|Mary is St. Joseph's Hospital to see the nurse, Doreen, who works two days a week at the local urban Indian clinic. While at work, Mary's arm and wrist began to swell and feel heavy. Doreen is gently examining Mary's arm and wrist.|
Doreen: I'm glad you were able to get here today and didn't wait until I was back at the clinic.
Mary: Why, is there something wrong? Does this mean my cancer has come back?
Doreen: No, I don't think it is anything serious like that. But, it may be related to the cancer treatment. I think you've developed lymphedema.
Mary: What is that? What does it mean?
Doreen: It is a condition that some breast cancer patients get, but usually only if they had lymph nodes removed or damaged. Since you did not have surgery, but you did have radiation, I want you to show me where they did the radiation please.
Mary, moves her clinic gown to show the markings on her breast that were used to help guide and pinpoint the radiation.
Doreen: Well, it seems rare that this radiation would have damaged much, but it is in line with where most people's lymphatic system runs.
Mary: What does that mean?
Doreen: Well, your body has the blood system that you're familiar with. It also has a less know circulatory system to help drain liquids and fluids from the arms and legs. It is important to fight infections. We need to do a few more tests today, but right now it looks like you have the symptoms of lymphedema. So, it may have been caused by the radiation damaging some of the lymph nodes. They are needed to help drain the fluids. While we do a test in a new machine, called tomography, I want to wrap your arm and have you elevate it.
Mary: I don't have insurance. How much money does this new machine cost and do I really need to have this done?
Doreen: It is helpful to know what we're actually treating. The symptoms look like lymphedema, but I would like the oncologists to check and confirm this. He is currently working with this new machine. The cost of the test can be covered through St. Joseph's Indigent Program. So it won't cost you anything.
Mary: But what does it do? Will it hurt me in any way? Does it take my blood or genes or anything?
Doreen: No, nothing like that. I can show you want it looks like, but it allows us to get a better picture of your tissues to see what may be causing the clogging of your fluid draining away from your arm.
This is what the tomotherapy machine looks like with the cover lifted off of it. The machine allows for spiral pictures to be taken. These help us see soft tissue and to get a better idea of what is going on in your arm. This hospital is using it for a clinical trial to see how it can improve diagnosis of lymphedema. I can send in the outreach worker who can explain it to you so that you can decide if you want to have this test.
Mary: I'm interested to hear more. I don't know that I'll do it though.
Doreen: that is fine. Mark will come in to talk with you and ask him as many questions as you'd like to make certain you're comfortable that you understand everything. Then make your decision. In the meanwhile, I'm going to have the lymphedema therapist wrap your arm and put on some cold compresses. We'll also have you elevate it. How does this sound to you?
Mary: Good. I'd like to know why this just started out of nowhere and I'd like to stop it from getting any worse.
Doreen: Okay, I'll send in both the therapist and Mark. I'll see you a little later.
Mark, the medical assistant comes in, explains what is involved in tomotherapy. He discusses the procedure in more detail with Mary. Mary asks several questions to confirm no genetic specimens will be taken and there is no apparent violation of her traditional spiritual beliefs. Mary signs the consent form for the test and is reassured that the test will not cost her any money. While waiting for the tomography test to be set up for her, the lymphedema therapist wraps her arm. She also puts a cool compress around her arm. She is given a soft pillow to raise her arm so that it is higher than her heart. About 90 minutes later, the nurse comes in to tell her she can come into the tomography room.
Tomotherapy is done, the radiologist and computer specialist read the test results. Mary does have lymphedema. The lymphedema therapist returns to Mary's room and fits her for a couple of different sleeves for her to wear to prevent the swelling from getting any worse. The therapist schedules three weeks of appointments to help treat Mary's lymphedema.