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Q: I have just finished 4 weeks of LE therapy and my therapist has told me I will need to do things at home for my lymphedema. Is this a usual practice? Why do I need to do things at home? I don't have time to spend on this everyday. This is frustrating. I thought I was finished with treatment.
A: I can understand your sense of A: frustration; however, your therapist's suggestion is very important and is the key to maintaining and further improving your swelling. Because we cannot repair the underlying lymphatic deficiency, which has resulted in your development of lymphedema, self-management over time is very important. Your body is continually producing lymph fluid as a normal process. Consequently, ongoing self-maintenance is necessary to minimize the accumulation of excessive lymph fluid in a particular body part, and to assist with lymph flow and lymph drainage to alternative lymph node basins. Each individual's self-management program should be tailored to his/her needs. Typically, self-management programs include the components of CDT: skin care, self-MLD, use of compression (compression garments and bandaging) and lymphedema exercise. While this may seem overwhelming at first, I am sure your LE therapist will work with you to develop a plan which you can incorporate into your daily routine. Staying with a home management program will help to maintain and possibly further improve your LE reduction over time.
Q: I had LE treatment six years ago for my legs. I wear compression stockings everyday and bandage every other nighttime to sleep. Recently, my legs have begun to get bigger. Can you tell me why this is happening?
A: Before I am able to give you advice about this, I would ask that you see your physician to make sure there is not a medical reason apart from your underlying lymphedema which is causing the increase in your leg swelling. Once you have seen your doctor, if there is no new medical cause for this occurrence, I would suggest that you make an appointment with your lymphedema therapist for follow up. Your home management routine may need to be modified or you may need a new set of bandages and garments. Usually, bandages and garments need to be replaced every 6 months. Both the bandages and the garments tend to stretch out over time and lose their effectiveness. If your legs have increased in size, you should be remeasured for your garments or you may need a repeat course of lymphedema therapy to reduce your swelling before being re-measured. Poorly fitting compression garments (either too small or too big) will not effectively control the LE.
Q: My therapist has asked me to make follow up appointments even though I am on a self-management program. I am doing okay on my own; do I need to go for additional visits?
A: You did not mention if you had just completed LE therapy. If so, it is quite reasonable for your therapist to ask you to come back for follow-up visits. Successful home management is the key to long-term LE control. Your therapist will want to see you after completion of the intensive program (Phase I) to monitor how your swelling is reacting to the reduction in therapy visits, and to possibly modify your home management program for maximum results. Quite often, slight alterations to the home management program are needed and additional education may also be needed to assist you in knowing how to adjust your home routine based upon the response of your swelling.
If it has been several months since your last therapy visit, your therapist may ask you to come in for a re-visit. Typically, this is scheduled when it is time for you to receive new compression garments. At times, adjustments to the garment (style and/or size) may be needed to maintain your lymphedema control adequately.
Q: I try to do my own self-MLD every day, but sometimes I fall asleep. Is it a problem if I miss a day?
A: Many lymphedema clinicians believe that daily self-MLD is optimal to enhance lymphatic return. However, if you miss a day here and there, please don't become overly concerned. Try to do the best that you can. Pick a portion of the day without interruptions when you can devote the time necessary and not be so tired that you fall asleep. If you have limited availability on a given day, focus on the key points for your condition, typically the proximal (trunk) components are important for the lymph fluid to drain centrally back to your heart and circulatory system. If you need assistance with modifying your self-MLD, your lymphedema therapist should be able to assist you with these changes.
Please address questions to: Editor c/o NLN, Latham Square, 1611 Telegraph Avenue, Suite 1111, Oakland, CA 94612-2138 or e-mail: nln@lymphnet.org. Deadlines for submissions (for the following issue) are: Feb 15, May 15, Aug 15, Nov 15.
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