Lymphedema Garments

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Preventing Lymphedema

A breast cancer diagnosis provokes tremendous fear and anxiety.  Couple that with treatment -- chemotherapy, radiation, or mastectomy -- and women experience even more stress and anxiety.

Afterward, most survivors feel so happy to be alive that they don't think twice about the side effects of treatment, such as lymphedema.  But about 20 percent of breast cancer survivors -- nearly 400,000 American women -- develop the condition.

How Lymphedema Begins

Removing lymph nodes is an important part of breast cancer treatment.  That way doctors can determine whether cancer has spread from its primary site.  Without these nodes, women are at increased risk for lymphedemas -- the build-up of lymphatic fluid in the tissue.

Signs and symptoms include a full sensation in the limb(s); tight skin; decreased hand, wrist or ankle flexibility; and difficulty fitting into clothing.  If left untreated, lymphedema can lead to serious infections.  Three stages -- ranging from mild to severe -- characterize the condition:

• Stage One (mild lymphedema).  During this phase, tissue is still in the pitting stage.  When you press an area with your finger, it indents and holds the indentation briefly.  Usually when you wake up in the morning, the area looks normal.  As the day progresses, however, slight swelling can occur.
• Stage Two (moderate lymphedema).  The tissue now has a spongy consistency and is non-pitting.  When pressed, the tissue bounces back without any indentation.  Fibrosis (formation of fibrous tissue) begins at this stage, marking the beginning of limb hardening and notable swelling.
• Stage Three (severe lymphedema).  At this stage, swelling is irreversible, and the affected area grows large.  The tissue feels hard (fibrotic) and unresponsive.

Treatment Options

To treat lymphedema, therapists move accumulated fluid out of the affected areas.  This process is called complex decongestive therapy (CDT).  It's based on compression bandaging, exercise and manual lymph drainage -- a form of massage that consists of rhythmic strokes that stimulate lymphatic vessels to contract and encourage lymph flow.  Skin care is also an important part of CDT.

If skin isn't maintained, lesions can develop that allow bacteria to enter an already immune-compromised system.  This produces addition lymph system destruction.  CDT treatment, however, helps maintain skin.  Swelling usually decreases in four to 14 treatments over two to four weeks.

To further reduce swelling in the arms, patients usually wear medical-grade compression garments.  With proper care, lymphedema can be prevented:

Infection

• Keep your arms clean.  Wash often if you perspire, but always dry your skin well so moisture doesn't remain in skin folds or between fingers.
• Protect your fingers, hands and arms from punctures.  Use your unaffected arm if you have blood drawn, your blood pressure taken, or need injections.
• Trim your fingernails carefully.  Don't cut or tear the cuticles.
• Wear gloves when you're working outside to avoid punctures from thorns and tools.
• Use an electric shaver under your arms.  The skin is less likely to become injured.

Muscle Strain

• Use your affected arm as normally as possible, but avoid heavy lifting and vigorous pushing, pulling or scrubbing.
• Ask your doctor, nurse or physical therapist about the best exercise program.

Burns

• Always wear protective clothing and sunscreen with an SPF 15 or higher.  If possible, stay out of the sun from 10 a.m. to 3 p.m.
• Avoid hot baths, saunas and dishwater.
• Wear oven mitts when cooking or baking.

Constriction

• Avoid anything that constrains your hands or arms, such as tight sleeves or cuffs, watchbands or jewelry.
• Make sure your bra fits properly so the straps don't dig into your shoulders.

With proper education and care, you can recognize lymphedema's symptoms and seek treatment early.  Talk to your therapist and learn more about how to avoid the condition.

1. Don't ignore any slight increase of swelling in your arm, hand, fingers or chest wall.
2. Never allow an injection or blood drawing in your affected arm(s).
3. Have your blood pressure checked regularly.
4. Keep the edemic or at-risk arm(s) spotlessly clean.  Use lotion after bathing, and when drying, be gentle and thorough.
5. Avoid vigorous, repetitive movements, such as scrubbing, pushing and pulling.
6. Avoid heavy lifting.  Never carry heavy handbags or bags with over-the-shoulder straps on your affected side.
7. Don't wear tight jewelry or elastic bands around affected fingers or arm(s).
8. Avoid extreme temperature changes when bathing or washing dishes.  Protect your arm from the sun at all times as well.
9. Avoid trauma, such as bruises, cuts, or sunburns.
10. When air traveling, wear a well-fitting compression sleeve.
11. Maintain your ideal weight through a low-sodium, high-fiber diet, and avoid smoking and alcohol.

With proper education, you can recognize lymphedema's signs and seek treatment early to avoid the condition's irreversible effects.

Ingrid Frank has successfully completed the specialized training required to become a certified fitter for Jobst Elvarex brand lymphedema garments (Certified Fitter #867202), as well as for Juzo and Sigvaris.

• Bellisse
• Medi USA
• Lymphnotes
• Juzo Lymphedema Garments
• Juzo Dream Sleeve
• LympheDIVAs: fashional lymphedema sleeves
• The National Lymphedema Network
• Post-mastectomy excercises and stretches (PDF)

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Contact us at ingrid@ingridfrankprosthetics.com or at (508) 655-6698
Webmaster: Jon Frank