Jul-Sept 2012: Self Care


Lymphlink Question Corner - Archive - July-Sept 2012

By: Bonnie B. Lasinski, MA, PT, CI-CS, CLT-LANA, Lymphedema Therapy and the Boris-Lasinski School, Woodbury, NY

Q: I completed a course of Complete Decongestive Therapy (CDT) for the lymphedema in my right arm and hand two months ago. My therapist recommended that I wear my compression glove and sleeve every day and that I bandage my affected arm and hand every night. I have not seen any more improvement in my lymphedema since I have been doing this and I am getting frustrated. Why should I continue to wear the compression garments/bandages if my lymphedema is not getting better?

A: You bring up a very good question about the use of compression garments/bandages following an intensive course of CDT. The purpose of the garments/bandages is to maintain the improvement in your lymphedema you obtained with treatment, including reduction in swelling, improvement in the condition of your skin of the affected arm/hand, reduction/resolution of pain in the affected area/s, reduced risk for infection in the affected area/s. Although some individuals do continue to have improvement in their lymphedema symptoms following the end of their intensive treatment course, the goal is to maintain whatever improvements you did gain and to prevent worsening of the condition. Some individuals don’t achieve much reduction in swelling/pain and other symptoms with CDT treatment but they do arrest the process of progression of the lymphedema and that is very important. Your disappointment is understandable. You are putting in great effort wearing your compression sleeve and glove and bandaging at night and expect to see improvement – that is natural. But keep in mind that lymphedema is a chronic condition and it is just as important to prevent progression of the condition as it is to gain improvement - so keep up the good work!

Q: I developed lymphedema (LE) in my right leg after radiation treatment following a hysterectomy for cervical cancer 2 years ago. Six months ago, I had excellent treatment for my lymphedema with good results. My therapist gave me a detailed self-care program of self-manual lymph drainage (MLD), skin care, exercises, and told me to wear a compression stocking during the day and showed me how to bandage my LE leg for night. I feel blessed that I had such a good therapist who taught me so much. I am a single mom and I work full time and have 2 children, ages 8 and 12. By the time we finish dinner and homework, baths, and the children get to bed, I am exhausted. I feel guilty because I don’t do my exercises every day and often go to bed without bandaging my leg. My leg doesn’t seem more swollen when I wake up but, lately, my compression stocking seems to get tighter at the end of the day and digs in at the ankle. I know I should probably be doing all that she taught me but I just can’t fit it all in. Help!

A: Have you discussed this with your lymphedema therapist?

There may be several reasons that your compression stocking feels tighter at the end of the day: Your leg may be swelling at night (you may not notice it visually) and then add to that the normal swelling that can happen throughout the day even with a compression stocking on the leg, and the stocking gets too tight for you at the end of the day; or, your stocking may be stretching out and not providing enough compression to contain your lymphedema allowing it to swell more by the end of the day – it may need to be replaced; or, your leg is swelling more because you are not able to exercise regularly - she/he may be able to give you an abbreviated exercise program that may be more manageable for you. There are alternatives to night compression bandaging that you can discuss with your therapist. Although these devices can be expensive, many insurance companies do cover them. These are not for everyone and you may be able to manage your swelling at night by sleeping with your affected leg elevated on a wedge pillow or elevating the foot of your mattress/bed. Each person is different and the best person to advise you is your lymphedema provider who knows your situation best. Lastly, once all the above is checked out, if the swelling still persists, please check with your oncologist to be sure that there is no recurrence of your cancer that can also cause an increase in swelling.

Q: How long do I need to wear my compression sleeve? My breast surgeon prescribed one when my arm started to swell after surgery. It has been 3 months now and I don’t see any evidence of swelling. I would like to see what happens if I don’t wear the sleeve. I get conflicting information from different people and my doctor tells me that there are no studies that looked at what happens over time if people stop wearing their compression garments.

A: Objective measurements taken at the same time of day by the same person with your arms and hands in the same position are the best way to monitor your arm and hand size. You can use a tape measure. It is always good to compare the uninvolved with the operated side because sometimes you can be retaining fluid in your body because of medications you may be taking, because of inflammatory processes going on in your body, or you can be gaining or losing weight that can cause a change in limb size. Discuss your desire to stop wearing your compression sleeve with your breast surgeon or lymphedema specialist. It would make sense to start removing it for short periods at first and observing how your limb reacts. If you don’t experience swelling you can try to keep the sleeve off for longer periods of time until you are not wearing it at all. As long as your limb size does not change and you have no pain, aching, or sensation of tightness in your arm or hand you may be able to dispense with wearing it. If you are going to be doing heavy work around the house or gardening or exercising you may want to wear the compression sleeve to support your limb. Your muscles will need more oxygen to do the work/exercise so more blood will flow to your muscles in your arm. Greater blood flow to the area means that more fluid will be deposited in your tissues needed to be moved by your lymphatics in that limb. Wearing the compression garment will help increase the pressure on those lymphatics, helping to increase lymph flow out of your arm, hopefully avoiding a return of your lymphedema. Pacing your activity and taking rest breaks frequently can help you to avoid increasing the amount of lymph fluid needing to be moved (lymph load) over the capacity of your lymphatic system to handle the fluid (lymph transport capacity). Lymphedema occurs when the lymph transport capacity is less than the lymph load.