Brief Answer:
Very good question- Basics as noted down.

Detailed Answer:
Hi.
Thanks for your query and concerns about your Mother.

To recapitulate: Mother has Stage III-B CA Br- undergone 4 cycles of Adriamycin/Cyclophosphamide - needs to undergo 4 cycles of Paclitaxel - Surgeon,s appointment - decision for surgery now or after completion of Chemo - LN dissection - chances of Lymphedema - Wants to know the ways to reduce it. (what we could proactively do before/after surgery to minimize the chances of getting it.)

Since I have seen all the discussions you had on this forum and as you must have read and interacted about Ca Breast, I would like to talk about the commonest avoidable things (?mistakes):

- Not to allow the upper limb on the side of the surgery for any intravenous or intramuscular injections. This is the simple most and single most precaution to avoid lymphedema. I can also understand that time may come where it becomes difficult and they do not allow injections through the leg veins for fear of DVT (Deep Vein Thrombosis), the preferred route before and after surgery can be Central venous catherisation, which I hope all centers follow strictly.
It is the avoidance of using this particular upper limb from now on.

- Physiotherapy, this is very important part of the preparation.
It is in the form of physical therapy for the whole body, chest physiotherapy. Keep the channels blood as well as lymphatics working well.

- Avoidance of dehydration at any cost. This is also one thing that is not taken care of, as the patient has nausea, vomiting , change of taste, stress, anxiety and all related to the disease, chemotherapy and all factors. By whatever means the rehydration must be well maintained, this keeps the venous and lymphatic channels healthy.

- Elevation of the limb on the affected side help a lot.

- These are the most basic rules that are least bothered about. Please follow these and the chances of lymphedema will be least possible. These are in addition to all the care that will be taken at the center of Her Surgery.

I have tried to tell you the basics, very simple rules which as you know are most forgotten or kept sideways. I hope you liked these, Please feel free to ask further relevant queries if you need to or if you feel that there is a gap-of-communications.
Please give feedback, I shall be very happy to assist you and your Mother the most.
Wishing her the best recovery.

---

Brief Answer:
ARM under evaluation.

Detailed Answer:
Hi.
Good Morning.
Was going through literature to review both the questions you asked.

*The ARM- Axillary Reverse mapping is still in infancy and under evaluation and whether to go for it or not will be a total decision of your Operating Surgeon, hence please discuss with your Surgeon. I looks risky.

* All the studies indicate varying percentage of lymphedema so difficult to pin-point. Many patients have been seen no to have this at all.There may be alternate channels of lymphatics.
The lymphatics are very variable in every patient and how the patient will respond is not predictable.

* And the biggest issue is Cancer-survival, to get rid of the disease. This principle can not be challenged at any cost. I hope you understand what I mean by.

May I please ask the reason for such a late detection in stage III-B ?
Hoe is your Mother now?/
Have you all started taking all the precautions I mentioned, small points but most important.
Maintain the Good Hemoglobin and Serum Protein, particularity the albumin; these two are the most important deciding factors.

Please feel free to discuss further.
I shall be happy to assist.

---