LymphLink July-September 2001, Volume 13, No. 3
DeCourcy Squire, PT, CLT, CDP, CS-CT
Summertime...and the livin' is easy...maybe.
If you have lymphedema, maybe not. The hot weather, increased number of biting and stinging insects, and many other factors can go into making summer a time of increased risk. Summer fashions make it harder to conceal a swollen limb. You may find yourself sitting out on the sidelines of many of your previous favorite vacation activities. For many people with lymphedema, summer has become a time to dread instead of a time to look forward to. This article is meant to help you take some sensible precautions so that your lymphedema stays under control while you enjoy the summer.
Beat the Heat
Many people with lymphedema find that their affected limb(s) swell more in the summer because of the heat. It's important to stay cool. If possible, be sure that you are in well air-conditioned places while indoors. Try to limit the time you spend outside during the hotter parts of the day, between 11 a.m. and 3 p.m.
If you do get hot, you need to try to cool your whole body as soon as possible. Cool or lukewarm showers or baths work better than very cold water. If you're hot, but it's not possible at that moment to get into a shower or tub, at least cool off your affected limb by wrapping a cold wet towel around it and elevating it with support. To avoid getting your compression garment wet, place a plastic garbage bag between your garment and the towel, encasing either your limb or the towel. Some people prefer to cool off by dampening the garment itself. If you do this, be sure that the garment dries in a reasonable amount of time and that there is no chafing of the skin, especially at the joint creases.
Drink lots of water, even more than you do in the winter, to help keep yourself well hydrated. This makes it easier for your body to regulate its temperature. Even if salty foods don't normally affect your swelling, they may be more likely to in the summer. For crunchy snacks, go for fresh raw vegetables instead of potato chips.
Wear light, loose, non-constricting clothing. Not only will it be cooler; it is also better for the free flow of your lymphatic system. Because of the tendency of lymphedematous limbs to swell more in the summer; clothes and underwear that fit well in the winter may be too tight for summer wear. Check each day to be sure that the edges of your clothing do not leave indentations in your skin. Do not wear the item if it leaves indentations - it can constrict some of your delicate superficial lymphatic system. Moreover, looser, non-constricting clothing will allow more air circulation so that perspiration and moisture won't be trapped next to your body.
Be sure that your compression garment is well fitted. If your health insurance covers two compression garments per year, get measured for one of them after the hot weather starts and for the other after it has ended. That way, your garments will accommodate normal seasonal changes in edema that can occur.
In the summer, be especially conscientious about washing your compression garment because sweat, body oils and various lotions such as sunscreen can cause the fabric to deteriorate more quickly. Follow the manufacturer's instructions and cautions very carefully about whether lotion can be applied before putting on the garment. Special care must be taken with garments that contain natural rubber.
Being outdoors in the summer can pose more problems than just overheating. Sunburn, prickly heat rashes, and insect bites and stings are also potential problems.
An insect repellent is a good idea but some of the more effective ones contain DEET, which you may not want to have on your skin. Health food stores will have natural repellents, usually with citronella as the active ingredient, and these can be less detrimental to your skin. However, you should avoid putting insect repellent on your skin and then wearing a compression garment over it. That may cause skin reactions and can also damage the fabric of your garment.
No matter which repellent you use, some insect bites probably are inevitable. Be prepared to treat them immediately to lessen the histamine effect, which can cause increased swelling in that area. Benadryl or hydrocortisone creams are two treatment options for insect bites. An ointment with aluminum sulfate as the active ingredient can also help decrease the effects of bites and stings. And a tip from my friend Connie: treat bee stings by applying a paste of meat tenderizer and water to the site of the sting. Treat an insect bite like any break in the skin on your limb at risk. Wash and dry the area completely and apply antibiotic cream to the area.
If you are going camping or hiking, be sure to take along a specialized first aid kit. The kit should include alcohol wipes to clean off any skin break, antibiotic cream for application on the skin, and bandages to protect the area. If your doctor agrees, you may also include antibiotics in your kit so that you can then start on a course of antibiotics without delay if your limb should become infected (hot, red, swollen, and/or painful) while you are away from home.
Wear clothing that will protect you from accidental scratches, poison ivy, etc. If you have leg lymphedema, be especially careful to wear shoes that fit well and will not blister your feet. If you have arm lymphedema, be careful not to carry heavy backpacks or other heavy loads.
Avoid excessive exposure to the sun, not only because of the possibility of overheating, but because sunburn will place an extra burden on your lymphatic system and can damage your superficial lymphatics. Skin that has been radiated may remain sensitive to the sun long after radiation treatment has ended. Also bear in mind that you can sometimes get a sunburn even when wearing a compression garment. If your limb is going to be exposed to the sun (for example when you are swimming and do not have your compression garment on) be sure to use a sunscreen with a high SPF (sun protection factor) of 20-30+. And if you are going in water, wear the waterproof kind.
In the Swim
Swimming is a great summer recreation and recommended for people with lymphedema (scuba diving is even better), but there are some risks involved. While the chlorine in the pool is helpful to keep it disinfected, it may be very drying to your skin. Apply a moisture barrier cream before getting in the water (and a sunscreen that is waterproof) and a good moisturizing lotion after you finish swimming.
To avoid a fungal infection if you have leg lymphedema, wear something on your feet at all times when you are not in the pool - especially in the shower area. If swimming in natural bodies of water, wear something on your feet even in the water to avoid cutting your feet on stones or shells. Due to the high risk of infection, it is best if you do not go into the water if you have skin breaks on your affected limb.
Although you don't necessarily need to wear a compression garment while swimming, you will need to apply some compression as soon as you are out of the water. Some people wear an older compression garment into the water and let it dry on them when they get out. If you don't want to do this or if you don't have a second compression garment you can use, you may need to have your bandages or your compression garment ready and waiting at the side of the pool or on the beach. If you use an alternative to night bandages such as a CircAid, Reid Sleeve, or MedAssist, all of which are fast and easy to don, you may wish to use the alternative compression device when you first get out of the water. Then you can don your compression garment when you are somewhere more convenient.
After swimming, take a shower or bath with fresh water to wash off. As with any time that you bathe, be sure to dry completely, especially between the toes, under the breasts, and in any skin folds. Using an unscented bath powder or an anti-fungal powder can help prevent fungal infections, which thrive in a moist environment. Powdering the inside of your shoes with anti-fungal powder can be helpful in the summer when your feet may tend to perspire more.
Traveling with Lymphedema
One of the great things about summer is going on vacation. But you don't want to arrive at your destination and find that your edematous limb is more swollen and uncomfortable. Car, train, and bus travel is generally worse for people with leg lymphedema, while airline travel can affect people with either arm or leg lymphedema.
If going by car, use air-conditioning to be sure you do not overheat. When not driving, sit in the back seat so that your limb can be elevated. With leg lymphedema, stop and take frequent rest breaks so you can walk around. With arm lymphedema, do not do the driving for long periods of time and be sure to take breaks to rest your arm. If traveling by train, walk in the aisle as much as possible. If traveling by bus, be sure to get off at each rest stop to walk around. Do ankle pumps and other exercises in your seat. If traveling by plane you will need to take more extensive precautions because the lower air pressure in the cabin can trigger or exacerbate lymphedema much more seriously than the inactivity-aggravated lymphedema of car, train, or bus travel. Be sure to have your compression bandage or garment on, including a glove for the hand and fingers, if you have arm lymphedema. Also, if you have arm lymphedema, take only the lightest carry on luggage and use wheeled suitcases (or rent a luggage trolley) for your checked luggage. If you have leg lymphedema, get an aisle seat, preferably with lots of leg room (business class, bulkhead, exit row) and walk around whenever you have a chance. Drink lots of water during the flight. To make sure you have enough, it's best probably to bring your own water. At baggage claim, stand back (or take a short walk or find somewhere to sit and elevate your leg) until the crowd around the carousel has cleared and it is safer to get your luggage without being bumped into.
(For more detailed information regarding travel precautions, please see "Tips for Travel," an excellent article by Judith Casley-Smith, Ph.D. that appeared in the April-June 2000 LymphLink issue.)
As always, you need to be careful about contact and/or extremely strenuous sports. Vigorous activity combined with the heat of the summer sun can increase the risk of overheating. If you are out in the sun, the heat is going to add to the potential for lymphatic overload, so be prepared to discover that activities that didn't bother you when the weather was cooler are now aggravating your lymphedema. This does not mean that you can't do the things you find fun, but it does mean that they will be much more fun if you do them safely, so as not to worsen your lymphedema.
Pace yourself, play for shorter periods of time, take breaks at regular intervals, and make sure you do not wear any constricting clothing. If your affected limb starts feeling tight, achy, bursting, fatigued, or heavy, then stop the activity at once. Those symptoms indicate that your lymphatic system is overloaded. Loosen anything that has become constricting, cool your limb off, and rest with the limb supported in an elevated position until the symptoms subside.
Activities that involve repeated movements against resistance (such as tennis or weight-lifting) or the danger of hard contact of a ball with your limb (soccer or volleyball) put your limb at more risk-but there are definitely people with lymphedema out there enjoying them.
This is really the take-home message: the precautions recommended when you have lymphedema or are at risk for it are not meant to keep you from living your life by hemming you in with all the "don'ts." Instead, these precautions are intended to give you a better chance at keeping your lymphedema under control so that you are free to get on with your life.
DeCourcy Squire is a physical therapist trained in the Casley-Smith and Földi methods of lymphedema treatment. She is a certified instructor in the Casley-Smith method and does consulting for the NLN. She can be contacted at lymphedematx [at] cs.com (firstname.lastname@example.org)
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