lymphatic remaining

[Scubatooth]

My dads boss is considering learning to dive but has a concern.

she recently had some lymph nodes removed and is concerned about the possibility of Lymphatic Fluid Build up in the tissues and there effects while diving and potential they may cause.


Thanks in advance

Tooth

 

[BillP]

Howdy Tooth:

The lymphatic fluid buildup in the tissues is called "lymphedema". The lymphatic fluid in the tissues is normally drained back to the circulation by the vein-like lymph channels. If enough lymph channels are disrupted when lymph nodes are removed, the fluid can have a hard time draining from the tissues causing swelling.

There are several concerns regarding lymph node removal and diving. One concern is the underlying condition that the nodes were removed for and any additional treatment that might be involved (chemotherapy for cancer, etc.) Another is scarring from the surgery that might result in limitation of movement- enough to affect diving. But your friend is concerned about the possibility of swelling.

Diving does not cause the swelling. In fact, some who have the swelling and dive say diving helps. (Well, OK, some cases of DCS can cause lymphedema presumably from bubbling in the lymph channels, but that's another story unrelated to your friend's questions.) If someone has the lymphedema it can limit range of motion in the area of swelling somewhat, and if there is a break in the skin in the area there probably is an increased risk of infection. Someone with lymphedema should take extra care to avoid coral cuts and other similar injuries in the area of swelling.

***Danger: Radical Iconoclastic Opinion Follows***

Now, a little history lesson. Before the turn of the last century a Dr. Halstead developed the Radical Mastectomy to treat breast cancer. In that operation he removed every lymph node that he could find in the armpit trying to remove all of the cancer. After such radical surgery it was VERY common to develop lymphedema of the arm. Dr. Halstead was a great surgical pioneer and developed the kind of reputation that caused other surgeons to keep his picture on their walls for the next century. Since lymphedema was so common, Dr. Halstead laid down the edict that after lymph node surgery the limb could never be used again except to fill out the sleeve of a shirt. You could never take a blood pressure there, draw blood, or start an IV ever again. Any patient who had had lymph node surgery should avoid gardening and any other activity where there was the remotest chance of a break in the skin. Dr. Halstead said so, so it was LAW, and doctors have laid down the law to patients ever since.

Unfortunately what was good in the 19th century for Dr. Halstead isn't necessarily true for the 21st century. But his "rules" became ingrained in the lore of medicine and are hard to change. His Radical Mastectomy is done now only in the most extreme of circumstances and is quite rarely seen. Fact is, after "modern" surgery if someone doesn't develop the lymphedema after lymph node removal, they have a normal limb and should have no limitations- at all. Lymphedema is far less common than it was in Dr. Halstead's day. IMHO, dving would be a great activity for someone who has undergone lymph node removal. They just need to exercise a little caution if they happen to be one of those few who develop lymphedema.

You can read a bit on DAN's website where they mention lymphedema in their discussion on breast cancer and diving:

http://www.diversalertnetwork.org/medical/faq/faq.asp?faqid=178

HTH,

Bill

 

[vetdiver]

I have had a bilateral mstectomy, and I had lymph nodes removed from my armpit on one side (this was done as a sentinel lymph node procedure, so very few nodes were removed). I have not had any problems at all, but I don't have lymphedema on dry land (or on an airplane or at altitude while hiking, for that matter).

In fact, as BillP's excellent post states, my surgical oncologist readily commented that diving INCREASES the pressure on my arm/surgical sites and would not, as a result, be expected to cause swelling.

Most likely, this will not be a big issue, but your dad's boss should certainly contact her surgeons and get the "OK".

 

[samundra]

I agree with vetdiver. I'm ten years post-op and my only addition to the excellent advice posted by BillP is not to underestimate the length of time it takes to feel fit and well again. It depends on a lot of factors, naturally, (age, fitness level, age of children, personal circumstances etc) but be prepared to think in terms of years rather than months.