October 21, 2025 • 22 mins
Dr. Joseph Dayan joins Dr. Nicole Saphier to shed light on lymphedema—an underrecognized condition that often affects breast cancer survivors. He explains the latest advances in surgical treatments, discusses how GLP-1 medications could play a role in prevention, and highlights key lifestyle changes that can reduce risk. The conversation underscores the importance of early diagnosis, patient education, and raising awareness for a condition that’s too often overlooked in post-cancer care. Wellness Unmasked is part of the Clay Travis & Buck Sexton Podcast Network - new episodes debut every Tuesday & Friday.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Wellness sun Mass. I'm doctor Nichol Saffire and
Breast Cancer Awareness Month continues.
Speaker 2 (00:07):
That's right.
Speaker 1 (00:07):
It may be October and you look around. You're seeing
a lot of pumpkins and pumpkins, spice lattes and apple doughnuts.
Speaker 2 (00:13):
And all of those other beautiful fall things.
Speaker 1 (00:16):
You're probably also seeing a lot of pink, especially if
you follow my social media. Why is that? Well, I
think we all know at this point one in eight
women will develop breast cancer in their lifetime.
Speaker 2 (00:28):
That number is only increasing.
Speaker 1 (00:29):
We're seeing rising incidences of breast cancer, especially in younger women.
So October is the time where we push our message
of early detection matters. The earlier you find cancer, the
easier it is for us to treat and to improves survivability.
So get your mammogram, make sure you're doing your breast checks,
all of that stuff. That's what October is all about
(00:51):
for the breast imaging world. But while yes, we may
diagnose over three hundred thousand new cases of breast cancer
in the United States this year alone, today's episode is
talking about something else. Let's talk about the four million
Americans women and men who are living with the history
(01:11):
of breast cancer, meaning they were just diagnosed and their
undergoing treatment right now, or they've completed their treatment and
they have been declared cancer free, or they've completed their treatment,
or they're still undergoing treatment because their disease has progressed. Now,
that's a lot of people, and these are survivors who
carry both the triumphs but also the challenges of this
(01:33):
disease forward. And that's what we're going to focus on
on today's episode, because survivorship doesn't always mean the end
of the story. And one of the most underrecognized and
under talked about but life altering complications of treatment from
breast cancer is lymphedema, which is a swelling often in
(01:53):
the arm, the breast, the chest, the neck, triggered by
treatments that disrupt the attic system. Estimates very broadly, but
up to twenty percent of breast cancer survivors may have
some level of persistent lymphidema, and it may climb even
higher as post treatment time passes. Is a debilitating condition.
(02:17):
You see women walking around, they may be having a
sleeve on their arm, a compression sleeve, but even after
the cancer is gone, they live with this constant pain
and reminder of what they have been through. So today
I'm honored to have doctor Dione joining us to unmask
the realities of lymphidema and talk about some exciting advancements
(02:37):
in the field because what was once felt as an
untreatable condition, now they're actually providing some options and some
relief to these women who are trying to continue on
with their life after their breast cancer diagnosis. Let's dive in.
Speaker 3 (02:52):
Well, thank you so much, Nicole for really shedding light
onto this disabling and permanent disease that's usually lost in
the shadows of cancer. Lymphidema is a currently incurable chronic
disease marked by swelling of the arm, but sometimes the chest,
the breast, and even the neck after removal of lymph
(03:15):
nodes and radiation most commonly. Basically, the lymphatic system is
the sewage system of the body. It clears out fluid
waste from your arm, from your breast, purifies it through
the lymph nodes, and then puts it back in the blood.
When lymph nodes are removed, however, or radiated, there can
be a blockage of that flow of lymph going into
(03:36):
those lymph nodes, and that fluid waste can back up
into the arm or the breast or the chest and
wreak havoc. That's just episode one. Episode two is the
reaction of your immune system, because the lymphatic system is
part of the immune system to that injury. And what
that means is the immune system reacts by causing a
(03:57):
lot of inflammation that causes further scaring throughout the arm.
Predisposes you to infection, sometimes life threatening infections that can
enter the bloodstream and this requires lifelong compression, massage, and
therapy and can lead to pain and disability at a
very high level.
Speaker 1 (04:18):
You say that this happens when you remove the lymph
nodes from the axila, the armpit, or you have to
irradiate them, but that is still standard of care because
our data tells us if we're not removing these lymph nodes,
especially if there's micro or macromatastasies, that increases their risk
of advanced cancer later on in their life. So what
can is there anything that can be done to kind
(04:39):
of decrease the risk of lymphidema or prevent it altogether.
Speaker 3 (04:42):
Well, this is a this is an exciting area because
it's much preferable to avoid lymphidema then try to treat it.
And so at the time of the removal of the
lymph nodes, the standard of care for many years was
just to close up and hope for the best, and
about one out of three women would go on to
develop them. However, just like just like we would reconstruct
(05:04):
a breast, or at least offer the option for breast
reconstruction after nystectomy, patients in an ideal setting should be
given the option of reconstructing the lymphatic system that's taken
apart during surgery. And what that involves is taking those
little tiny tubes that we're going into the lymph nodes
that are being removed, and instead of just clipping them
(05:26):
like a dead end, plugging them into a vein to
give the fluid an exit out of the arm. And
this is called immediate lymphatic reconstruction, a type of lymphovenous
bypass that can reduce the risk of causing lymphedema. That's
working on the site of the site of the surgical
injury itself, but also there are things that you can
(05:48):
reduce your overall level of risk. For example, increase body weight,
higher BMI over thirty or even over twenty five can
increase your risk of developing lymphedema.
Speaker 2 (06:01):
And there why is that?
Speaker 1 (06:02):
Why does I mean we talk about excess wasys being
a risk factor for a lot of illness.
Speaker 2 (06:07):
How does that increase lymphidema risk?
Speaker 3 (06:09):
Two ways that we know. One is it increases the
load of fluid waste produced, so it increases the stress
and demand of the lymphatic system. And two is that
we see an increase in inflammation along the specific lymphatic vessels,
those tubes transporting lymph and that inflammation impairs the ability
(06:31):
of lymph to flow out of the arm and also
causes scarring.
Speaker 2 (06:35):
But is this lymphatic bypass?
Speaker 1 (06:37):
I mean, this sounds incredible, I mean and it actually
makes a lot of sense, but I don't actually hear
about it in day to day practice. So is this
something that is you know, potentially on the horizon of
being standard of care or know how how women even
have access to this?
Speaker 3 (06:52):
Fortunately, there are more and more people getting involved and
interested in learning these techniques. Typically it's done by plastic
surgeon or microsurgical trained a surgeon that can connect very
tiny tubes together. So it's it's not widely available, but
it's becoming more common in majors in major centers, and
(07:16):
we perform this regularly.
Speaker 1 (07:19):
Now, is this something obviously being done at the time
of surgery?
Speaker 2 (07:23):
Is ideal? Is it something that is potentially being.
Speaker 1 (07:25):
Used for treatment for those who are already suffering from lymphidema.
Speaker 3 (07:30):
Yes, ideally this is done at the time of surgery
and you avoid the problem to begin with. But if
a patient should develop lymphidema, there are a variety of
different surgeries that can be done. One is lymphovenus bypass,
which is taking that blocked lymphatic vessel, cutting it and
plugging it into a vein so that there's fluid that
can that can drain out of the arm. And there
(07:51):
are a number of other procedures like lymph node transplant
basically replacing the lymphodes that were removed at the time
of surgery, kind of like planting seeds that grow new
lymphatic vessels at a variety of other techniques.
Speaker 1 (08:06):
So for anyone out there listening to this who may
be suffering from some lymphidema, obviously the bypass is the
most aggressive. Putting anybody through surgery comes with.
Speaker 2 (08:15):
Its own risk.
Speaker 1 (08:16):
But what are some non invasive things that they can
be doing to try and help with some of the
discomfort that they have.
Speaker 3 (08:22):
Well, lymphabena is bypass actually minimally invasive. It doesn't generally
hurt because these things are so tiny live no transplants
a bigger surgery, but there are non surgical things that
can be done and this is a new and exciting
part of frontiers of lymphidema treatment. So one is the
role of GLP one receptor agnis drugs like ozepic and
(08:47):
Manjaro commonly used to treat weight loss, diabetes, and now
sleep apnia. We've seen so many secondary benefits like reduction
in heart attack, strobe, dementia, but on the lymphidema front
we were first to publish the use of these drugs
and treating lymphidema and also looked at patients who underwent
(09:07):
removal of their lymph nodes, comparing those who were taking
a GLP one versus those not on a GLP one
and found that the group taking GLP ones were at
much lower risk of developing lymphedema.
Speaker 1 (09:22):
Now do you think that is because you're lowering their bmi?
As you said, you know someone who has excess weight
there at increased risk or do you actually think that
there's something maybe hormonally happening from the GLP one in
addition to removing the excess weight that's also contributing to
decreasing the risk of limphidema.
Speaker 3 (09:39):
That's a great question, and I think it's both. There
is doctor PhD. Doctor Jorge Castarina out at Tulane had
recently presented they've identified a GLP one receptor on lymphatic
vessel itself, so we think that the actual drug is
(10:04):
directly affecting the lymphatic system. There are also pathways where
GLP one receptor agnes can reduce inflammation and that's a
big cause of lymphedema as well as reducing the weight,
which is associated with increased lymphedema and worsening function. So
I think they're direct and indirect effects.
Speaker 1 (10:24):
You're listening to Wellness and Mass, we'll be right back
with more. So if you're publishing on this and we
have so many women out there suffering with lymphidema, I mean,
do you see in the foreseeable future that GLP ones
could be prescribed for women with limpidema?
Speaker 3 (10:42):
I do believe. So we've launched the first of its
kind prospective study, so a high level study to determine
if GLP ones do in fact reduce lymphedema, because we've
had so much anecdotal evidence. So we've been treating patients
offully with GLP ones who weren't interested in surgery or
(11:03):
were having surgery but weren't exactly optimized, and we want
them to get the best result, and so their numbers
have been down their limb size, most of them, not all,
but most of them have seen a benefit their limpiedema.
Therapists tell us, the patients themselves tell us, and of
course we measure this, but we really have to see
what the high level study shows a long term but
(11:26):
I'm very optimistic looking at our preliminary data.
Speaker 1 (11:29):
Well, we certainly need high level studies to get insurance
companies to cover certain things, as we all know, and
then it still even takes a long time.
Speaker 2 (11:38):
You know.
Speaker 1 (11:38):
The thing for me with GLP ones is I feel
like they're being overused and overused when maybe unnecessary, and
underused when there could be potential benefit. And you know,
people automatically get turned off when the conversation of GLP
ones happen because they're like, oh, I'm not going to
take ozembic.
Speaker 2 (11:56):
I'm not going to.
Speaker 1 (11:56):
Take these And while I to criticize them, think maybe
people are reaching for these medications for weight loss well
before they probably should, and when we're being introduced to
another medication that's essentially a lifelong prescription for something because
the minute you take you stop taking it, your weight
comes back and then.
Speaker 2 (12:14):
Some for a lot of people.
Speaker 1 (12:16):
But unfortunately it's getting a bad rap because I too.
Speaker 2 (12:19):
If you read the data, there.
Speaker 1 (12:21):
Are some well documented benefits when it comes to GLP
ones and I'm not just talking about, you know, wearing
a smaller waste size. I'm talking about I'm talking about
the decreased strokes, cardiovascular potentially dementia, and the fact that
they could potentially help patients with lymphidema, to me is
just incredible and I would much rather see the money
(12:43):
going for these people for their GLP ones, even with
just anecdotal evidence. So I'm glad to hear it's being
used off label, but it's very expensive and not everyone
can afford these medications.
Speaker 3 (12:56):
I agree, and I'm with you. I think when it
comes to any of these discuss trends, politics and culture
all come into this. When we should really look at
the data and the science. If the data shows for
a patient with lymphidema that is diagnosed with a permanent,
incurable condition, that there is a potential benefit to reverse
(13:19):
what they have, and they're doing they're spending hours a
day treating this. That's a wonderful thing. And I also
think most people aren't aware that for hormone receptor breast cancer,
which is most breast cancers not triple negative hormone receptor,
these patients are put on a hormone suppress suppression which
changes their metabolism, and about forty percent of them will
(13:44):
gain significant weight. So they're doing.
Speaker 1 (13:46):
Essentially putting someone into menopause overnight. So perimenopausal menopausal women
like myself, if you realize how it's harder to lose
weight as you get to a certain age, well, as
he's saying, these medications just kind of thrust into this
menopause overnight.
Speaker 3 (14:01):
And then so exactly, and you have many young women,
many of our patients are in their thirties. They're very active,
they're doing and eating the same way they have been,
but all of a sudden, they've put on twenty five
or thirty pounds despite being active despite a diet and exercise,
so it can be very very difficult. Your body metabolism
(14:25):
just changes, so I think everybody is different. It has
to be looked at case to case. We don't directly
go to GLP one for everything. We want to do
everything all natural. But the reality is is that many
patients are exhausting everything. We see patients that spend hours
a day and they're getting nowhere with their limb and
(14:45):
the GLP one helps them. I personally am on GLP
one for diabetes, so this is not a drug. Is
a drug I have personal experience with All drugs have
potential side effects and adverse effects, and you should speak
to your doc her when getting on anything new, as
well as your oncological team.
Speaker 1 (15:04):
I diagnosed one of my best friends with breast cancer
a couple of years ago and she said bilateral mustectomy.
Ever since, but she is dealing with the same thing.
It's hormone positive. Losing weight is just a major struggle
for her, and she works out more than anyone I know.
She eats incredibly. I have encouraged the GLP ones for
(15:25):
her and she's just not quite there yet, which I
you know, I applaud her for not wanting to take
quote unquote the easy way out, but it's not necessarily
the easy way out. When your body is working against you.
The medications that you're taking to try and decrease your
risk of your cancer to come back, it's really working
against you trying to have a healthy weight. So there
(15:45):
are benefits of GLP ones. So for women out there
who maybe who are having some maybe just mild lymphidema,
I want to go back to that for a second,
because I just think lymphidema's not talked about enough. They're
having mild lymphiedema, maybe they're not quite ready for medication
for surgery. What are just some things that women can
be doing at home to try and decrease their lymphedema
(16:07):
from progressing.
Speaker 3 (16:12):
Right, Well, I'm glad you brought up my o lymphidema
as a general note. Lymphidema, like any disease, process starts
before you see the swelling, just like breast cancer before mammography.
The only way you diagnosed it is either by seeing
an alternative mass or feeling a large lump in the
breast or the axilla. Lymphidema started long before you actually
(16:32):
see the swelling, and this is kind of lost on
a lot of medicine that really doesn't move to do
anything until you see the big swollen arm. But the
things that you can do are actually lymphatic massage helps.
So when any patient comes to our office, we'll image
their lymphatic systems. We actually inject a tiny amount of
die and the patient can see their lymphatic system. That's
(16:56):
important because you can see if you have lymphatics that
are only partly blocked, or if the whole arm is blocked.
If everything's blocked, you can squeeze that arm, but it's
like squeezing a toothpaste with the cap still on, and
you really then the role of surgery is to provide
an exit so that therapy actually does move something out
(17:19):
of your arm. In patients who have a partial obstruction,
actually massage from the fingers all the way up to
the axilla, to the armpit and to the neck. There's
a special type of lymphatic massage called manuallymphatic drainage that
olymphi emotherapist does is definitely beneficial. We see this on
the imaging of the actual lymph moving. It's a beautiful,
(17:40):
very beautiful organ system that exercise muscle. When muscles contract,
they're actually squeezing your lymphatics, and that facilitates the movement
of fluid out of the actual limb. There's also breathing exercises.
Your diaphragm is a big negative pressure pump, so your
(18:01):
lymphatic system includes your entire body, all your organs from
your legs, your arms, your head and neck. But there
are breathing exercises that can facilitate lymphatic transport in the
larger vessels up the main lymphatic duct into your bloodstream.
And of course, in patients where weight is elevated, weight
(18:26):
reduction will will improve and reduce inflammation and improve emphatic flow.
Speaker 1 (18:31):
I actually love that you show patients with the lymphatic
dye because when people can visualize what's actually happening and
they have a better understanding, I truly think that their
outcomes are better because of that, because if they have
an understanding of it, then they understand why to do
the massage, why they might potentially need that bypass surgery,
(18:52):
as you're mentioning, I think that's that's great, and it
takes away that whole paternalistic aspect of medicine, which we're
so notorious for of just saying this is what's wrong,
this is what needs to be done, and you're taking
it so that they're a part of that conversation by
understanding it, and as they can pick that active role
in their healthcare, it's great.
Speaker 3 (19:11):
Well, the imaging has been a huge transformation in lymphatic reconstruction,
So in surgery you need to see it. If you
can see it, you can operate it on it, you
can understand it, and the treatment can match the actual
problem that you're looking at. If you're just looking at
the size of the limb and you're not looking under
the skin, you really don't know what you're dealing with.
(19:35):
So imaging is transformed things. The other thing that patients
can do because going to a lymphidemo therapist is not
always it's not always available. As a surgeon, it would
be very difficult for me every day or every other
day to go. But to have pneumatic there are pneumatic
compression devices where it's sort of an at home system
(19:55):
where you slide your arm and your chest into while
you're watching or just say around. This thing actually does
the massage for you and pumps things. So another that's
another option many patients aren't aware of.
Speaker 1 (20:09):
So doctor Diane, thank you so much for being here today.
I think I've actually learned a lot. And I thought
I know a lot of limpandema, but I have an
even better understanding now. And I don't even know bypass
was an option, and now that's making me feel very
ignorant in kind of my own field. But I think
it's just very hopeful for people who are suffering from this,
(20:31):
because I do see them every single day coming in
wearing their lymphatic sleeves, talking about the massage, but still
just an excruciating pain.
Speaker 3 (20:39):
I think also that lymphatic surgery is something we do
every week. There are minimally invasive options usually available to
most people. If you have a big problem, it's probably
going to involve more. But I think it's something that
at least patients should be aware of that exists, just
like patients undergoing to stectomy should be aware their breast
(21:00):
reconstructions and option. And it's really a pleasure to see
you as a colleague. Memorials Encountering is near and dear
to my heart. I spent a decade there and I
really bless you for all the great work you do
and it's great to have excellent colleagues. Thank you so
much well.
Speaker 1 (21:20):
As we have heard, the story of breast cancer is
not only about diagnosis and treatment. It's also about the
long journey many survivors are walking afterwards. And as I mentioned,
with more than four million people living with the history
of breast cancer in the United States, a large percent
of them are suffering from lymphedema, meaning hundreds of thousands
of people are coping with this often invisible, chronic complication.
(21:45):
There is hope, as we have heard, through awareness, early detection,
preventative strategies, and comprehensive care, many of these cases can
be managed, and some may be preventable altogether. As we
just heard, doctor Dion's insight helped Castle on how clinicians
and surgeons and patients alike can better unmask and maybe
(22:06):
address lymphedema before it becomes debilitating. So if you are
someone you love is navigating life post breast cancer care,
continue this conversation with them, because there are clearly things
that can be done about lymphatic health. Ask about monitoring,
as we heard, you want to make sure you are
getting in front of it instead of behind it because
it's easier to treat it earlier on than when it's
(22:29):
gotten out of control. Thank you so much for listening.
I'm doctor Nicole Sapphire. This is wellness Unmasks. Make sure
you listen to all of our episodes on iHeartRadio or
wherever you get your podcasts, and we'll see you next time.
Welcome to Wellness sun Mass. I'm doctor Nichol Saffire and
Breast Cancer Awareness Month continues.
Speaker 2 (00:07):
That's right.
Speaker 1 (00:07):
It may be October and you look around. You're seeing
a lot of pumpkins and pumpkins, spice lattes and apple doughnuts.
Speaker 2 (00:13):
And all of those other beautiful fall things.
Speaker 1 (00:16):
You're probably also seeing a lot of pink, especially if
you follow my social media. Why is that? Well, I
think we all know at this point one in eight
women will develop breast cancer in their lifetime.
Speaker 2 (00:28):
That number is only increasing.
Speaker 1 (00:29):
We're seeing rising incidences of breast cancer, especially in younger women.
So October is the time where we push our message
of early detection matters. The earlier you find cancer, the
easier it is for us to treat and to improves survivability.
So get your mammogram, make sure you're doing your breast checks,
all of that stuff. That's what October is all about
(00:51):
for the breast imaging world. But while yes, we may
diagnose over three hundred thousand new cases of breast cancer
in the United States this year alone, today's episode is
talking about something else. Let's talk about the four million
Americans women and men who are living with the history
(01:11):
of breast cancer, meaning they were just diagnosed and their
undergoing treatment right now, or they've completed their treatment and
they have been declared cancer free, or they've completed their treatment,
or they're still undergoing treatment because their disease has progressed. Now,
that's a lot of people, and these are survivors who
carry both the triumphs but also the challenges of this
(01:33):
disease forward. And that's what we're going to focus on
on today's episode, because survivorship doesn't always mean the end
of the story. And one of the most underrecognized and
under talked about but life altering complications of treatment from
breast cancer is lymphedema, which is a swelling often in
(01:53):
the arm, the breast, the chest, the neck, triggered by
treatments that disrupt the attic system. Estimates very broadly, but
up to twenty percent of breast cancer survivors may have
some level of persistent lymphidema, and it may climb even
higher as post treatment time passes. Is a debilitating condition.
(02:17):
You see women walking around, they may be having a
sleeve on their arm, a compression sleeve, but even after
the cancer is gone, they live with this constant pain
and reminder of what they have been through. So today
I'm honored to have doctor Dione joining us to unmask
the realities of lymphidema and talk about some exciting advancements
(02:37):
in the field because what was once felt as an
untreatable condition, now they're actually providing some options and some
relief to these women who are trying to continue on
with their life after their breast cancer diagnosis. Let's dive in.
Speaker 3 (02:52):
Well, thank you so much, Nicole for really shedding light
onto this disabling and permanent disease that's usually lost in
the shadows of cancer. Lymphidema is a currently incurable chronic
disease marked by swelling of the arm, but sometimes the chest,
the breast, and even the neck after removal of lymph
(03:15):
nodes and radiation most commonly. Basically, the lymphatic system is
the sewage system of the body. It clears out fluid
waste from your arm, from your breast, purifies it through
the lymph nodes, and then puts it back in the blood.
When lymph nodes are removed, however, or radiated, there can
be a blockage of that flow of lymph going into
(03:36):
those lymph nodes, and that fluid waste can back up
into the arm or the breast or the chest and
wreak havoc. That's just episode one. Episode two is the
reaction of your immune system, because the lymphatic system is
part of the immune system to that injury. And what
that means is the immune system reacts by causing a
(03:57):
lot of inflammation that causes further scaring throughout the arm.
Predisposes you to infection, sometimes life threatening infections that can
enter the bloodstream and this requires lifelong compression, massage, and
therapy and can lead to pain and disability at a
very high level.
Speaker 1 (04:18):
You say that this happens when you remove the lymph
nodes from the axila, the armpit, or you have to
irradiate them, but that is still standard of care because
our data tells us if we're not removing these lymph nodes,
especially if there's micro or macromatastasies, that increases their risk
of advanced cancer later on in their life. So what
can is there anything that can be done to kind
(04:39):
of decrease the risk of lymphidema or prevent it altogether.
Speaker 3 (04:42):
Well, this is a this is an exciting area because
it's much preferable to avoid lymphidema then try to treat it.
And so at the time of the removal of the
lymph nodes, the standard of care for many years was
just to close up and hope for the best, and
about one out of three women would go on to
develop them. However, just like just like we would reconstruct
(05:04):
a breast, or at least offer the option for breast
reconstruction after nystectomy, patients in an ideal setting should be
given the option of reconstructing the lymphatic system that's taken
apart during surgery. And what that involves is taking those
little tiny tubes that we're going into the lymph nodes
that are being removed, and instead of just clipping them
(05:26):
like a dead end, plugging them into a vein to
give the fluid an exit out of the arm. And
this is called immediate lymphatic reconstruction, a type of lymphovenous
bypass that can reduce the risk of causing lymphedema. That's
working on the site of the site of the surgical
injury itself, but also there are things that you can
(05:48):
reduce your overall level of risk. For example, increase body weight,
higher BMI over thirty or even over twenty five can
increase your risk of developing lymphedema.
Speaker 2 (06:01):
And there why is that?
Speaker 1 (06:02):
Why does I mean we talk about excess wasys being
a risk factor for a lot of illness.
Speaker 2 (06:07):
How does that increase lymphidema risk?
Speaker 3 (06:09):
Two ways that we know. One is it increases the
load of fluid waste produced, so it increases the stress
and demand of the lymphatic system. And two is that
we see an increase in inflammation along the specific lymphatic vessels,
those tubes transporting lymph and that inflammation impairs the ability
(06:31):
of lymph to flow out of the arm and also
causes scarring.
Speaker 2 (06:35):
But is this lymphatic bypass?
Speaker 1 (06:37):
I mean, this sounds incredible, I mean and it actually
makes a lot of sense, but I don't actually hear
about it in day to day practice. So is this
something that is you know, potentially on the horizon of
being standard of care or know how how women even
have access to this?
Speaker 3 (06:52):
Fortunately, there are more and more people getting involved and
interested in learning these techniques. Typically it's done by plastic
surgeon or microsurgical trained a surgeon that can connect very
tiny tubes together. So it's it's not widely available, but
it's becoming more common in majors in major centers, and
(07:16):
we perform this regularly.
Speaker 1 (07:19):
Now, is this something obviously being done at the time
of surgery?
Speaker 2 (07:23):
Is ideal? Is it something that is potentially being.
Speaker 1 (07:25):
Used for treatment for those who are already suffering from lymphidema.
Speaker 3 (07:30):
Yes, ideally this is done at the time of surgery
and you avoid the problem to begin with. But if
a patient should develop lymphidema, there are a variety of
different surgeries that can be done. One is lymphovenus bypass,
which is taking that blocked lymphatic vessel, cutting it and
plugging it into a vein so that there's fluid that
can that can drain out of the arm. And there
(07:51):
are a number of other procedures like lymph node transplant
basically replacing the lymphodes that were removed at the time
of surgery, kind of like planting seeds that grow new
lymphatic vessels at a variety of other techniques.
Speaker 1 (08:06):
So for anyone out there listening to this who may
be suffering from some lymphidema, obviously the bypass is the
most aggressive. Putting anybody through surgery comes with.
Speaker 2 (08:15):
Its own risk.
Speaker 1 (08:16):
But what are some non invasive things that they can
be doing to try and help with some of the
discomfort that they have.
Speaker 3 (08:22):
Well, lymphabena is bypass actually minimally invasive. It doesn't generally
hurt because these things are so tiny live no transplants
a bigger surgery, but there are non surgical things that
can be done and this is a new and exciting
part of frontiers of lymphidema treatment. So one is the
role of GLP one receptor agnis drugs like ozepic and
(08:47):
Manjaro commonly used to treat weight loss, diabetes, and now
sleep apnia. We've seen so many secondary benefits like reduction
in heart attack, strobe, dementia, but on the lymphidema front
we were first to publish the use of these drugs
and treating lymphidema and also looked at patients who underwent
(09:07):
removal of their lymph nodes, comparing those who were taking
a GLP one versus those not on a GLP one
and found that the group taking GLP ones were at
much lower risk of developing lymphedema.
Speaker 1 (09:22):
Now do you think that is because you're lowering their bmi?
As you said, you know someone who has excess weight
there at increased risk or do you actually think that
there's something maybe hormonally happening from the GLP one in
addition to removing the excess weight that's also contributing to
decreasing the risk of limphidema.
Speaker 3 (09:39):
That's a great question, and I think it's both. There
is doctor PhD. Doctor Jorge Castarina out at Tulane had
recently presented they've identified a GLP one receptor on lymphatic
vessel itself, so we think that the actual drug is
(10:04):
directly affecting the lymphatic system. There are also pathways where
GLP one receptor agnes can reduce inflammation and that's a
big cause of lymphedema as well as reducing the weight,
which is associated with increased lymphedema and worsening function. So
I think they're direct and indirect effects.
Speaker 1 (10:24):
You're listening to Wellness and Mass, we'll be right back
with more. So if you're publishing on this and we
have so many women out there suffering with lymphidema, I mean,
do you see in the foreseeable future that GLP ones
could be prescribed for women with limpidema?
Speaker 3 (10:42):
I do believe. So we've launched the first of its
kind prospective study, so a high level study to determine
if GLP ones do in fact reduce lymphedema, because we've
had so much anecdotal evidence. So we've been treating patients
offully with GLP ones who weren't interested in surgery or
(11:03):
were having surgery but weren't exactly optimized, and we want
them to get the best result, and so their numbers
have been down their limb size, most of them, not all,
but most of them have seen a benefit their limpiedema.
Therapists tell us, the patients themselves tell us, and of
course we measure this, but we really have to see
what the high level study shows a long term but
(11:26):
I'm very optimistic looking at our preliminary data.
Speaker 1 (11:29):
Well, we certainly need high level studies to get insurance
companies to cover certain things, as we all know, and
then it still even takes a long time.
Speaker 2 (11:38):
You know.
Speaker 1 (11:38):
The thing for me with GLP ones is I feel
like they're being overused and overused when maybe unnecessary, and
underused when there could be potential benefit. And you know,
people automatically get turned off when the conversation of GLP
ones happen because they're like, oh, I'm not going to
take ozembic.
Speaker 2 (11:56):
I'm not going to.
Speaker 1 (11:56):
Take these And while I to criticize them, think maybe
people are reaching for these medications for weight loss well
before they probably should, and when we're being introduced to
another medication that's essentially a lifelong prescription for something because
the minute you take you stop taking it, your weight
comes back and then.
Speaker 2 (12:14):
Some for a lot of people.
Speaker 1 (12:16):
But unfortunately it's getting a bad rap because I too.
Speaker 2 (12:19):
If you read the data, there.
Speaker 1 (12:21):
Are some well documented benefits when it comes to GLP
ones and I'm not just talking about, you know, wearing
a smaller waste size. I'm talking about I'm talking about
the decreased strokes, cardiovascular potentially dementia, and the fact that
they could potentially help patients with lymphidema, to me is
just incredible and I would much rather see the money
(12:43):
going for these people for their GLP ones, even with
just anecdotal evidence. So I'm glad to hear it's being
used off label, but it's very expensive and not everyone
can afford these medications.
Speaker 3 (12:56):
I agree, and I'm with you. I think when it
comes to any of these discuss trends, politics and culture
all come into this. When we should really look at
the data and the science. If the data shows for
a patient with lymphidema that is diagnosed with a permanent,
incurable condition, that there is a potential benefit to reverse
(13:19):
what they have, and they're doing they're spending hours a
day treating this. That's a wonderful thing. And I also
think most people aren't aware that for hormone receptor breast cancer,
which is most breast cancers not triple negative hormone receptor,
these patients are put on a hormone suppress suppression which
changes their metabolism, and about forty percent of them will
(13:44):
gain significant weight. So they're doing.
Speaker 1 (13:46):
Essentially putting someone into menopause overnight. So perimenopausal menopausal women
like myself, if you realize how it's harder to lose
weight as you get to a certain age, well, as
he's saying, these medications just kind of thrust into this
menopause overnight.
Speaker 3 (14:01):
And then so exactly, and you have many young women,
many of our patients are in their thirties. They're very active,
they're doing and eating the same way they have been,
but all of a sudden, they've put on twenty five
or thirty pounds despite being active despite a diet and exercise,
so it can be very very difficult. Your body metabolism
(14:25):
just changes, so I think everybody is different. It has
to be looked at case to case. We don't directly
go to GLP one for everything. We want to do
everything all natural. But the reality is is that many
patients are exhausting everything. We see patients that spend hours
a day and they're getting nowhere with their limb and
(14:45):
the GLP one helps them. I personally am on GLP
one for diabetes, so this is not a drug. Is
a drug I have personal experience with All drugs have
potential side effects and adverse effects, and you should speak
to your doc her when getting on anything new, as
well as your oncological team.
Speaker 1 (15:04):
I diagnosed one of my best friends with breast cancer
a couple of years ago and she said bilateral mustectomy.
Ever since, but she is dealing with the same thing.
It's hormone positive. Losing weight is just a major struggle
for her, and she works out more than anyone I know.
She eats incredibly. I have encouraged the GLP ones for
(15:25):
her and she's just not quite there yet, which I
you know, I applaud her for not wanting to take
quote unquote the easy way out, but it's not necessarily
the easy way out. When your body is working against you.
The medications that you're taking to try and decrease your
risk of your cancer to come back, it's really working
against you trying to have a healthy weight. So there
(15:45):
are benefits of GLP ones. So for women out there
who maybe who are having some maybe just mild lymphidema,
I want to go back to that for a second,
because I just think lymphidema's not talked about enough. They're
having mild lymphiedema, maybe they're not quite ready for medication
for surgery. What are just some things that women can
be doing at home to try and decrease their lymphedema
(16:07):
from progressing.
Speaker 3 (16:12):
Right, Well, I'm glad you brought up my o lymphidema
as a general note. Lymphidema, like any disease, process starts
before you see the swelling, just like breast cancer before mammography.
The only way you diagnosed it is either by seeing
an alternative mass or feeling a large lump in the
breast or the axilla. Lymphidema started long before you actually
(16:32):
see the swelling, and this is kind of lost on
a lot of medicine that really doesn't move to do
anything until you see the big swollen arm. But the
things that you can do are actually lymphatic massage helps.
So when any patient comes to our office, we'll image
their lymphatic systems. We actually inject a tiny amount of
die and the patient can see their lymphatic system. That's
(16:56):
important because you can see if you have lymphatics that
are only partly blocked, or if the whole arm is blocked.
If everything's blocked, you can squeeze that arm, but it's
like squeezing a toothpaste with the cap still on, and
you really then the role of surgery is to provide
an exit so that therapy actually does move something out
(17:19):
of your arm. In patients who have a partial obstruction,
actually massage from the fingers all the way up to
the axilla, to the armpit and to the neck. There's
a special type of lymphatic massage called manuallymphatic drainage that
olymphi emotherapist does is definitely beneficial. We see this on
the imaging of the actual lymph moving. It's a beautiful,
(17:40):
very beautiful organ system that exercise muscle. When muscles contract,
they're actually squeezing your lymphatics, and that facilitates the movement
of fluid out of the actual limb. There's also breathing exercises.
Your diaphragm is a big negative pressure pump, so your
(18:01):
lymphatic system includes your entire body, all your organs from
your legs, your arms, your head and neck. But there
are breathing exercises that can facilitate lymphatic transport in the
larger vessels up the main lymphatic duct into your bloodstream.
And of course, in patients where weight is elevated, weight
(18:26):
reduction will will improve and reduce inflammation and improve emphatic flow.
Speaker 1 (18:31):
I actually love that you show patients with the lymphatic
dye because when people can visualize what's actually happening and
they have a better understanding, I truly think that their
outcomes are better because of that, because if they have
an understanding of it, then they understand why to do
the massage, why they might potentially need that bypass surgery,
(18:52):
as you're mentioning, I think that's that's great, and it
takes away that whole paternalistic aspect of medicine, which we're
so notorious for of just saying this is what's wrong,
this is what needs to be done, and you're taking
it so that they're a part of that conversation by
understanding it, and as they can pick that active role
in their healthcare, it's great.
Speaker 3 (19:11):
Well, the imaging has been a huge transformation in lymphatic reconstruction,
So in surgery you need to see it. If you
can see it, you can operate it on it, you
can understand it, and the treatment can match the actual
problem that you're looking at. If you're just looking at
the size of the limb and you're not looking under
the skin, you really don't know what you're dealing with.
(19:35):
So imaging is transformed things. The other thing that patients
can do because going to a lymphidemo therapist is not
always it's not always available. As a surgeon, it would
be very difficult for me every day or every other
day to go. But to have pneumatic there are pneumatic
compression devices where it's sort of an at home system
(19:55):
where you slide your arm and your chest into while
you're watching or just say around. This thing actually does
the massage for you and pumps things. So another that's
another option many patients aren't aware of.
Speaker 1 (20:09):
So doctor Diane, thank you so much for being here today.
I think I've actually learned a lot. And I thought
I know a lot of limpandema, but I have an
even better understanding now. And I don't even know bypass
was an option, and now that's making me feel very
ignorant in kind of my own field. But I think
it's just very hopeful for people who are suffering from this,
(20:31):
because I do see them every single day coming in
wearing their lymphatic sleeves, talking about the massage, but still
just an excruciating pain.
Speaker 3 (20:39):
I think also that lymphatic surgery is something we do
every week. There are minimally invasive options usually available to
most people. If you have a big problem, it's probably
going to involve more. But I think it's something that
at least patients should be aware of that exists, just
like patients undergoing to stectomy should be aware their breast
(21:00):
reconstructions and option. And it's really a pleasure to see
you as a colleague. Memorials Encountering is near and dear
to my heart. I spent a decade there and I
really bless you for all the great work you do
and it's great to have excellent colleagues. Thank you so
much well.
Speaker 1 (21:20):
As we have heard, the story of breast cancer is
not only about diagnosis and treatment. It's also about the
long journey many survivors are walking afterwards. And as I mentioned,
with more than four million people living with the history
of breast cancer in the United States, a large percent
of them are suffering from lymphedema, meaning hundreds of thousands
of people are coping with this often invisible, chronic complication.
(21:45):
There is hope, as we have heard, through awareness, early detection,
preventative strategies, and comprehensive care, many of these cases can
be managed, and some may be preventable altogether. As we
just heard, doctor Dion's insight helped Castle on how clinicians
and surgeons and patients alike can better unmask and maybe
(22:06):
address lymphedema before it becomes debilitating. So if you are
someone you love is navigating life post breast cancer care,
continue this conversation with them, because there are clearly things
that can be done about lymphatic health. Ask about monitoring,
as we heard, you want to make sure you are
getting in front of it instead of behind it because
it's easier to treat it earlier on than when it's
(22:29):
gotten out of control. Thank you so much for listening.
I'm doctor Nicole Sapphire. This is wellness Unmasks. Make sure
you listen to all of our episodes on iHeartRadio or
wherever you get your podcasts, and we'll see you next time.
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