Ask Dr. Stanley Rockson

Areas of expertise:
  • Lymphedema
  • Lymphedema prevention
  • Genetics
  • Lymphatic malformations, venous malformations, complex vascular anomalies
  • Protein-losing enteropathy
  • Chylous effusions
  • Impact of systemic disease on lymphatic function

Dr. Rockson is the Allan and Tina Neill Professor of Lymphatic Research and Medicine at Stanford University School of Medicine. After earning his medical degree from Duke University School of Medicine in Durham, North Carolina, Dr. Rockson completed his internship and residency training in internal medicine at the Peter Bent Brigham Hospital of Harvard Medical School, in Boston, Massachusetts, and fellowship training in the cardiac unit of Massachusetts General Hospital, Harvard Medical School. He is a fellow of the American College of Cardiology, American College of Angiology, and American College of Physicians, as well as a member of the International Society of Lymphology, American Society of Internal Medicine, the Society of Vascular Medicine and Biology, and the Paul Dudley White Society, among others. Dr. Rockson is the Director of the Stanford Center for Lymphatic and Venous Disorders and serves as Editor-in-Chief of Lymphatic Research and Biology.


Submit a New Question
  1. Test Question for Dr. Rockson
    Question (Jim, ):
    • no need to answer. Working on email visibility issue. Jim
    Answer:
    • Mar 2017

      here is the comment

  2. Lower leg lymphedema and diuretics
    Question (Marilyn , ):
    • I've had lower leg lymphedema for 20+ years. Early symptoms occurred after being on me feet all day in the heat, like at an amusement park. The skin was red, bumpy, burned, itched, and the swelling and pain curtailed any next day enjoyment. Exercise became less and less because my legs always swelled and itched. I gained weight and the legs became even worse with open wounds and leaking fluid that I couldn't keep the little gnats away no matter how much I bandaged them. One year ago I had gastric bypass and lost 124 lbs. my legs are very skinny now and the sores are gone. My legs are terribly discolored (dark purple/red) and the skin is very sensitive. Following my surgery I developed a huge DVT behind my knee and in my upper arm. I am still on xeralto. I manage the fluid in my legs using bumex and an electronic compression machine. The bumex lowers my blood pressure and my pulse runs around 42-44, so exercise is very limited again. My legs hurt every minute of every day. All I can take is Tylenol and it does work. What should be my next course of action? Cardiology? PT? Can dermatology help me?

    Answer:
    • Mar 2017

      I believe, from your description, that a thorough evaluation of your venous system might be helpful - either cardiology, vascular medicine, or vascular surgery. This does not sound like a dermatologic problem.

  3. lung biopsy with lymphadema
    Question (Gabriella, ):
    • I have lymphedema on my right arm. I have had chemotherapy and radiation on my right breast. I am scheduled to have a CT scan directed biopsy on my lower right long. Can this procedure increase my lymphedema?

    Answer:
    • Mar 2017

      There is some potential shared lymphatic drainage between your right arm and the chest wall, but the added lymphedema risk of the procedure that you will have is extremely small.

  4. Chills with MLD
    Question (Jan, ):
    • I have a patient with lymphedema in both lower extremities, polycythemia vera, Meniere's Disease, hypertension, and elevated cholesterol. She takes hydroxyurea for the PV. I recently got her a Flexitouch for home use and she said that she gets chills after each treatment. I asked her if she gets chills when I do MLD with her during our physical therapy sessions. She said that she does but she attributed this to the cold weather. I searched PubMed and found 5 articles talking about hydroxyurea setting off infection-like symptoms that subside when the drug use is discontinued. Have you heard anything about chills and MLD or Flexitouch with no fever, nausea or vomiting? What do you recommend we do? Thanking you in advance. Jan Bruckner, PT, PhD, CLT-LANA

    Answer:
    • Feb 2017

      This is a new problem to me. One can envision that massage therapy and/or Flexitouch could send showers of bacteria if there was an active cellulitis, but that doesn’t seem to be the case here, by your description. As a first step, the patient can try to record body temperature before, during and after Flexitouch use. If there is no fever, then I don’t see any implicit reason that the treatment couldn’t be continued.

      Thanks for this question.

  5. lymphedema and hormone replacement therapy
    Question (Yvonne, ):
    • I am wondering if you have any information regarding primary lymphedema and hormone replacement therapy. I have lymphedema in both legs, which manifested around age 12. I have managed it quite well for over 40 years. But, it seems that with the onset of menopause, it has become increasingly difficult to manage. In the past year, I had 4 different episodes of cellulitis, two of which involved hospital stays due to sepsis. (I had always heard this was a complication of lymphedema but never quite believed it!) For a host of symptoms, hormone replacement therapy has been recommended – even to potentially improve the management of the lymphedema - but, my doctor will not prescribe it without more information regarding potential blood clots and lymphedema. Any thoughts would be greatly appreciated.

    Answer:
    • Feb 2017

      If the lymphedema is not on the basis of prior clotting in the veins, then there is no elevated risk for the hormone replacement therapy (all estrogen therapy carries some risk for increasing deep vein thrombosis). The effect of hormone therapy on lymphedema is unpredictable—it could make the condition either better or worse (or, perhaps, be neutral).

      Good luck!

  6. lymphedema and hormone replacement therapy
    Question (Yvonne, ):
    • I am wondering if you have any information regarding primary lymphedema and hormone replacement therapy. I have lymphedema in both legs, which manifested around age 12. I have managed it quite well for over 40 years. But, it seems that with the onset of menopause, it has become increasingly difficult to manage. In the past year, I had 4 different episodes of cellulitis, two of which involved hospital stays due to sepsis. (I had always heard this was a complication of lymphedema but never quite believed it!) For a host of symptoms, hormone replacement therapy has been recommended – even to potentially improve the management of the lymphedema - but, my doctor will not prescribe it without more information regarding potential blood clots and lymphedema. Any thoughts would be greatly appreciated.

    Answer:
    • Mar 2017

      The relationship between the lymphatic system and female hormones is complex, but, in principle, hormone replacement therapy should not aggravate the preexisting lymphedema. However, these hormones do carry a risk of blood clots in all perimenopausal women, so the decision to use them should be based on a risk/benefit analysis of the individual patient.

  7. Lymphedema
    Question (Peggy , ):
    • I have had primary Lymphedema in my right leg for 30 yrs. In October 2016 I tore the miniscus in my knee and it has yet to heal. I am in constant pain and the doctor has suggested a cortisone shot MAY help in the healing process by reducing the inflammation. I am fearful the shot may have an adverse affect and increase the swelling. Please advise me. I would very much appreciate your professional opinion and any advice you can share to help me make my decision. Thank you very much

    Answer:
    • Dec 2016

      Many decisions in Medicine require a balance between risk and benefit, including your current one. If the cortisone reduces the inflammation in your knee, it will potentially have a beneficial overall effect on your lymphedema, but the effect of the cortisone itself on the lymphedema, as well as the minor trauma from the injection may have adverse consequences, as you fear. I cannot advise the best personal strategy for you without examining you, but, in sum, it seems like a reasonable proposal. At the end, it will have to be a personal decision for you.

      Best of luck to you!

  8. Primary Intestinal Lymphangiectasia (PIL)
    Question (Nidia, ):
    • My 5 month old has chylous ascites. I believe it started either at birth or shortly after. She has been in a children's hospital for a month now and still doctors are continuing with what has been done in published PIL situations. she is otherwise a very healthy baby with no preexisting medical condition and was born at 42 wks. She has been on TPN for 2 weeks and will go back on a medium chain triglyceride formula to see how the body will tolerate it. Tests of her lymphatic system showed a small abrasion but they cannot say if there are smaller ones throughout the intestines. it took 4 months to really see her stomach was too large. Have you had any cases like this where the body healed itself and they went on to live a normal life? Does that exist? As of now i have no answers.

    Answer:
    • Dec 2016

      I certainly understand your concerns. The simple answer is that, in some cases, the lymphatic circulation can mature over time, so that the initial problem decreases as the child grows. TPN is the correct initial medical management for the chylous ascites; when she is ready for an attempt at food by mouth, there are medications that can help to maintain the benefit of the TPN.

      I don’t have any specific recommendations at this time, but it will be important to eventually be under the care of a specialist who is familiar with this condition and its management.