Wellness Unmasked: New Hope for Lymphedema: Breakthroughs in Treatment and Prevention

Summary

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Podcast Summary: The Clay Travis and Buck Sexton Show

Special Episode: Wellness Unmasked: New Hope for Lymphedema – Breakthroughs in Treatment and Prevention
Date: October 21, 2025
Host: Dr. Nicole Saphier (with guest Dr. Dayan)

Episode Overview

This special installment of the podcast centers on lymphedema—a chronic, often life-altering condition affecting many breast cancer survivors. Host Dr. Nicole Saphier, joined by expert Dr. Dayan, brings attention to the under-recognized but significant complication of cancer treatment. The episode explores the current landscape of lymphedema prevention, emerging treatments, and practical advice for patients, offering hope for improved outcomes and quality of life.

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Key Discussion Points & Insights

The Hidden Challenge of Lymphedema

• Breast Cancer Context

  • October is Breast Cancer Awareness Month.
  • Over 4 million Americans are living with a history of breast cancer, facing not just survivorship but lingering challenges.
  • Lymphedema can affect up to 20% (or higher) of breast cancer survivors.
    "One of the most under recognized and under talked about, but life altering complications of treatment from breast cancer is lymphedema."
    — Dr. Nicole Saphier [03:41]

• Understanding Lymphedema

  • Chronic condition; marked by swelling in the arm, chest, breast, or neck caused by lymphatic system disruption typically after lymph node removal or radiation.
  • Debilitating, requires lifelong management, can predispose to infections.
  • "The lymphatic system is the sewage system of the body... When lymph nodes are removed or radiated... fluid waste can back up... and wreak havoc."
    — Dr. Dayan [05:34]

Preventing and Reducing Lymphedema Risk

• Standard Cancer Treatment & Side Effects

  • Lymph node removal is standard to prevent cancer spread, yet increases risk of lymphedema.
  • High body weight (BMI >25/30) is a risk factor.

• Advancements in Surgery: Immediate Lymphatic Reconstruction

  • Innovative “lymphovenous bypass” is now available at some major centers.
  • During lymph node removal, tiny lymphatic tubes are connected to veins, offering an exit for lymph fluid—akin to reconstructing the system much like breast reconstruction.
  • "Just like we would reconstruct a breast... patients... should be given the option of reconstructing the lymphatic system..."
    — Dr. Dayan [07:20]
  • Not yet standard care everywhere, but spreading.

• Why Weight Matters

  • Higher fluid load and inflammation impair lymphatic flow in those with high BMI.
  • Weight management can help both prevention and treatment.

Treatments: Surgical and Non-Surgical

• Surgical Interventions

  • Lymphovenous bypass: reroutes blocked lymphatic vessels into veins.
  • Lymph node transplant: transplants healthy lymph nodes to the affected area.
  • Surgeries range from minimally invasive to more extensive.

• Non-Surgical Therapies

  • Pharmaceutical Advances: GLP-1 Receptor Agonists (Ozempic, Mounjaro)

    • These drugs, widely known for diabetes and weight loss, may directly benefit lymphedema by decreasing inflammation and improving lymphatic vessel function.
    • Early studies and off-label use show promise.
    • "We were first to publish the use of these drugs in treating lymphedema... found [patients] taking GLP-1s were at much lower risk."
      — Dr. Dayan [11:00]
    • Not yet insurance-covered; large prospective studies underway.

  • Manual Lymphatic Drainage & Massage

    • Specialized therapy (by trained lymphedema therapists) or at-home techniques can help move fluid and minimize swelling.
    • “Massage from the fingers all the way up to the axilla... There's a special type of lymphatic massage called manual lymphatic drainage..."
      — Dr. Dayan [23:15]
    • Visualization helps patient engagement: Lymphatic imaging (injecting dye) shows real-time flow, enabling personalized therapy.

  • Compression & Pneumatic Devices

    • At-home pneumatic compression machines provide automated massage, aiding those without access to specialists.
    • "There are pneumatic compression devices... an at-home system... that actually does the massage for you..."
      — Dr. Dayan [25:31]

  • Lifestyle Measures

    • Exercise—muscle contractions aid lymph movement.
    • Breathing exercises—diaphragmatic breathing can help lymphatic drainage.
    • Weight management reduces inflammation and improves circulation.

Notable Perspectives on Medication

• Cautious Optimism for GLP-1s

  • Patients should consult with care teams; not every case calls for medication.
  • "We don't directly go to GLP-1 for everything. We want to do everything all-natural. But ... the GLP-1 helps them."
    — Dr. Dayan [20:22]
  • Mixed views on the broader, sometimes controversial use of GLP-1s (Ozempic, etc.) in society.

• Struggles Unique to Survivors

  • Many breast cancer survivors, especially those on hormone blockers, experience rapid weight gain due to metabolic changes, making weight loss much harder.
    • "These medications just kind of thrust you into this menopause overnight and then some."
      — Dr. Nicole Saphier [20:06]
  • Individualized, compassionate care is key.

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Notable Quotes & Memorable Moments

• The Emotional and Physical Toll

  • “Even after the cancer’s gone, they live with this constant pain and reminder of what they have been through.”
    — Dr. Nicole Saphier [04:55]

• Medical Progress

  • “What was once felt as an untreatable condition—now they're actually providing some options and some relief to these women...”
    — Dr. Nicole Saphier [05:22]

• Hope for Patients

  • “Imaging has been a huge transformation in lymphatic reconstruction... If you can see it, you can operate on it, you can understand it and the treatment can match the actual problem...”
    — Dr. Dayan [25:31]

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Timestamps for Key Segments

• Introduction & Breast Cancer Stats: 02:41–05:30
• Lymphedema: What & Why: 05:30–06:56
• Risk Reduction & Prevention: 06:56–08:40
• Immediate Lymphatic Reconstruction Explained: 07:20–09:31
• GLP-1 Drugs in Lymphedema Prevention: 11:00–12:17
• The Role of Inflammation & Obesity: 08:48–09:13
• Are These Treatments Available Now?: 09:31–10:44
• Practical Noninvasive At-home Tips: 22:32–24:51
• Patient Empowerment via Imaging: 24:51–25:31
• The Need for Ongoing Research, Policy Change: 17:49–19:16
• Conclusion & Final Insights: 27:40–28:55

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Episode Tone & Closing Takeaways

This episode is engaging, hopeful, and educational, blending scientific advances with practical advice and empathy for survivors. Dr. Saphier and Dr. Dayan stress the importance of awareness, proactive treatment, and the power of patient understanding.

Key takeaways for listeners:

• Lymphedema is common yet underdiagnosed among breast cancer survivors—but hope is increasing due to new surgical and medical interventions.
• Early detection and multidisciplinary management make a meaningful difference.
• Empowerment through patient education, personalized therapy, and advocacy for research can change outcomes.

“If you or someone you love is navigating life post breast cancer care, continue this conversation... Ask about monitoring. ... It's easier to treat it earlier on than when it's gotten out of control.”
— Dr. Nicole Saphier [28:00]

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Transcript

[Kal Penn]

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[Ed Helms]

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[Dr. Dayan]

Ah, come on. Why is this taking so long? This thing is ancient.

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[Dr. Nicole Safire]

I'm Dr. Nicole Safire and breast cancer awareness month continues. That's right, it may be October. And you look around, you're seeing a lot of pumpkins and pumpkin spice lattes and apple donuts and all of those other beautiful fall things. You're probably also seeing a lot of pink, especially if you follow my social media.

[Podcast Host/Interviewer]

Why is that? Well, I think we all know at.

[Dr. Nicole Safire]

This point, one in eight women will develop breast cancer in their lifetime. That number is only increasing. We're seeing rising incidences of breast cancer, especially in younger women. So October is the time where we push our message of early detection matters. The earlier you find cancer, the easier it is for us to treat and it improves survivability. So get your mammogram, make sure you're doing your breast checks, all of that stuff. That's what October is all about for the breast imaging world. But while, yes, we may diagnose over 300,000 new cases of breast cancer in the United States this year alone, today's episode is talking about something else. Let's talk about the 4 million Americans, women and men, who are living with a history of breast cancer, meaning they were just diagnosed and they're undergoing treatment right now, or they've completed their treatment and they have been declared cancer free, or they've completed their treatment or they're still undergoing treatment because their disease has progressed. Now, that's a lot of people. And these are survivors who carry both the triumphs but also the challenges of this disease forward. And that's what we're gonna focus on on today's episode. Because survivorship doesn't always mean the end of the story. And one of the most under recognized and under talked about, but life altering complications of treatment from breast cancer is lymphedema, which is a SW often in the arm, the breast, the chest, the neck, triggered by treatments that disrupt the lymphatic system. Estimates vary broadly, but up to 20% of breast cancer survivors may have some level of persistent lymphedema and it may climb even higher as post treatment time passes. It is a debilitating condition. You see women walking around, they may be having a sleeve on their arm, a compression sleeve, but even after the cancer's gone, they live with this constant pain and reminder of what they have been through. So today I'm honored to have Dr. Dayan joining us to unmask the realities of Lymphedema and talk about some exciting advancements in the field, because what was once felt as an untreatable condition, now they're actually providing some options and some relief to these women who are trying to continue on with their life after their breast cancer diagnosis.

[Dr. Dayan]

Well, thank you so much, Nicole, for really shedding light onto this disabling and permanent disease that's usually lost in the shadows of cancer. Lymphedema is a currently incurable chronic disease marked by swelling of the arm, but sometimes the chest, the breast, and even the neck. After removal of lymph nodes and radiation, most commonly, basically, the lymphatic system is the sewage system of the body. It clears out fluid waste from your arm, from your breast, purifies it through the lymph nodes, and then puts it back in the blood. When lymph nodes are removed, however, or radiated, there can be a blockage of that flow of lymph going into those lymph nodes, and that fluid waste can back up into the arm or the breast or the chest and wreak havoc. That's just episode one. Episode two is the reaction of your immune system, because the lymphatic system is part of the immune system to that injury. And what that means is the immune system reacts by causing a lot of inflammation that causes further scarring throughout the arm, predisposes you to infection, sometimes life threatening infections that can enter the bloodstream. And this requires lifelong compression, massage and therapy, and can lead to pain and disability at a very high level.

[Podcast Host/Interviewer]

You say that this happens when you remove the lymph nodes from the axilla, the armpit, or you have to irradiate them. But that is still standard of care because our data tells us if we're not removing these lymph nodes, especially if there's micro or macro metastases, that increases their risk of advanced cancer later on in their life. So is there anything that can be done to decrease the risk of lymphedema or prevent it altogether?

[Dr. Dayan]

Well, this is an exciting area because it's much preferable to avoid lymphedema than try to treat, treat it. And so at the time of the removal of the lymph nodes, the standard of care for many years was just to close up and hope for the best. And about one out of three women would go on to develop lymphedema. However, just like we would reconstruct a breast or at least offer the option for breast reconstruction after mastectomy, patients in an ideal setting should be given the option of Reconstructing the lymphatic system that's taken apart during surgery. And what that involves is taking those little tiny tubes that were going into the lymph nodes that are being removed and instead of just clipping them like a dead end, plugging them into a vein to give the fluid and exit out of the arm. And this is called immediate lymphatic reconstruction, a type of lymphovenous bypass that can reduce the risk of causing lymphedema that's working on the site of the surgical injury itself. But also there are things that you can reduce your overall level of risk. For example, increased body weight, higher BMI over 30 or even over 25 can increase your risk of developing lymphedema. And there.

[Podcast Host/Interviewer]

Why is that? Why does, I mean, we talk about excess waste being a risk factor for a lot of illness. How does that increase lymphedema risk?

[Dr. Dayan]

Two ways that we know. One is it increases the load of fluid waste produced, so it increases the stress and demand of the lymphatic system. And two is that we see an increase in inflammation along the specific lymphatic vessels, those tubes transporting lymph. And that inflammation impairs the ability of lymph to flow out of the arm and also causes scarring.

[Podcast Host/Interviewer]

But is this lymphatic bypass? I mean, this sounds incredible. I mean, and it actually makes a lot of sense, but I don't actually hear about it in day to day practice. So is this something that is potentially on the horizon of being standard of care or is it, you know, how, how women even have access to this?

[Dr. Dayan]

Fortunately, there are more and more people getting involved and interested in learning these techniques. Typically it's done by a plastic surgeon or microsurgical trained surgeon that can connect very tiny tubes together. So it's, it's not widely available, but it's becoming more common in majors, in major centers, and we perform this regularly.

[Podcast Host/Interviewer]

Now, is this something obviously being done at the time of surgery is ideal? Is it something that is potentially being used for treatment for those who are already suffering from lymphedema?

[Dr. Dayan]

Yes. Ideally this is done at the time of surgery and you avoid the problem to begin with. But if a patient should develop lymphedema, there are a variety of different surgeries that can be done. One is lymphovenous bypass, which is taking that blocked lymphatic vessel, cutting it and plugging it into a vein so that there's fluid that can, that can drain out of the arm. And there are a Number of other procedures like lymph node transplant, basically replacing the lymph nodes that were removed at the time of surgery, kind of like planting seeds that grow new lymphatic vessels and a variety of other other techniques.

[Podcast Host/Interviewer]

So for anyone out there listening to this who may be suffering from some lymphedema, obviously the bypass is the most aggressive. Putting anybody through surgery comes with its own risk. But what are some non invasive things that they can be doing to try and help with some of the discomfort that they have?

[Dr. Dayan]

Well, lymphopenous bypass, actually minimally invasive. It doesn't generally hurt because these things are so tiny. Lymph node transplant is a bigger surgery, but there are non surgical things that can be done. And this is a new and exciting part of frontiers of lymphedema treatment. So one is the role of GLP1 receptor agonists, drugs like Ozempic and Mounjaro, commonly used to treat weight loss, diabetes and now sleep apnea. We've seen so many secondary benefits like reduction in heart attack, stroke, dementia. But on the lymphedema front, we were first to publish the use of these drugs in treating lymphedema and also looked at patients who underwent removal of their lymph nodes, comparing those who were taking a GLP1 versus those not on a GLP1 and found that the group taking GLP1s were at much lower risk of developing lymphedema.

[Podcast Host/Interviewer]

Do you think that is because you're lowering their bmi? As you said, someone who has excess weight, they're at an increased risk? Or do you actually think that there's something maybe hormonally happening from the GLP1 in addition to removing the excess weight, that's also contributing to decreasing the risk of lymphedema?

[Dr. Dayan]

That's a great question, and I think it's both. There is PhD Dr. Jorge Castorena out at Tulane had recently presented. They've identified a GLP1 receptor on the lymphatic vessel itself. So we think that the actual drug is directly affecting the lymphatic system. There are Also pathways where GLP1 receptor Agnes can reduce inflammation, and that's a big cause of lymphedema as well as reducing the weight, which is associated with increased lymphedema and worsening function. So I think there are direct and indirect effects.

[Podcast Host/Interviewer]

You're listening to Wellness en Masse. We'll be right back with more.

[Dr. Nicole Safire]

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[Dr. Dayan]

Ah, come on. Why is this taking so long? This thing is ancient.

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[Podcast Host/Interviewer]

So if you're publishing on this and we have so many women out there suffering with lymphedema, I mean, do you see in the foreseeable future that GLP1s could be prescribed for women with lymphedema?

[Dr. Dayan]

I do believe so. We've launched the first of its kind prospective study, so a high level study to determine if GLP1s do in fact reduce lymphedema. Because we've had so much anecdotal evidence. So we've been treating patients off label with GLP1s who weren't interested in surgery or who were having surgery but weren't exactly optimized. And we want them to get the best result. And so their numbers have been down their limb size. Most of them, not all, but most of them have seen a benefit. Their lymphedema therapists tell us, the patients themselves tell us. And of course we measure this. But we really have to see what the high level study shows long term. But I'm very optimistic looking at our preliminary data.

[Podcast Host/Interviewer]

Well, we certainly need high level studies to get insurance companies to cover certain things, as we all know, and then it still even takes a long time. The thing for me with GLP1s is I feel like they're being overused when maybe unnecessary and underused when there could be potential benefit. And people automatically get turned off when the conversation of GLP1s happen because they're like, oh, I'm not going to take Ozempic, I'm not going to take these. And while I too criticize them, I do think maybe people are reaching for these medications for weight loss well before they probably should. And when we're being introduced to another medication that's essentially a lifelong prescription for something because the minute you stop taking it Your weight comes back and then some for a lot of people. But unfortunately it's getting a bad rap because I too, if you read the data, there are some well documented benefits when it comes to GLP1s and I'm not just talking about wearing a smaller waist size. I'm talking about the decreased strokes, cardiovascular, potentially dementia, and the fact that they could potentially help patients with lymphedema to me is just incredible. And I would much rather see the money going for these people for their GLP1s, even with just anecdotal evidence. So I'm glad to hear it's being used off label. But it's very expensive and not everyone can afford these medications.

[Dr. Dayan]

I agree and I'm with you. I think when it comes to any of these discussions, trends, politics and culture all come into this, when we should really look at the data and the science. If the data shows for a patient with lymphedema, that that is diagnosed with a permanent incurable condition, that there is a potential benefit to reverse what they have. And they're doing. They're spending hours a day treating this. That's a, that's a wonderful thing. And I also think most people aren't aware that for hormone receptor breast cancer, which is most breast cancers not triple negative or hormone receptor, these patients are put on hormone suppress suppression which changes their metabolism and about 40% of them will gain significant weight.

[Podcast Host/Interviewer]

So they're doing essentially putting someone into menopause overnight. So perimenopausal, menopausal women like myself, if you realize how it's harder to lose weight as you get to a certain age. Well, as he's saying, these medications just kind of thrust you into this menopause overnight and then some.

[Dr. Dayan]

Exactly. And you have many young women. Many of our patients are in their 30s, they're very active, they're doing and eating the same way they have been, but all of a sudden they've put on 25 or 30 pounds despite being active, despite diet and exercise. So it can be very, very difficult. Your body metabolism just changes. So I think everybody is different. It has to be looked at case to case. We don't directly go to GLP1 for everything. We want to do everything all natural. But the reality is many patients are exhausting everything. We see patients that spend hours a day and they're getting nowhere with their limb and the GLP1 helps them. I personally am on GLP1 for diabetes. So this is not a drug. This is a drug. I have personal experience with all Drugs have potential side effects and adverse effects. And you should speak to your doctor when getting on anything new, as well as your oncologic team.

[Podcast Host/Interviewer]

I diagnosed one of my best friends with breast cancer a couple of years ago, and she's had bilateral mastectomy ever since. But she is dealing with the same thing. It's hormone positive. Losing weight is just a major struggle for her, and she works out more than anyone I know. She eats incredibly. I have encouraged the GLP1s for her, and she's just not quite there yet, which I applaud her for not wanting to take the easy way out, but it's not necessarily the easy way out. When your body is working, working against you. The medications that you're taking to try and decrease your risk of your cancer to come back, it's really working against you trying to have a healthy weight. So there are benefits to GLP1s. So for women out there who maybe, who are having some, maybe just mild lymphedema, I want to go back to that for a second because I just think lymphedema is not talked about enough. They're having mild lymphedema. Maybe they're not quite ready for medication, for surgery. What are just some things that women can be doing at home to try and decrease their lymphedema from progressing, if anything?

[Dr. Dayan]

Right. Well, I'm glad you brought up mild lymphedema. As a general note, lymphedema, like any disease process, starts before you see the swelling. Just like breast cancer before mammography, the only way you diagnosed it is either by seeing an ulcerative mass or feeling a large lump in the breast or the axilla. Lymphedema started long before you actually see the swelling. And this is kind of lost on a lot of medicine that really doesn't move to do anything until you see the big swollen and arm. But the things that you can do are actually lymphatic massage helps. So when any patient comes to our office, we'll image their lymphatic system. So we actually inject a tiny amount of dye and the patient can see their lymphatic system. That's important because you can see if you have lymphatics that are only partly blocked or if the whole arm is blocked. If everything's blocked, you can squeeze that arm, but it's like squeezing a toothpaste with the cap still on. And you really. Then the role of surgery is to provide an exit. So that therapy actually does move something out of Your arm in patients who have a partial obstruction, actually massage from the fingers all the way up to the axilla, to the armpit and to the neck. There's a special type of lymphatic massage called manual lymphatic drainage that a lymphedema therapist does is definitely beneficial. We see this on the imaging of the actual lymph moving. It's a beautiful, very beautiful organ system that exercise muscle. When muscles contract, they're actually squeezing your lymphatics and that facilitates the movement of fluid out of the actual limb. There's also breathing exercises. Your diaphragm is a big negative pressure pump. So your lymphatic system includes your entire body, your organs from your legs, your arms, your head and neck. But there are breathing exercises that can facilitate lymphatic transport in the larger vessels up the main lymphatic duct into your bloodstream. And of course, in patients where weight is elevated, weight reduction will improve and reduce inflammation and improve lymphatic flow.

[Podcast Host/Interviewer]

I actually love that you show patients with the lymphatic dye because when people can visualize what's actually happening and they have a better understanding, I truly think that their outcomes are better because of that. Because if they have an understanding of it, then they understand why to do the massage, why they might potentially need that bypass surgery as you're mentioning. I think that's great. And it takes away that whole paternalistic aspect of medicine which we're so notorious for, of just saying this is what's wrong, this is what needs to be done. And you're taking it so that they're a part of that conversation by understanding it and they can take that active role in their healthcare.

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[Dr. Dayan]

Well, the imaging has been a huge transformation in lymphatic reconstruction. So in surgery you need to see it. If you can see it, you can operate it on it, you can understand it and the treatment can match the actual problem that you're looking at. If you're just looking at the size of the limb and you're not looking under the skin, you really don't know what you're dealing with. So imaging has transformed things. The other thing that patients can do, because going to a lymphedema therapist is not always available, it's not always available. As a surgeon, it would be very difficult for me every day or every other day to go, but to have pneumatic. There are pneumatic compression devices where it's sort of an at home system where you slide your arm and your chest into while you're watching or just sitting around. And this thing actually does the massage for you and pumps things. So that's another option many patients aren't aware of.

[Podcast Host/Interviewer]

So, Dr. Diane, thank you so much for being here today. I think I've actually learned a lot, and I thought I knew a lot of lymphedema, but I have an even better understanding now. And I didn't even know bypass was an option. And now that's making me feel very ignorant in kind of my own field. But I think it's just very hopeful for people who are suffering from this because I do see them every single day coming in, wearing their lymphatic sleeves, talking about the massage, but still just an excruciating pain.

[Dr. Dayan]

I think also that lymphatic surgery is something we do every week. There are minimally invasive options usually available to most people. If you have a big problem, it's probably going to involve more. But I think it's something that at least patients should be aware of that exists, just like patients undergoing mastectomy should be aware that breast reconstruction is an option. And it's really a pleasure to see you as a colleague. Memorial Sloan Kettering is near and dear to my heart. I spent a decade there, and I really bless you for all the great work you do, and it's great to have excellent colleagues. Thank you so much.

[Dr. Nicole Safire]

Well, as we have heard, the story of breast cancer is not only about diagnosis and treatment. It's also about the long journey. Many survivors are walking afterwards.

[Podcast Host/Interviewer]

And as I mentioned, with more than.

[Dr. Nicole Safire]

4 million people living with a history of breast cancer in the United States, a large percent of them are suffering from lymphedema, meaning hundreds of thousands of people are coping with this often invisible, chronic complication. There is hope, as we have heard. Through awareness, early detection, preventative strategies, and comprehensive care, many of these cases can be managed, and some may be preventable altogether. As we just heard, Dr. Dayon's insight helps help cast light on how clinicians and surgeons and patients alike can better unmask and maybe address lymphedema before it becomes debilitating. So if you or someone you love is navigating life post breast cancer care, continue this conversation with them because there are clearly things that can be done about lymphatic health. Ask about monitoring. As we heard, you want to make sure you are getting in front of it instead of behind it because it's easier to treat it earlier on than when it's gotten out of control. Thank you so much for listening. I'm Dr. Nicole Safire. This is Wellness Unmasks. Make sure you listen to all of Our episodes on iHeartradio wherever you get your podcast and we'll see you next time.

[Kal Penn]

Hey audiobook lovers, I'm Cal Penn.

[Ed Helms]

I'm Ed Helms.

[Kal Penn]

Ed and I are inviting you to join the best sounding book club you've ever heard with our new podcast, Irsay The Audible and iHeart Audiobook Club.

[Ed Helms]

Each week we sit down with with your favorite iHeart podcast hosts and some very special guests. To discuss the latest and greatest audiobooks.

[Kal Penn]

From audible, listen to Earsay on America's number one podcast network, iHeart. Follow Earsay and start listening on the free iHeartradio app today.

[Dr. Dayan]

Ah, come on. Why is this taking so long? This thing is ancient.

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