• Compromised Lymph Nodes and the Skin Consultation – What to Ask

    There is no way to avoid working with clients whose lymph nodes have been compromised. A compromised lymph node is one that has been impaired as a result of medical treatments such as liposuction, thyroidectomy, breast reduction, or the node has been removed, radiated, or biopsied during diagnostic procedures or cancer treatments. It does not matter whether the diagnostic results were positive for cancer or not; the fact the nodes were tested means they have been compromised. Anyone with a compromised lymph node within a primary routing area – specifically cervical, axillary, or inguinal – is at risk for developing lymphedema.

    Lymphedema is an abnormal accumulation of a protein-rich interstitial fluid that can occur in the arms or legs, associated trunk quadrants, and also in the head and neck. The condition develops when lymph vessels or lymph nodes from a primary routing cluster are damaged or removed, or the integrity of the lymphatic system is in some way compromised. Although frequently associated primarily with breast cancer, lymphedema may also occur as a late or long-term side effect of medical treatment for melanoma, head, neck, and throat cancer, as well as cancers located in the lower quadrants such as ovarian or gastric carcinomas. The risk of lymphedema is a lifetime risk, and the condition itself is irreversible, uncomfortable and can be painful. While there is no cure for lymphedema, it can be managed.

    Managing lymphedema involves diligent care of the affected limb, and it is expensive and time-consuming. Skin treatment modifications during cleansing, massage, and heat applications on the neck, décolleté or arms during a treatment session will always be required for the client with compromised axillary or cervical lymph nodes.

    Many of us work with a detailed intake, which is essentially a compilation of well thought out questions intended to stimulate discussion about a client’s preferences, lifestyle and stress levels, sun exposure, and what her primary skin treatment objectives are. This type of comprehensive consultation reveals valuable information for the therapist, and although considered imperative for the first time client, it is often not revisited during the ongoing process of seeing regular clientele. Unfortunately clients don’t always readily self-identify as having compromised lymph nodes, and therapists who don’t know better seldom ask. Clients may not self-identify because they don’t understand the critical implications inherent in the modified delivery of their skin care treatment, or they think the therapist may turn them away, or perhaps the medical diagnosis and subsequent treatment are so far in their past that they think the information is no longer relevant.

    I invite you to reconsider the consultation process, especially with your existing clients. Return to basics. Remember, the consultation is about communication. Communication is the process by which information is successfully shared between two or more people. Ask your clients whether they have had medical treatments that affected any of their lymph nodes, and then modify your service accordingly.

    Karey Hazewinkel York has 12 years of experience specializing in advanced skin care education. A licensed esthetican, massage therapist and spa consultant with a bachelor’s degree in sociology and gerontology, Karey runs a program at the Hoag Family Cancer Center, providing support to patients focusing on skin changes during and after cancer treatment. Being a breast cancer survivor herself, she is keenly aware of the importance of assisting all patients in feeling more comfortable with this new part of their life.