Judith Casley-Smith, Ph.D.
[We found the following information invaluable for patients planning to travel, especially by air. Though Dr. Casley-Smith speaks primarily to the Australian population, these guidelines are applicable to all of us around the world. You can find the entire text of this article online at the Lymphoedema Association of Australia's website, www.lymphoedema.org.au. Our thanks to Dr. Casley-Smith for sharing this information with our readership. Ed.]
A FEW TIPS BEFORE EMBARKING ON YOUR TRIP
- Check with your doctor and be sure that you have enough prescription drugs (if you need them) to see you through your trip. Get them filled by your pharmacist before you leave; however, carry the scripts with you, as well, in case of mishap, or if traveling out of country, for checking by foreign Customs Officers (which may happen).
Ask for a prescription for antibiotics as a precaution, in case you get an infection in your lymphedema limb, and carry them with you. (Penicillin is the #1 choice, unless you are allergic to this). If you are traveling to a tropical country in the wet season, where filariasis is endemic, I recommend taking D.E.C. with you, one dose/week. If you feel flu-like symptoms after taking it that last for 24 hours, then take another dose the following week, etc.
- Purchase a top quality sunburn cream SPF 20-30+. Remember you can get sunburned through a compression garment, especially because of the synthetic fabrics. Take moisturizing lotion and a body wash that is mineral-oil based (not soap).
- Travel Insurance (that covers health as well as luggage) is worthwhile, providing you read the small print. You may have to state that you have a pre-existing condition to claim payment if you need treatment. (This may need to be signed by your Doctor.)
- Buy some insect repellent [ideally, Deet-free. Ed.], and take something to treat stings if you do get them.
- Pack some antifungal powder and use it, especially between the toes! This may only be a prophylactic measure (to prevent infection), but hotel bathrooms, pool areas and warm moist climates in particular, can lead to the onset of tinnea (Athletes foot). This can be easily transferred to the groin or under the breast fold areas, especially when lymphedema is present. Apart from inflammation, it also causes breakdown of the skin so that bacterial entry is facilitated, which may lead to bacterial infections. This powder may also need to be "puffed" into your shoes, especially if you are wearing sneakers or boots
- If vaccinations are required for your trip, do not have them in the affected limb! You may have a reaction to these, so if possible, have them at intervals, if you need more than one.
- Cases. For flight, take a small and as light a case (or two smaller ones if need be) as possible, unless you are traveling with someone who can carry it for you. A case with wheels is advisable (but you can only manage one)! If you are by yourself, get a porter to help you if one is available. I know this can be expensive in some airports, but if it means you have a safe and happy trip, it may be worth it! Don't remove a case from a luggage carousel with a lymphoedematous arm. If you have a lymphoedematous leg/s, be careful not to bump them when you remove luggage from the carousel or when you try to load cases onto a trolley. Try not to let someone run into you from behind and cause damage! I know this is often difficult in big airports, but it is better to stand back and let impatient people get their luggage first than to risk damage!
- Hand luggage. Realize that you really do not need much, even when on long flights, e.g. a sweater, a book, (for women: minimal makeup) and a change of shirt or blouse in case something gets spilled on you during travel! Don't carry your hand luggage with an affected arm! Include your travel documents in this rather than carry an additional separate bag. Carry your medication/s with you, or at least enough to last you for a few days.
- If you are traveling by automobile, please get someone to help you move cartons (of food etc.), or anything that is heavy. Onset of lymphoedema has often been triggered by this situation. Get help also loading and unloading per-bought supplies from the supermarket etc.
- Clothing. Clothing for traveling should be light, loose and non-constricting, especially around the waist (for women: under the breasts). Be careful of tight belts and jewelery. Clothing should preferably be layered so that you can remove a jacket if you are going from a cold to a hot climate or vice versa. Wear comfortable shoes. If you have lymphoedema of the leg/s, it would be better not to remove your shoes while traveling. Don't travel in short skirts or shorts if you have lymphoedema of the leg/s - infection can be easily picked up from the aircraft seats.
- Compression garments. Check that these are in good condition before you leave. If you have an old one, take it as a back-up garment in case something happens to your good one/s! If you have been wearing a sleeve that stops at the wrist or stocking that leaves the toes exposed, then a glove on the hand is necessary during flight and it would be a good idea to bandage the toes and any exposed foot area before donning the stocking.
- Special Compression. If you are traveling in some countries (such as China), realize that the pressurization in various aircraft is not necessarily of the same "International Aircraft Company" standard. As an extra precaution, you might consider taking a blow up "splint" which one patient used most successfully in place of a garment under these circumstances. She said the splint got "very tight" during flights, but she returned without any onset of lymphoedema. The alternative is to wear two garments - one over the other- or to bandage in addition to wearing a garment, if you can, to provide extra pressure. If you are bandaging, remember, with leg lymphoedema, to pad at the back of the knee for comfort and to stop chafing and also around the ankle, and at least in the elbow fold with arm lymphoedema.
BOOKING YOUR TRAVEL
- If traveling by air, some airlines may still allow you to request an emergency exit (or a bulk head) seat. This means that your "light" travel bag can be used as a foot rest in front of a much larger space! Economy classes put seats so close together these days that someone with long legs often cannot sit with their feet properly on the ground or on a foot rest. This is dangerous not just for patients with lymphoedema, but also can cause D.V.T. (deep vein thrombosis) when this position has to be maintained for many hours. Consider an upgrade to Business Class, even if it means a nice vacation every 2 or 3 years rather than one each year!
- If the flight is a long one, try and arrange a "stop-over" for 1-2 days on the way. Some airlines include this as part of their package.
- If a long bus trip is being booked, choose one with as many stops as possible and get out and move around when these occur! If you have a long car trip, then you can stop frequently and have a 5 minute exercise break. Remember to protect your limb from the sun with a white cloth or shirt, etc., if you are sitting on the sunny side of the vehicle. If, on a bus, work out which side the sun is going to shine on the bus and request a seat on the opposite side.
- If going to a Ski resort or mountains, realize that the lowered atmospheric pressure as you ascend can either trigger or worsen lymphoedema. Take the same precautions as you would during flights, (or watch the limb carefully) and apply pressure as needed.
- Keep your seat belt loosely fastened so that you have room to move as much as possible, except during take-off and landing or during real turbulence, when it should be properly tightened.
- Get up and move around as long as the "fasten-seat-belt" sign is not lit.
- Exercises and self-massage can be done while seated. Shoulders can be rolled and breathing exercises performed. Appropriate nodal clearance e.g. under arm and/or in the groin as is appropriate for your situation, and then trunk clearance towards these nodes, with light stroking towards them, can be done, especially under a blanket which is supplied during flights. Feet can be flexed and pointed and ankles rotated, as can be fingers and wrists.
If you have lymphoedema of the arm you could take a ball to squeeze, or clench your fist and twist your arm outwards and inwards much like you would "wring" a wet towel, with your arm above your head if possible. If you stop on a longer flight and are allowed to enter the terminal, get out and walk around.
- The same applies to long bus trips as to long aircraft flights.
WHEN YOU ARRIVE
- Do not remove your garment for a few hours or until you reach your hotel, etc.
- Then have a cool shower and a rest with the affected limb elevated. Use a "Body Wash" (mineral oil-based cleanser) and then a good moisturizer on the affected limb particularly.
- Some more exercise would be good at this point!
- Wash all your travelling clothes (or dry clean) before wearing again.
- Then start to really enjoy your vacation!
DURING YOUR VACATION
Many of the above points still apply:
- Avoid sunburn
- Avoid insect bites (especially spider bites)
- Don't overdo sports that you are not used to. Be wary of the more strenuous excursions that may cause trauma (or bumps and stress) to limbs
- Beware of fungal infection (tinnea)
- Wear buckle-up plastic sandals if you have lymphoedema of leg/s, if on the beach or paddling. If on a coral beach or snorkelling near coral, be extra careful. Coral infection can cause lymphoedema in people with normal limbs
- Use a good skin moisturizer
- If it is hot, realize that you can cool your limb with your compression garment on just by wetting it! Put your limb under a tap or shower. Evaporation will then cause cooling
- Be careful shaving, pushing back cuticles etc.- the general "Do's and Don'ts" (see Risk Reduction)
These are just general precautions when traveling, and although particularly applicable to a person with lymphoedema, basically apply to every member of your family as well! A lot of it is good common sense. Holidays are a time for enjoyment, but also give you extra space to pamper yourself. Relax and do it. Try and do all the things that you want to do. Take what simple precautions that you can - and have a wonderful and safe trip.
Articles posted by permission from authors.
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