Flu Shots and Lymphedema

Getting a flu shot shouldn't be a complicated thing, right? Roll up the sleeve, brace for impact, insertion, completion, and leave. That's the way it should go down, but for someone with lymphedema, it's not that easy.

After a recent annual physical, the doctor reminded my husband and I we needed to have the flu vaccine. We'd become familiar with this routine and were ready to receive the shots at his office when our doctor sadly shook his head and informed us his office hadn't received their allotment of inoculations yet. "Not to worry," he said, "You can stop by any local pharmacy and have your shots today. Many pharmacies are participating in the annual inoculation program and won't charge anything as long as you have insurance that covers the dose."

On the way home from the physician's office, we noticed a large sign outside our local pharmacy indicating their participation in the program. Pulling into the parking lot, we were thankful to see only a couple of cars. Thinking this would be a quick stop, we meandered inside.

Walking through the store, we made our way back to the pharmacy and indicated our desire for the flu vaccine. As we filled out necessary paperwork regarding the shot, we read the warnings about potential side effects and other pertinent information. We signed on the dotted line and returned our forms, then were instructed to sit and wait until called.

Before being seated, I asked to speak to the pharmacist. I told the pharmacy assistant I had important information regarding my health that I needed to share. The assistant asked me to divulge the information to her and she'd pass the news on to the doctor. Reluctantly, I leaned over the counter and whispered, "I'm a breast cancer patient and have lymphedema in both arms. I am not allowed to have the flu vaccine in my either arm. I need to have the shot in my hip."

I watched as the assistant's face changed to that of surprise. It was evident, by her reaction, my request was not a common one. As she turned to walk over to the pharmacist, I continued to watch. She whispered into the doctor's ear and the pharmacist's eyes widened.

Within a few months of surgery, I'd noticed an abnormal swelling in my upper arms. After seeing the oncologist, I was diagnosed with lymphedema, a painful condition often occurring after the removal of lymph nodes or breast cancer surgery. With the removal of nodes from both arms, the lymphatic system's proper flow of lymphatic fluid through the body had been disrupted. This disruption caused a buildup of fluid in the extremities causing swelling and discomfort.

"With lymphatic limbs," my doctor advised, "any injection, tight pressure, or injury could exacerbate the condition and might possibly lead to a more serious condition called cellulitis." I was told it was up to me to guard my arms since I was the one who would be affected adversely should injury take place, but doing so often invoked odd reactions from medical staff.

As I waited, I couldn't help wondering why getting an immunization in the hip was such a big deal. The only reason I could think of, at this pharmacy, was the fact that there was no private area. Immunizations were given in an open area, in front of other customers. And, while I didn't relish the thoughts of dropping my drawers in front of inquiring eyes, I'd already made up my mind that if that was what it took, that was exactly what I would do. Modesty had left me long ago after my diagnosis of breast cancer.

Thankfully, the pharmacist took me into an employee break room to administer the vaccine. I was glad to have the privacy the room offered, but hoped no employees would come into have lunch while my cheek was exposed.

Just before the pharmacist injected the needle, she confided in me. "I've never had to give a shot in the hip before, in fact, I had to call my fiancé, who is a physician, and ask him exactly how to do it." Her confession didn't offer peace of mind.

The pharmacist was unsuccessful on her first attempt and apologized profusely. Standing there with my buttock exposed, I tried to remain calm and patient. Since she was behind me, I couldn't see what she was doing, but I assumed she was reloading the vaccine and steadying her aim.

Within just a few seconds, I felt the quick jab of the needle and the burn of the medication entering my body. I almost laughed when the doctor breathed a sigh of relief. To lighten the mood, I looked over my shoulder and spoke to her saying, "I bet you're glad you don't have to do this every day, aren't you?" She smiled and shook her head in the affirmative.

As we walked out of the breakroom, I thanked her for understanding. She accepted my gratitude and went back to work.

Lymphedema has been a challenging side effect of breast cancer surgery and affects every aspect of daily living. Protecting limbs may seem like overkill to someone without knowledge of the condition, but the cautionary efforts are for my benefit.

Educating others about lymphedema is often shouldered by the person with the condition and while I don't always enjoy doing it, I do it because I must. If I keep quiet, I'll suffer the consequences - and I'm not willing to risk bodily harm because of pride.

Getting a flu shot shouldn't be a big deal, but sometimes it is, and that's okay. Laughter and making light of the situation can help make others a little less uncomfortable.

For those with breast cancer, lymphedema, or a weakened immune system, it might be a good idea to call ahead and inform the pharmacy or your doctor's office about pre-existing health issues in order to avoid any unnecessary embarrassment. For those with lymphedema, it's important to speak up. Not all medical staff are familiar with lymphedema, its side effects, or precautions to prevent exacerbation of the condition. Be your own best advocate.