EUTAWVILLE -- Eutawville resident Lillie Doctor didn't know she would have another battle to fight after surviving breast cancer. The first mountain had been tough enough to climb.

She had been receiving care at the H. Filmore Mabry Center for Cancer Care and underwent cancer surgery that required the removal of lymph nodes from under her arm in 2005. When her arm began swelling, Doctor was taken by surprise and didn't know what to do before being sent to Palmetto Health Baptist Hospital in Columbia.

She had developed lymphedema, a chronic, progressive form of edema caused by an impaired lymphatic system. Made up of lymph (a clear fluid), lymph vessels and lymph nodes, the lymphatic system is responsible for returning excess fluid from the tissues back into blood circulation. It plays an important role in protecting against disease and illness.

The removal of Doctor's lymph nodes during surgery, however, caused lymph fluid not to circulate out of her right arm. Instead, the fluid began to build up in her arm. The protein-rich lymph fluid also continued to absorb water.

"Lymphedema comes in different stages. I started out mild, but now I'm moderate going to severe. I basically have something on my arm 24 hours a day," said Doctor, who can either bandage her arm with a special type of bandage or put on specially fitted compression garments. She also has a gauntlet, or glove with an extended cuff for the wrist that is cut out at the finger tips.

"Most of the time, I do the compression garment because the bandaging limits what you can do," Doctor said. "I have to be careful not to get any cuts or bites on that arm. There are a lot of hazards with lymphedema."

Doctor, who has already been on antibiotics to fight an infection in her arm, has been advised not to get sunburn and to rub -- not scratch -- itches on her arm, as heat, insect bites and any excessive strain are among the triggers for increased swelling.

"The biggest complication is cellulitis (inflammation of cellular tissue). If you get a cut or scratch, any bacteria can feed off of the fluid and turn into an infection," said Susan Spires, an occupational therapist specializing in lymphedema at Palmetto Health Baptist Hospital's Lymphedema Treatment Center. She treats Doctor and other lymphedema patients and educates them on how best to manage their chronic condition.

Spires said there are two types of lymphedema. Primary lymphedema is characterized by individuals born with an impaired lymphatic system. Secondary lymphedema, which is what Doctor has, is developed from various kinds of trauma to the lymph nodes or vessels, including surgery, radiation, chemotherapy, burns and severe cuts.

"There is no medication for it; however, some antibiotics are used for infections," Spires said. "Diuretics are not effective because it's a different system of the body that's affected. Treatment involves lymphatic massage, compression bandages and garments. These are good skin and basic edema precautions."

"They teach me how to massage the arm. It's a very light massage," Doctor said. "Instead of moving the fluid, you stop the fluid from moving all together. They also taught me how to wrap the arm and bandage it with the special bandage."

Spires stressed that not all breast cancer patients who have lymph nodes removed like Doctor will develop lymphedema.

"About 25 to 35 percent of post-breast cancer patients have lymphedema," she said. "The other 65 to 75 percent that don't have it are at risk, so they may at some point still get it."

Doctor said she can do most of the housework she used to be able to do -- it just takes her a little longer.

"The arm gets tired easily," she said. "My range of motion is not as good as in my other arm. I have to ask somebody a lot of times, as far as reaching up into cabinets." Doctor said she relies heavily on the assistance of her 17-year-old daughter, Victoria.

As part of treatment, Spires said patients are taught exercises to stimulate lymphatic flow and circulation and are given skin-care tips to prevent fungal and bacterial growths.

"Our treatments are only as successful as the patients' efforts," she said. "There is a lot of personal responsibility when it comes to managing lymphedema. You have to wear compression garments and try to bandage and massage from time to time, or it will get worse."

Doctor said she is determined not to let her lymphedema stop her from living. She is in remission from cancer, is adhering to instructions given to her in her treatment classes and has already found a good seamstress who accommodates for her larger right-arm size.

"Three years ago, I never thought I would have to do this. I was fine," Doctor said. "All of a sudden, my life changed. But I'm a survivor."

T&D Staff Writer Dionne Gleaton can be reached by e-mail at dgleaton@timesanddemocrat.com or by telephone at 803-533-5534. Discuss this and other stories online at TheTandD.com.

Signs, symptoms and lymphedema prevention tips

Lymphedema is a chronic, progressive form of edema caused by an impaired lymphatic system. The Lymphedema Treatment Center at Palmetto Health Baptist Hospital gives the following signs and symptoms of the disease and offers prevention tips to ward against it.

Signs and symptoms:

* Swelling

* Infections (bacterial, fungal and viral)

* Papillomas, warts

* Fluid leaking out of skin

* Change in skin texture

* Change in posture or gait

* Numbness or feelings of pins and needles

Edema prevention tips:

* Do not ignore increases in edema. Earlier treatment is more successful.

* Wear well-fitting compression garments during active, awake hours. Appropriate levels of compression are needed for different edema stages. Garments need to be replaced every six months and can be worn for up to 16 hours a day.

* Avoid rigorous, repetitive movement against resistance with affected limb, including hard scrubbing, pushing, pulling or raking for long time periods.

* Avoid heavy lifting and heavy prosthetic devices.

* Maintain your ideal weight. Obesity causes a strain on the lymphatic system. As part of diet, a low-sodium diet is recommended if you tend to swell from salt.

* Avoid smoking, and drinks lots of water, at least eight glasses a day. Avoid alcohol and caffeine intake. If you don't, drink an extra glass of water for each drink of alcohol or caffeine you have.

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