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QUESTION: I had a lumpectomy and axillary node surgery. Fourteen nodes were removed and were found to be non-cancerous-thank God! I am going to be scheduled soon for radiation. The thing I am worried about is lymphedema. The problem is my job. I am a postal worker-rural route delivery. My job involves casing mail, pulling it down out of the case, loading heavy trays of mail and packages weighing up to 40 pounds. After that, I get in my car and stick my arm out of the car into sub-zero temps in winter 500 times to deliver to 500 mail boxes-all with my right arm, which is the side I had my surgery on. Will I be able to continue doing my job? Everything I read on the subject tells me that my job is totally wrong for avoiding lymphedema. I need my job. I don't know if I will be able to get into a different postal job if I have to quit being a rural carrier. Is it worth the risk to continue putting such a stress on my arm? I don't have to make any decisions now, but after radiation, I will be expected to return to work. Any advice?

ANSWER: First, it's great that you feel the energy and drive to go back to your demanding job, because right away, it shows that you are recovering nicely and your determination is coming back-that is, what makes YOU, YOU, right?

Let me give you a little background on arm lymphedema. Your risk of arm swelling after a level I and II dissection (there are three levels; I and II are the bottom two) is about 5-10%. The risk does not go up significantly with breast-only radiation. (If you were to need lymph node radiation—which you don't—then your risk would most likely increase a little, however.) I agree that your job is probably too strenuous on your right arm, putting you at some increased risk for right arm swelling as well as for some aches and pains along the arm. Those tissues take a long time to heal after the surgery—but even after things have simmered down and become stable, you are still at some risk for these problems.

Clearly there is a lot of mail to deliver and it's up to the person in your position to do it. So how can your job be modified so you can keep your job and keep your arm safe from trauma (and distribute the mail)? Is there a way for you to use your LEFT arm instead of your right? What would happen if you were left-handed instead of right? What would happen if you had a broken arm? Can your mail-car be adapted so you can drive in a different way in order to use your left arm? Is there another job in the post office that would be more reasonable for you? Do you need support from your community to make the necessary changes happen? If so, can you write to your newspaper's feature section to help you find an innovative solution between you, others in the community, and the post office? Maybe they could write a story in progress, letting people know how to help along the way. It's safe to go on the assumption that everyone will want to help you-at least act like they do. Thank them for caring, and make sure you take it one step at a time, keep moving in the right direction, and show them how important their ongoing support is. Try to enlist your boss along the way to help work it out. Your doctor can be an important advocate for you by making a few calls or writing a letter of support. Good luck with your situation. Let us know what happens.

—Marisa Weiss, M.D.