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Tuesday, December 09, 2008 Wendy, Community Member, asks

Q: can you take blood presure in arm after bialteral mastectomy.

my friend just had a bilateral mastectomy. She has heard that she can not have blood pressure taken in the arm anymore is this true.

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Answers (7)
PJ Hamel, Health Guide
12/ 9/08 10:11pm

Wendy, people used to believe this, but studies have shown that women with double mastectomies, who get their blood pressure taken in either arm, aren't at any more risk for lymphedema than anyone else. So it's kind of an old wives' tale... Nevertheless, if she's apprehensive, she can ask to have her blood pressure taken in the femoral artery in her leg. Hope this helps- PJH

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Dr. Joe, Community Member
5/10/12 9:50am

Peripheral vascular disease in the legs is much more common than in the arms.  So a wrong (lower) BP is somewhat more likely in the leg than in the arm.

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Angi, Community Member
12/10/08 2:50pm

Wendy the factor in this is if she had any lymph nodes removed during her bi-lateral mastectomy.  If nodes were taken from one side then all needle sticks and pressue cups should be avoided in that arm only.  If they only removed the sentinal node for a biopsy then it will be okay - lymphedema is mainly a factor when all nodes have been removed, though there can still be minor problems when just one has been removed.  If she had nodes removed from both sides, then for the sake of lymphedema it should be avoided and pressure taken in the leg.  However in the event of an emergency pressure cups or needle sticks won't matter much when it's a matter of life or death.  If such a case happens then likely her doctor will rx antibiotics should an infection occur.

Angi

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Sheina, Community Member
1/18/10 11:15pm

This is not an old wives tale.  It is very important to find out whether lymph nodes were removed during the mastectomy.  If lymph nodes have been removed, then it is important to take from other arm, or the leg -- this is to prevent lymphedema in the arm.

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PJ Hamel, Health Guide
1/19/10 7:20am

It's true, there actually is some controversy over this - whether you need to avoid blood pressure cuffs or not. Expert opinions differ. To be super-safe, if you've had lymph nodes removed under both arms, ask for blood pressure to be taken somewhere else. PJH

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Dr. Joe, Community Member
5/10/12 9:53am

Being super safe is fine but I have had so many patients worry about this while they smoke, weigh over 250 pounds and don't control their diabetes.

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mskat531, Community Member
5/31/11 3:52pm

This depends on which doctor you ask. I had a bilateral in March, one doctor told me the same as they told your friend, and another said it was an old wives tale. I have had all axillary nodes removed in both arms and have been getting blood pressure on leg and foot draws for blood tests. I was hospitalized in an emergency situation and had IV's in my arm with no ill effects. I've also had IV chemo  done using the arm. Although when they tried to do a blood pressure on my arm it caused excruciating pain and they had to stop and do it on my leg. I now have blood tests drawn from my arm since it is much less painful than the foot draw and no danger of blood clots in the legs. As long as it keeps working for me, that is the way I will do it. I'm hoping that after some time and I'm completely healed that I'll be able to have blood pressures on my arm also, as they are often inaccurate when they do them on my leg.

 

Our bodies are complicated and someone else in the same circumstances may have a completely different reaction than you do. Best answer is do what you think is right for you. You know your body and how it reacts better than anyone else, just listen to it and stop doing what you're doing if it causes problems. 

 

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PJ Hamel, Health Guide
5/31/11 5:17pm

The problem is, none of us knows how susceptible to lymphedema we are. for some women, it's "business as usual" with blood draws and blood pressure readings taken from the arm - and they're fine. For others, a blood draw or even repeated blood pressure cuffs can help instigate lymphedema. If you've had a mastectomy on one side, then it makes sense to simply have the work done on the other side; if you've had a bilateral, and need blood pressure readings and/or blood draws infrequently, then you might hazard using an arm. And, certainly if you're unable to use another part of your body for whatever reason, well, then you have to use your arms. But you're probably increasing your risk for lymphedema when you do... Tough choice, as with so many cancer decisions! PJH

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Phyllis Johnson, Health Guide
5/31/11 6:52pm

Fortunately, from the lymphedema prevention point of view, most people who have bilateral mastectomies do not have lymph nodes removed on both sides so  if using the leg or foot isn't working well for them, they can do blood pressure and needle sticks on the side that didn't have lymph nodes removed.

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Dr. Joe, Community Member
5/10/12 10:17am

The blood pressure warning is not rooted in lymphedema.  Historically breast cancer was surgically treated with radical mastectomy.  This was a terribly disfiguring procedure where the pectoral muscles were removed exposing the ribs and the axilla (armpit) was cleaned out.  In the arm pit all of the tissue was removed to get the lymph nodes leaving the main arm artery traumatized.  Sometimes the artery would scar down to a smaller diameter and this would lead to a lower blood presssure reading.  Certainly all patients would also have severe lymphedema.  There are very few surviving patients who had a true radical mastectomy now.

 

The modified radical mastectomy is a common procedure now.  It rarely involves traumatiizing the artery.  In fact we rarely even see it during the surgery.  So a wrong blood pressure reading is no a real concern.

 

Lymphedema is still a post operative issue.  Taning a blood pressure in an anrm with lymphedema is very inlikely to worsen it let alone cause it in an amr that does not have it.

 

Patients are being told the same information that was pertainent in the 1970's.  Even some doctors are trained wrong.  Staying up with surrent procedures and information is not easy but important.

 

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PJ Hamel, Health Guide
5/10/12 11:25am

I'm sure it's not easy staying current with all the medical information and research out there, Joe - it's pretty mind-boggling. Thanks for your good feedback here; my opinion is, if taking blood pressure in your "off" arm isn't an issue, then why not? But if there's no choice, for whatever reason, than to take it in the arm close to surgery, then you're probably not putting yourself at very much risk, if any at all. Thanks again for connecting here - PJH

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Dr. Joe, Community Member
5/10/12 12:36pm

Part of my point is that there are soooo many mis-informed patients who are deathly afraid to get a BP taken on their surgical side when it is perfectly safe to do so.  As in - they had just sentinal node biopsy and not axillary node disection.  These patients are told by almost every nurse that treats them that someone who uses that arm for blood draw, IV and BP is committing mal-practice.

 

We only have a limited amount of veins.  IV's can cause them to scar and disappear.  Every month I run into a situation where a patient has no good usalble viens in the off arm and the patient is deathly afraid to let us touch the other.

 

Same goes with BP's.  We do lots of operations on arms.  Using the opposite arm for BP is typically better than using the leg (we have a fair amount of peripheral vascular diesease in our O.R. population).  

 

We frequently operate on an arm on the side that had the breast cancer and the patient's never worry about it.  If we try to start an IV they get very upset.    If an IV is bad because of the possible side effects of infection and infiltration, how could surgery be OK to them?  It is because of the dogma pounded into their brains by other health care providers who are just passing down bad information for generations.

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PJ Hamel, Health Guide
5/10/12 4:52pm

Well, Joe, you're doing your part here to help women get over their unrealistic fears. Thanks - PJH

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Donna Richardson, Community Member
5/11/12 4:24pm

After mastectomy on right side, why are we not to draw blood on that side?

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PJ Hamel, Health Guide
5/11/12 9:13pm

Donna, there's a bit of controversy about this perhaps being "old" information; read through the posts on this thread and you'll understand why. The reason is purportedly because you've had axillary lymph node surgery as well, and would be more prone to lymphedema; so it's best to avoid any undue stress on the arm, which would put pressure on the lymph system. Hope this helps - PJH

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Martha J. Davis, Community Member
2/19/14 3:29am

I am 91 years old, a 38 year bilateral mastectomy cancer survivor. Hospital visits for B/P readings and blood drawing readings and annual check ups are horrendous not only for me, but for all health personal. I have been having blood drawings by a phlybotomist from my right foot, but no one knows where to do the B/P checks.

The older I get, the more scary this is to me....Please help me sort this out.

Right foot drawing, - Lower right foot - test for a good vein, - put hot pack over foot - tie tournequet above ankle - use butterfly needle and draw.

I not only need information from someone who knows, not only for myself, but others that need this help. When I need an operation or an IV for in hospital treatments for the cellulitus attacks, they have to put the IV in my neck on the right side...

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PJ Hamel, Health Guide
2/19/14 5:14am

Martha, it sounds like you've dealt with lymphedema and cellulitis in the past, which makes this more difficult; if you didn't already have a lympedema history, I'd suggest you just go ahead and take a chance and consider using your arms.

 

That said, we're not doctors here, simply well-read breast cancer survivors; so we're not in a position to offer specific medical advice. But looking broad picture – I wonder if so many blood draws are strictly necessary? Perhaps your GP is ordering them without knowing how difficult they are. As for blood pressure, it can be taken in your leg, if I'm not mistaken.

 

Make sure everyone concerned (not just the lab) – your GP and any specialists – know what a hassle this is, and see if the draws can be cut to a minimum. Beyond that - I wouldn't think you'd want to change doctors/hospitals in hopes of finding a better situation, but that might be your last resort. Good luck - PJH

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Phyllis Johnson, Health Guide
2/19/14 7:04am

Martha, the National Institutes of Health's website has a section on lymphedema prevention.  It has a long list of suggestions for preventing and managing lymphedema, which includes no blood pressure checks or blood draws from an arm that had lymph nodes removed.  So if you did not have lymph nodes removed on both sides, you could still have blood pressure and blood draws on the side where no lymph nodes were removed.  Often when a bilateral mastectomy is done, the surgery is more extensive on the side with cancer, and more minimal on the side without cancer.  If you have not had lymphedema in both arms and if you are following the other lymphedema prevention tips on the NIH website, you could take a calculated risk and have procedures done on the non-affected arm if having the B/P and blood draws in your foot is becoming problematic.  It sounds like you have health issues that require frequent and accurate monitoring, so talk to your doctor about whether your risk of health problems because of inaccurate B/P readings is greater than your risk of lymphedema.  For example, if your doctor is trying to get your blood pressure medicine regulated, it may be more important to get regular accurate B/P readings right now than it is to worry about lymphedema.  However, if lymphedema is the cause of cellulitis attacks, doing everything possible to keep it under control may be your most important health issue right now.  You might want to ask for a referral to a trained lymphedema therapist, who could assess the condition of both your arms and make suggestions.  Lymphedema therapists see many patients with concerns like yours and probably have tips for the best way to get blood pressure readings in places other than the arm.  

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Phyllis Johnson, Health Guide
2/19/14 7:11am

Martha, another thing you can ask about is whether a wrist blood pressure monitor would be appropriate for you.  

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By Wendy, Community Member— Last Modified: 04/18/14, First Published: 12/09/08