Managing Lymphedema and Getting on With Life

We all experience swelling for some reason or another from time to time. Think a puffy face after eating pizza or another salty food or a swollen knee after an arthroscopic repair.

But lymphedema is different. It goes beyond a little puffiness. Serious lymphedema can exponentially swell a limb to the point that it throbs with pain and damages the skin and underlying tissues.

The key difference between lymphedema and postsurgical or injury-related swelling is that it doesn’t go away. Instead, it’s often a chronic condition that, while manageable, isn’t curable.

The lymphatic system cannot regenerate. That means lymphedema requires life-long management. The good news is with proper care, patients can maintain their health in a way that does not let lymphedema impact their daily lives.

What To Expect At Treatment

Lymphedema occurs when the body cannot properly circulate lymph fluid, a substance in the body that helps fight infection. When lymph fluid is produced with no way to move through the body, swelling occurs, most often in the arms or legs.iStock_000021428971XLarge_E_8x10

The condition can be caused as a result of a congenital defect to the lymphatic system. But more often it’s the result of some kind of trauma to the system, such as surgery, cancer treatment or infection.

The first step is always to get the swelling under control to reduce discomfort and avoid risk to the skin. The initial phase of treatment involves regular visits to a doctor’s office and or physical therapist for monitoring and care of the area. Patients will typically have visits four to five times a week for four to six weeks, depending on the patient.

Treatment involves 45 minutes to an hour of manual lymph drainage or massage, followed by bandaging of the limb. Patients will also learn how to care for their skin, avoid infection, develop an exercise plan and learn long-term home management.

The next phase of treatment involves independent care at home. Patients continue bandaging their affected limb at home each evening, while wearing compression garments during the day. Regular exercise, self-massage and proper skin care will help patients remain mobile, so they can get on with living.

Skin Care

The thing about lymphedema is that it can really do a number on your skin. Not only does extreme swelling stretch your tissues, but all the fluid between tissues puts you at a greater risk of infection from the smallest cut or slightest irritation.

Everyone should have a skin care routine. But for lymphedema patients it’s essential. Using anti-bacterial or lower pH balanced soap will help reduce the risk for infection. Low pH balanced lotion can also help work with your skin’s natural defenses to create a barrier against bacteria.

Low pH products, a pH of less than 7.0,  that are great for lymphedema patients include Eucerin, Curel, Dermal Therapy, Lac-hydrin, Melaleuca, Avon, Johnson & Johnson, Goldbond and Lymphoderm. Products with a high pH that should be to avoided include Nivea, Lubriderm, Keri and Suave. A higher pH can dry out skin and damage your skin’s ability to ward off infection.

While keeping your skin clean and moisturized is important, that alone won’t prevent an infection. Skin breakdown, especially in patients whose limbs are severely swollen, can occur. Daily skin checks to look for breaks in the skin (like cuts, abrasions, insect bites, hangnails, cracked or torn cuticles) is critical.

It’s also important to thoroughly dry skin after a shower either with a towel or a hair dryer on a cool setting for hard to reach areas. For deep skin folds patients can use rubbing alcohol to promote dryness.

And if you must shave, be cautious! A sloppy shave can cause nicks and cuts, which could lead to an infection. An electric shaver is always safer, but if you prefer to use a razor, use a clean one every time.

If you spot any signs of infection, such as redness, warmth, tenderness of the skin with increased swelling, chills or fever, call your doctor.

Care of Bandages

Think of your bandages like dress socks or pantyhose. You wouldn’t want to wear them for too long without washing them for fear they may get stinky. The same thing applies with bandages. It’s important they remain clean and in good condition, so they can provide the proper compression.

Bandages should be washed every 2-3 days or more frequently in warmer weather. Stockinette and finger/toe bandages should be washed daily since they are worn directly on the skin. Bandages can be washed by hand and line dried, or machine washed and dried. Machine washing is recommended every two weeks to help spring bandages back into shape.

Use cold or lukewarm water with a mild liquid detergent ( no powder detergent). When machine washing, place bandages in a lingerie bag or pillowcase for protection. Dry on low heat. Any padding should be hand-washed to avoid tearing. When air drying, lay bandages flat to prevent stretching.

Always roll bandages immediately after drying them or removing them to avoid wrinkling. And never use clips to fasten them, since they could cause tearing. Instead, use tape to hold the bandages in place.

Exercise Guidelines and Precautions

Got all that? Well, once you do then you can start thinking about the best ways to stay active and exercise without irritating your limb. But before you go getting all excited, don’t forget you have to wear your compression garments or bandages during exercise.

Since working out with something tight around your arm or leg might feel weird at first, it’s a good idea to gradually increase reps and types of exercises so you know what works and avoid the potential of overuse. Exercise in circuits alternating movements and areas of the body. Make sure to rest between each activity.

Avoid weights or tight clothing that wrap around the wrists or ankles, which could cause constriction. And don’t do exercises that require sitting or standing for long periods of time without movement.

Exercises that will allow a lymphedema patient to comfortably and safely feel the burn (okay, just a little burn) include swimming, walking, low-impact cardio, yoga and water aerobics for patients with an inflamed upper extremity. Walking, biking, skating, calf pumps, swimming, 5-10 minute intervals of low-impact cardio, yoga or water aerobics are great choices for patients with a swollen lower extremity.

Most exercises longer than 30 minutes aren’t a good idea. Some not-so-obvious no-no’s include racquet sports, golf, shoveling snow, carrying luggage or grocery bags, and weight lifting for patients with swollen arms. For folks with swollen legs, soccer, running, hockey, moving furniture, weight lifting and intense horse riding are out.
That seems like a lot to remember. But once you get it down, you’ll be able to successfully keep swelling in check and keep on keeping on.