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What to expect during lymphedema therapy
You and the lymphedema therapist will talk about the goals of therapy. You can expect one or all of the following from your treatment:
- manual lymphatic drainage (massage): The lymphedema therapist will do a special light massage that moves the lymph fluid to unaffected areas of your body. This will also soften areas of hardness in your tissues.
- compression bandaging: The lymphedema therapist will put multi-layered bandages including low-stretch bandages on your arm or leg after the massage. The pressure varies along the bandaged area to keep the fluid from returning to your arm or leg. Bandages keep the fluid out of your arm or leg by increasing the pressure of your skin. This helps the contraction of your muscles stimulate your lymph vessels and help the fluid move out of your arm or leg.
- exercises: The lymphedema therapist will show you how to do exercises to keep your lymph fluid moving. He or she can also show you special range of motion exercises if your arm or leg does not have normal movement or use.
- skin and nail care: The lymphedema therapist will give you skin and nail care information that will help reduce the risk of infection.
- fitting for a compression garment: The lymphedema therapist will help fit you or send you to be fitted for a compression garment if you have been treated and your swelling has decreased as much as possible. This special garment helps maintain the decrease achieved during treatment.
The amount of time spent in treatment depends on the amount of swelling you have. You will talk with your lymphedema therapist about a follow-up plan.
Check with your insurance provider to see if your treatment and supplies will be covered.
How to tell if you need to wear the bandages
You should wear your bandages during treatment as directed by your lymphedema therapist.
Once you can wrap the bandages yourself, you may remove them to shower. Until then, put a plastic bag over the bandages (tuck in the top) to shower.
How to tell if the bandages are too tight or wrapped wrong
If your bandages are too tight, you will have cold fingers or toes, blue fingers or toes and pain in your hand or foot.
Remove your bandages and rewrap if these signs do not go away by moving your hand or foot. If you wrap one area of your arm or leg too tightly, fluid could pool below that point.
How often bandages should be washed
Wash the bandages about every two to four days (when they look soiled or lack their elasticity).
Washing the bandages help make the fabric elastic again. Wash and rotate between two sets of bandages.
How To wash the bandages
Put the bandages in a mesh bag. Set your washer to the delicate or gentle cycle (in cold water). Do not use bleach or fabric softener. Use a mild detergent.
Let the bandages air dry. Do not put the bandages in the dryer or hang them on an outdoor clothesline.
If you hang the bandages (inside), fold them in half so the weight of the water does not cause them to stretch as they dry. Do not wring or stretch the bandages while they are wet.
Roll the bandages after they are dry. (This makes them easier to put on.) Be sure not to roll the bandages too tightly or they will pre-stretch and need to be washed more often.
Helpful hint when putting on your bandages
Use a moisturizer or lotion every day just before you put on the bandages. Using a tubular cotton stocking makes a protective layer between your skin and the bandages.
When you need to replace your garment
Compression garments last about six months. Depending how often or how long you wear the garment, you may need to replace it before or after the six months.
Do not throw away old garments unless they no longer fit right. You can still wear them if you do messy activities.
How often garments should be washed
Wash the garments about every two to three days (when they look soiled or lack their elasticity). Washing the garment helps make the fabric elastic again.
How to wash the garments
Put the garment in a mesh bag. Set your washer to the delicate or gently cycle (in lukewarm water). Do not use bleach or fabric softener. Use a mild detergent. Special washing solutions are available.
To dry, put the garment on a towel and press firmly until almost dry. To finish drying, lay the garment flat on a towel or sweater rack. Do not put garments in the dryer or hang them on an outdoor clothesline.
Helpful hints when putting on your garment
- Rubber gloves: Wearing rubber gloves will make putting on the garment much easier. They let you grip the fabric easily and let you smooth out the garment with little effort. Gloves also protect the garment from runs and snags caused by fingernails and jewelry.
- Slip-on aids: A slip-on aid is available for arm, leg and foot garments. It is made of a smooth, silk-like material that lets you pull the garment over your hand/foot and heel easily. To use, you slip the aid over your hand/foot and insert your foot into the garment. When the garment is on, remove the slip-on aid through the foot area.
A special lotion (made of small silicone beads) is also available as a slip-on aid for arm and leg garments. To use, you rub a small amount of lotion on your arm or leg. This makes the garment slide on easily.
- Proper fit: It is important to notice that the fabric is woven in straight lines. After putting the garment on, make sure that all rows of seams and stitches run up and down your leg or arm. Use your rubber gloves to smooth and straighten the fabric. Make sure the lines travel straight from your ankle to thigh or from your wrist to upper arm.
- Leg and foot guidelines: It is a common mistake to over-stretch the garment while putting it on. This can loosen the compression in the ankle and calf areas and cause binding (creasing) in the knee or thigh areas. The garment gives you different compression at different points. There is more pressure at your ankle and less at your thigh.
The fabric usually shows closer knit at the ankle and calf and appears more stretched at the knee and thigh. If your garment always bunches up behind your knee, it is likely overstretched. To fix this, work the fabric down to the calf and distribute it evenly.
- Adhesive lotion: Sometimes, the garments slide down your arm or leg. Sliding or rolling of the fabric can cause the garment to not work right. You may find it irritating to have to readjust it often. You can use adhesive lotion to fix this problem. The adhesive washes off your skin and out of the fabric easily with soap and water.
To use, put on the garment, turn the border over and use the roll-on applicator on your skin just above the edge of the garment. Apply the lotion in a few spots. (You may need more.) Rotate where you put the beads of adhesive. This will help keep your skin from becoming irritated. Wait three to four minutes for the lotion to dry so it becomes tacky. Turn the garment border back around the perimeter until it sticks.
- Skin moisturizers and lotions: The fabric in some garments won't work well with lotions.
Important information about exercises
Always check with your doctor before starting any exercise program. Talk with him or her about any medical problems that may limit your ability to exercise.
If you have lymphedema, wear compression bandages or compression garments during exercises. They give your muscles firm support when the muscles contract (tighten).
This increases the "muscle pump" which helps the fluid leave your arm or leg.
Exercise provides you with many physical benefits. It can also improve your self-esteem and psychological well-being.
Exercises to manage lymphedema in your arm or leg
Your arm or leg may feel tight, stiff and sore with lymphedema. Exercises will help after surgery to improve flexibility, strength and to move lymphatic fluid.
Your therapist may have you wear your bandages or compression garments during exercise.
- Abdominal breathing
Changing the pressure in your abdomen creates a "suction effect" to help increase the flow of lymph fluid.
- Flexibility exercises
These help to prevent or decrease the tightness in your arm or leg, help the flow of lymph fluid and improve the use of your arm or leg. The best exercise is a gentle stretch while you breathe deeply. Do not hold your breath.
A specific exercise program will be designed for you.
- Strengthening exercises
Muscle tightening helps speed the flow of lymph fluid. When your muscles contract (tighten), the pumping action of the lymph vessels increases. This helps the fluid move out of your arm or leg.
Exercise in moderation and increase your exercises slowly. If you are lifting weights, use one- to two-pound weights:
— Start with one set of five to 10 repetitions. Work your way to three sets of 10 repetitions with each exercise.
— If you are straining to lift weights, your lymph system may not be able to handle the increase in fluid.
Stop the exercise as soon as your arm or leg begins to feel tired.
After doing your exercises, watch your arm or leg for swelling. If you see swelling, lie down and raise your arm or leg. Make sure to use lighter weights the next time you exercise. If you had no swelling and the exercise was moderately easy, you may add a few repetitions to your next session.
Talk with your doctor or lymphedema therapist about using resistant or stretch bands. The bands come in many levels of resistance. The band color tells you the resistance level.
- Aerobic activities
Breathing faster helps speed the flow of lymph fluid. Aerobic exercise can help you beat fatigue and give you more energy for your everyday activities. Aerobic exercise can help keep you from gaining weight.
Do aerobic exercises 20 to 30 minutes at a time at least five times a week. You may need to start by only doing five minutes at a time and work up gradually.
Good types of aerobic exercises include walking (treadmill, outdoors or at a mall), biking, light aerobics and swimming.