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Conqueror Copes With Lymphedema

CancerWise - October 2008

By Dawn Dorsey

After surgery and nearly a year of chemotherapy and radiation, Kristine Dice’s advanced breast cancer is officially in remission. But don’t call her a survivor. She insists she’s a cancer conqueror.

Taming her cancer took intense treatment, and the disease left its calling card in the form of upper extremity lymphedema (ULE).

This chronic condition, which may be brought on by diagnostic procedures, radiation or surgery, affects up to 20% of breast cancer survivors, according to the National Lymphedema Network.

Treatment may cause ULE

Lymph nodes filter excess fluid in the body before it enters the bloodstream and help the body fight infection. ULE causes a collection of fluid, which is high in protein. This buildup, usually in the arms, acts as a magnet for swelling and a food source for infection.

ULE is most common in women who have had breast surgery and lymph node removal, followed by radiation therapy. It tends to be a lifetime issue.

Dice eats an elephant

Kristine Dice

When Dice, a research nurse, came to work in
M. D. Anderson’s Department of Breast Medical Oncology in 2003, she had been a nurse for more than 30 years. For almost as long, she faithfully had annual mammograms and performed self-examinations.

But late in 2004, after she had a mammogram in one of M. D. Anderson’s mobile mammography units, two suspicious areas were spotted: one in her left breast and one in a lymph node in her left armpit. Another mammogram revealed a second tumor in the right breast, and a needle biopsy revealed all the areas were cancerous.

“The tumors were so deep in the muscle beneath my breast that I couldn’t feel them,” Dice says. “The oncologist couldn’t even feel them. It’s amazing the mammogram picked them up, and I credit that to the persistence and expertise of the people who did the test.”

Dice’s diagnosis of stage Ill breast cancer was followed with four courses of FAC, a chemotherapy cocktail of 5-fluorouracil, Adriamycin® (doxorubicin) and Cytoxan® (cyclophosphamide). During treatment she had severe infections, causing her to be hospitalized on several occasions.

“It was rough, but I can do anything for a little while,” Dice says. “How do you eat an elephant? One bite at a time.”

Treatment ends

After FAC, Dice was treated with 12 cycles of Taxol® (paclitaxel), which caused few side effects.

Her hair even started to grow back. However, during treatment and the months following it, she had three painful episodes of cellulitis, an infection of the tissue under the skin that required hospitalization.

Chemotherapy was followed by surgical removal of her right breast and surrounding lymph nodes.

As soon as she recovered from surgery, she began radiation. After her last radiation treatment, she rang the bell that symbolizes she had finished with treatment. But her challenges were far from over.

Massage, bandaging help lymphedema

Dice takes Femara® (letrozole), a hormone-blocking, cancer-fighting medication that makes her feel achy most of the time. She also lives with ULE, which started during radiation therapy.

She regularly visits the team of physical therapists at M. D. Anderson. They help her live with ULE using a variety of tools, including compression bandaging techniques. And they give her lymphatic drainage massages, a special, gentle type of massage that helps release the built-up fluid.

“Sometimes the lymphedema comes on quickly, sometimes it’s more gradual,” she says. “Heat makes it worse, so I’m not able to spend much time outside. I get a bit of a break in the winter.”

Bandages can be fun

Since the smallest injury, even a paper cut or scratch, can result in an infection that lands her in the hospital, Dice has to be extra careful. Every day she wears a compression sleeve from her armpit to just past her wrist and a compression glove with only the fingertips open. But she makes the best of it.

“I found paisley, fuchsia and gold lamé sleeves and gloves,” she says. “I have to wear them, but there’s no law that says I can’t have fun.”

Conquering takes courage

Dice still works at M. D. Anderson, but she transferred to the Department of Gynecologic Oncology where she continues to work as a research nurse. In the Department of Breast Medical Oncology she was tempted to compare herself to breast cancer patients who did not survive. Yet, her work helps her face her challenges.

“If I didn’t really love what I do, I wouldn’t have been able to make it through all this,” she says. “Continuing with cancer research at M. D. Anderson gives me the courage to push.”

Dice says she has two choices: to be a survivor and just get by or to be a conqueror.

“I can say this is the best day God has ever made, and I can be joyful,” she says. “Why would I not? Cancer is not bigger than I am.”

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© 2014 The University of Texas MD Anderson Cancer Center