Member: EACH (Eersterust Association for Community Health)
Written by: Sr M L Theron
Message: Palliative care teams treat patients holistically, focusing not only on a diagnosis but on the person’s overall health.

Looking beyond the obvious when swelling persists

This is the story of a 79-year-old patient whom I have known for 2 years.  She had cardiac failure and had a knee replacement about a year ago.

 She was admitted a few months ago. When I visited her after the discharge, I noticed her right arm was swollen.  The swelling was persistent and did not subside.

 At my next visit, I advised her to ask her doctor to examine the arm; at that visit, they only did an X-ray and found nothing.

 Two weeks later, I visited again and wrote a letter of reference for her to take to her doctor; after that, she was finally being worked up further.

 The provisional diagnosis is now suspected to be inflammatory Breast Cancer with right upper limb Lymphoedema Secondary to Lymphatic Obstruction.  She is currently being worked up for staging.

 She is on Warfarin for her Cardiac condition, so she has started bridging with Clexane and is booked for a biopsy and a mammogram.

 This case taught me the importance of looking beyond the obvious and that persistent Unilateral Limb swelling should never be dismissed as Cardiac Oedema without proper breast examination.