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A Tough Trial

Lymphovenous bypass reduces swelling for lymphedema patient after being told there was nothing more that could be done

Lymphovenous bypass reduces swelling for lymphedema patient after being told there was nothing more that could be done

As a criminal prosecutor, Pam Anderson's trial preparation doesn't end with research and depositions; her image is as much a part of her courtroom persona as the arguments she makes. But after surgery, chemotherapy and radiation for breast cancer, Anderson's left arm became so swollen that that her suit jackets no longer fit.

She had to wear a compression sleeve and glove to control the swelling -- not the look she was going for while making her case in front of a judge and jury. "It was embarrassing," says Anderson, 47, of Nashville, Tennessee. "The jury looks at you and wonders why you're wearing them."

Anderson had developed lymphedema, a condition that affects about 25 percent of women with breast cancer after they've had lymph nodes removed or radiation treatment. When lymph nodes are removed or damaged by radiation, lymph fluid sometimes can't drain properly. It accumulates, causing swelling and pain.

In Anderson's case, the swelling began about three months after she completed radiation treatments. When it started, she thought she had pulled a muscle or tendon in her arm. "I had trouble reaching for a glass from a cabinet or raising up my arm," she says. "My hand looked like I had a bee sting and I couldn't wear my wedding rings."

Her oncologist referred her to a lymphatic therapist for weekly visits lasting about 90 minutes each. The therapist massaged her arm to break up tight bands of tissue called cords that formed in Anderson's arm and limited her range of motion. Bandaging helped control the swelling, but Anderson wanted a more effective alternative.

"I know lymphovenous bypass is not a cure, but my quality of life has been amazingly better since I had this surgery."

Discovering New Evidence

"It was frustrating because in Nashville the doctors said nothing more could be done," Anderson recalls. She refused to accept that no other options were available. As an attorney, she understands that a thorough investigation can be key to winning a case. So Anderson educated herself about lymphedema and started asking questions. Her online searches using the term "lymphedema surgery" led her to surgeon David W. Chang, MD, at the University of Chicago Medicine.

"I saw his seminar on a YouTube video," Anderson says. Chang is among a handful of surgeons in the United States who perform lymphovenous bypass surgery, which can reduce rather than just manage swelling from lymphedema. "Boom, there it was, but nobody in Nashville seemed to know about this," Anderson says.

"I saw his seminar on a YouTube video," Anderson says. Chang is among a handful of surgeons in the United States who perform lymphovenous bypass surgery, which can reduce rather than just manage swelling from lymphedema. "Boom, there it was, but nobody in Nashville seemed to know about this," Anderson says.

She contacted Chang's office and drove to Chicago for a consultation. Anderson was a good candidate for the surgery, he says, because the swelling affected her arm and hadn't yet become severe. Treatment for other types of cancer -- pelvic tumors, for example -- may cause lymphedema in the legs. Chang's research has shown that lymphovenous bypass reduces swelling more effectively in arms than in legs.

The procedure is complex, but recovery is quick and the risk of harmful side effects is minimal. During surgery, Chang injects a fluorescent green dye that lights up a map of the lymphatic system in the swollen arm. The map shows him where lymphatic vessels are located. "I can see clusters of dye collected in those areas," he says.

Even though the green dye is visible with the naked eye, Chang uses a sophisticated camera designed specifically for the lymphatic system that gives him a precise, infrared view of the affected area.

Once he has identified lymphatic vessels, he marks them with a pen. Using a microscope that magnifies the areas up to 25-fold, he makes incisions about an inch long to reach lymphatic vessels about the size of a mechanical pencil lead and the tiny surrounding veins. He then sews the ends of the lymphatic vessels to nearby veins. The flow of lymph fluid is restored, relieving the swelling.

"Because the incisions are small and at a superficial level, there usually is little or no pain," Chang says. Most patients leave the hospital the next day. Anderson was no exception. Her surgery was on a Friday in mid-December 2013. She was released on Saturday and went back to work on Monday.

"Because the incisions are small and at a superficial level, there usually is little or no pain," Chang says. Most patients leave the hospital the next day. Anderson was no exception. Her surgery was on a Friday in mid-December 2013. She was released on Saturday and went back to work on Monday.Now, seven months after her surgery, Pam is "having a great summer not wearing my sleeve and glove!"

Anderson kept her arm bandaged for about a month after the surgery. Her follow-up care required one more trip to Chicago for a check-up two months after surgery. By then, her swelling had subsided and there was no visible difference in the size of her arms.

Now she only wears her compression sleeve and glove when exercising or on air flights. And her incision scars are barely noticeable. "One on the interior of my wrist just looks like a wrinkle," she notes. "And another one, at the top of my forearm approaching the elbow, looks like a cat scratch."

Reaching a Verdict

Making the decision to have lymphovenous bypass surgery wasn't difficult for Anderson. "I just wish more people knew about this, and that they should have the surgery early, before damage sets in," Anderson adds. It may not be long before lymphovenous bypass surgery is more widely available. Teams of doctors from many major medical schools have come to Chicago to learn Chang's techniques. "It's taking off," he says.

When Anderson's cases go to trial now, she can face the jury comfortably wearing a business suit. "I know lymphovenous bypass is not a cure, but my quality of life has been amazingly better since I had this surgery."