DEAR DR. ROACH: I have lymphedema, which isn’t curable. I use a compression device on a daily basis, and it does help. I take nifedipine and lisinopril for my blood pressure. I am 70 years old and did not have lymphedema until two years ago. Are there any recommendations for this problem? — F.S.
ANSWER: Lymphedema is swelling (“-edema”) caused by improper working of the lymphatics (“lymph-“). In many people, lymphedema happens after a medical or surgical problem, such as arm edema after diagnosis/treatment of breast cancer. However, lymphedema can come on for unknown reasons. It may happen in both men and women, in either the upper or lower extremities.
Lymphedema can be misdiagnosed. Chronic venous insufficiency, swelling in a limb after a blood clot, and lipedema (a disease of abnormal fat deposition) can all be misdiagnosed as lymphedema. However, it’s also common that the diagnosis can be delayed for years.
Wound specialists, plastic surgeons and vascular surgeons often have expertise in diagnosis and management of lymphedema. The diagnosis is usually made by a careful history and physical exam, but sometimes advanced imaging studies are performed to be sure of the diagnosis.
Initial treatment for mild lymphedema includes frequent elevation of the affected limb; regular moderate exercise (this has been controversial in the past, but most studies now show improvement in lymphedema from exercise); skin care; and compression therapy as prescribed by an expert. Improper compressive clothing can make the problem worse. I avoid medications that can cause swelling, such as nifedipine, whenever possible.
Compression devices help squeeze out excess fluid, and I am glad it is working for you. Manual lymphatic drainage, usually performed by specially trained physical therapists, is a first-line treatment when it is available. Many individuals or their family can be trained on how to do manual lymphatic drainage.
DEAR DR. ROACH: I have a male friend, 71, who has been on a low nightly dose of lorazepam for 15 years, originally prescribed for anxiety and insomnia due to work. He’s been retired for 10 years, but when he asked his doctor about getting off the medication, his doctor said, “If it ain’t broke, don’t fix it.” I think he should taper off of it, since the anxiety is gone. What are your thoughts? — D.
ANSWER: Although I have been known to say the same thing to some of my patients, I do try to taper my patients off of benzodiazepines like lorazepam (other members of this class include diazepam, clonazepam and many more, almost all of which have generic names that end in “-pam”). These medicines increase the risk of falls and motor vehicle accidents. Of course, lower doses have a lower risk, but as we get older, the dose that was originally considered very low isn’t as low anymore.
Furthermore, because the body has mechanisms for becoming accustomed to the dose, people can develop withdrawal while taking a stable dose. Finally, I don’t like to prescribe a long-term drug that no longer has usefulness in treating an issue.
However, tapering off of a medication takes time and isn’t always easy. Moreover, sometimes the anxiety is gone, in part, because the medicine is doing its job! So, there isn’t one answer for every person, and your friend’s feelings about it are critical to this decision.
* * *
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
(c) 2023 North America Syndicate Inc.
All Rights Reserved

Copy the Story Link