Early identification of lymphedema is best achieved using a “Prospective Surveillance Model” (PSM). Through this, individuals are monitored for the development of lymphedema as a part of a holistic, individualized approach to measuring overall function and quality of life over time. A key part of this involves pretreatment measurements of potentially affected body parts and the assessment of treatment-related and individual risk factors by a trained lymphedema specialist.
Early detection and diagnosis is key for optimal lymphedema management as the initial stages can be reversible, whereas later stages are less responsive to treatment. Therefore, surveillance visits with a trained therapist performed at varying intervals throughout your care are important in assuring that lymphedema is identified and treated in a timely manner.
As a part of your surveillance visits, you will also receive education regarding lymphedema risk and management. It is important to inform your medical provider if at any time you notice swelling or any other symptoms (e.g., fullness, tightness, heaviness, pain) of your treated area.
The following are guidelines to help promote lymph drainage during and after cancer or other high-risk treatments/interventions:
- Maintain full active range of motion in the affected extremity. This will help to maximize use of your muscles to assist with lymph drainage.
- Maintain an active lifestyle and avoid being sedentary.
- Consider a weight-loss program if you are overweight.
- Prevent trapping fluid in affected body areas by wearing properly fitted undergarments, clothes and loose fitting jewelry or watches.
- Prevent overuse of the affected area or prolonged repetitive use.
- Reduce the risk of swelling during flights or long car rides by performing breathing and gentle exercises every 2 hours, standing and stretching, elevating the affected area if possible, and drinking plenty of water.
Infection and Injury Precautions
Infection or injuries may trigger the onset or worsening of lymphedema. The following precautions may help to avoid this:
- When possible, use your unaffected arm/leg for blood draws, vaccinations or injections.
- Reduce your skin’s exposure to extreme temperatures, such as saunas or direct contact with ice packs, and try to cool down when overheated.
- Prevent burns to your affected body parts.
- Wear sun protective clothing and always use sunscreen.
- Prevent cuts, scratches, or other injuries to affected areas:
- Use caution with hair removal techniques, use electric shavers to prevent cuts, and avoid creams, lotion, plucking or waxing.
- Wear protective gloves, shoes, and clothing with yard or similar types of work.
- Treat any cuts, burns, scrapes or bites immediately by washing them well with soap and water, applying antibacterial ointment and covering with a bandage. Consult with your care team as to the appropriate antibiotic ointment.
- Do not touch or try to squeeze skin blemishes (e.g., pimples or black heads)
- Avoid using harsh chemicals and wear thick rubber gloves when handling such chemicals (e.g. cleaning products).
- Use inspect spray to avoid bites.
- Avoid dry, cracking skin by using low-pH, fragrance free moisturizers.
- Use caution with nail care on your affected arm/leg:
- Use cuticle softener and gently ease back your cuticles with a cotton swab.
- Monitor your nails for signs of fungal infection (e.g., discoloration, thickening, crumbling edges) and contact your care team immediately if you notice any signs.
Lymphedema Garments and Accessories
Compression is an essential component of lymphedema management. Pressure on swollen areas provided by compression garments promotes the movement of lymph fluid out of the affected area and back into the body’s circulation. Consistent use of compression is necessary in order to prevent the worsening or return of swelling, especially after lymphatic massage or pumping. Compression therapy can also help to soften hardened tissues and control pain.
The compression used for lymphedema management involves low-stretch or short-stretch compression bandages or garments that apply firm, even pressure on affected areas. When you move, the compression also helps to improve the effectiveness of your muscle’s pumping mechanisms which promote the removal of lymph fluid.
- Short-stretch bandages are used in combination with either of the following layers or a bandage liner.
- Elastic gauze bandage
- Foam or cotton padding
- Bandage liners are used in place of the layering materials above, with short-stretch bandaging over.
- They washable and can be more convenient, in particular for self-bandaging.
- Compression garments come in a variety of types including, sleeves, gloves, gauntlets, hoses, chaps, anklets, shorts, bras and face masks.
- A combination of compression garments are often worn together in order to best address and reduce all the swelling in affected body areas.
Compression wraps are made of thick fabric brace-like material with interlocking hook and loop straps. They may also contain foam technology for improved comfort with evening and nighttime use.
Compression Pads/Swell Spots
Swell pads and “spots” consist of reusable foam padding intended to be used with either compression bandaging or garments to provide more focused pressure on an area helping to better soften swelling and hardened tissue. They come in many shapes, sizes, and are designed to match the contours of the affected body area requiring the extra compression.
Garment donning devices and bandage rollers can make daily use of these forms of compression much easier. Examples of such tools include: EZ Roller, Easy Slide, Ezy-As, Mediven Arm or Leg Butler, Juzo Slippie Gator, Dycem, Jobst Donning Gloves.
Bandage and Garment Care
Using special washing solutions (e.g., Jolastic) for laundering elastic garments can help extend their life as they are formulated to remove soil, body acids and skin salts without damage to the fabric. Always use liquid soap when washing bandages or garments. The following are basic instructions for cleaning and caring for your lymphedema bandages:
Hand wash finger webbing and rinse well with clear water.
- You can either hand wash your bandages or put them in a delicates/laundry bag to machine wash them. Use hot water, and be sure to rinse them thoroughly with clear water.
- Never use products such as bleach or Woolite®.
- Dry bandages by laying them to air-dry on a flat surface (do not hang them).
- Do not iron the bandages.
- Wash bandages after every 3rd
- Replace bandages after every ~3 months of use.
- Wash knitted linings by hand and rinse with clear water.
- Air-dry on a flat surface.
- Roll foam tightly and submerge it in soapy water – squeeze the foam while submerged, then rinse with clear water.
- Air-dry on a flat surface.
- Cotton padding is not washable – discard it when soiled.
Local Support Groups
Lymphedema Support Group
Coordinators: Amy Flinn, PT, CLA-LANA and Celeste Lane
650 University Ave, Suit 109, Sacramento, CA 95825
Certain Thursday mornings. Please call to confirm.