Advice

GENERAL ADVICE FOR PATIENTS

Particular advice to those with lymphoedema and those who are at risk
of developing lymphoedema.

PERSONAL HYGIENE

Personal hygiene and looking after our body are highly important for
everyone to assist in maintaining good health. It becomes even more
important for lymphoedema sufferers and those at risk to care for their
affected limb, in particular the skin, which is the largest organ in the
body. The skin has several functions. It regulates the body temperature,
protects the body from infection, excretes waste products and prevents
tissue dehydration. Normal skin is soft, supple and slightly moist. Skin
on a lymphoedematous limb can become firm, dry and develop cracks.
This fragile skin is dehydrated so easily breaks down and is less able to
protect the body from infection and less able to perform its other
functions.

It is advisable to apply a good quality moisturizing lotion to the limb
twice daily and check the condition of the skin while doing so.

SKIN INFECTIONS

Skin punctures

It is advisable to avoid having skin puncture procedures such as
acupuncture, blood sampling, blood transfusions and I/V drips on the
affected limb and also having blood pressure taken on the affected limb
if possible. There is no scientific evidence to prove that these medical
procedures can worsen existing lymphoedema or be the precipitative
factor to cause lymphoedema to develop in an at risk limb. However,
clinical evidence has shown numerous instances when oedema has
developed in an at risk limb and an existing lymphoedema has been
aggravated within hours following one of the above mentioned
procedures. There have been too many cases to be coincidental. It is
recommended to wear a medic alert bracelet for this purpose.

Cellulitis

Cellulitis is an acute inflammation of subcutaneous tissue caused by a
bacterial infection. It is a common complication of lymphoedema
occurring in the affected limb. It can also affect people who do not have
lymphoedema and who are in good health.

It is sometimes referred to as erysipelas or secondary acute
inflammation. The cause is unknown but it is usually claimed to be
caused by a streptococcal infection, which is penicillin sensitive. The
portal of entry for the infection is believed to be through the skin, hence
the importance of skin hygiene. However, it is believed that, once
infection has gained entry to lymphoedematous tissue, it is never fully
eradicated but remains quiescent with varying episodes of reactivation.

The condition starts rapidly, often without warning although attacks may
be preceded by vague symptoms such as aching and feeling unwell. A
feeling of heat ensues with redness, pain and an increase of oedema.
Severe attacks can produce a fever, headaches and vomiting and be
classified as acute febrile cellulitis, requiring hosplitalisation and a
course of intravenous antibiotics. Less severe attacks are treated with
oral antibiotics and rest. The lymphoedematous limb is commonly
worsened causing removal of the compression garment and consequent
treatment to restore normal limb shape.

EFFECT OF HEAT AND EXERCISE

Heat is the enemy of lymphoedema, whether it is internally generated or
externally applied.

The effect of heat on the body is to increase the blood circulation and
cause more fluid to pass from the blood capillaries into the tissues.
This, in turn, increases the amount of swelling in a lymphoedematous
limb and could be the precipitating factor in the onset of lymphoedema
in at risk limbs.

Aerobic exercise such as jogging, playing sport or participating in
aerobic classes are examples of internally generated heat. Being
outdoors in high temperatures, indulging in hot spas or saunas are
examples of externally applied heat.

Caution is advised when participating in these activities. Those who
have lymphoedema should wear their compression garment at all times
but particularly when exercising or are outdoors in the heat. If swelling
worsens in the affected limb, the activity should be stopped, ice packs
applied to the limb in elevation as soon as possible to cool it down and
rest. Advice and assessment by their lymphoedema therapist should be
obtained the following day, if possible.

Those who develop swelling in an “at risk” limb in one of the above
situations should follow the same advice but will probably not have a
compression garment to apply. Advice and assessment by a medical
practitioner or a lymphoedema therapist should be obtained as soon as
possible.

In addition to the above advice on the effect of heat and exercising,
there are two other types of exercise which need to be performed with
caution.

Repetitive movements performed over sustained periods of time such as
typing, playing a musical instrument, knitting or sewing can also cause
or exacerbate swelling as can movements requiring maximum physical
effort such as lifting and carrying heavy objects or weight training.

In considering the above advice regarding heat and exercising, it should
be stressed that these are not strict rules which apply equally to
everyone. It is advisable for all those concerned to approach exercising
and other potentially deleterious activities with caution and common
sense in order to ascertain the amount of activity each person can
participate in without provoking or worsening the oedema.

DAILY MANAGEMENT

Compression Garments

Maintain your garments in good condition. Ideally, they should be
washed by hand in lukewarm water with a mild liquid detergent (not soap
flakes or poorly dissolved powders), rinsed well in water, squeezed
gently or patted (not wrung) in a dry towel and dried naturally indoors or
outdoors in the shade. Use of a washing machine, drying machine or hot
water is not advised.

It is advisable to wear rubber gloves when putting the garment on and
off as it is much easier to grip and this reduces the risk of damaging the
fabric. In addition, it is easier to smooth out any wrinkles in the
garment. A special glue may be applied to the skin to avoid each end of
the garment slipping.

Some patients experience difficulty applying and removing stockings by
themselves. This can apply to the elderly or those who are incapacitated
by muscle weakness and joint stiffness. Different types of stocking
donners are available to assist in this task. Advice may be obtained
from this Clinic.

Clothing

Females who have arm lymphoedema or are at risk should wear bras
with wide shoulder straps to avoid restricting lymph drainage.

Bras with wide side pieces provide better support to the side of the
chest, where swelling can develop.

Do not wear tight restrictive clothing, such as underpants or ankle
socks, or jewellery on the wrist, such as a watch, which may restrict
lymph drainage.

Always wear protective gloves when gardening, doing manual work
outdoors and when doing washing up.

General Advice

Avoid getting the affected limb sunburnt by wearing appropriate clothing
and/or wearing a block-out cream. Ensure that blisters do not get
infected.

Avoid cutting the skin when cutting your nails. Use a nail file.

Avoid cutting the skin when shaving your legs.

Avoid insect or mosquito bites by wearing appropriate clothing and
wearing a repellent when outdoors.

Avoid cuts, abrasions, burns, scalds and cat scratches. Treat with
antiseptic liquid and cover with adhesive dressing.

Avoid trauma such as sprains, bruises or worse. Treat with ice,
compression, elevation and rest.

For more information, see Living With Lymphoedema.

ADVICE WHEN FLYING

Clinical experience has shown that flying can increase the amount of
oedema in a lymphoedematous limb if it is unsupported by not wearing a
suitable compression garment. This has been seen to occur even on
flights of short duration, such as one hour. It has also been shown that
at risk limbs can develop lymphoedema from flying. There is no
scientific evidence to prove this phenomenon but it is believed to be due
to the low cabin pressure of 11 pounds per square inch (psi) compared
with the normal atmospheric pressure of 14.7 psi that facilitates the
development of the oedema. In addition, the unaccustomed amount of
physical activity involved with travel such as carrying heavy suitcases
could overload the lymphatic system in the affected limb, similar to
doing weight training in a gym. Using luggage on wheels is
recommended. It has also been suggested that long periods of inactivity
on flights can reduce lymphatic flow, causing stagnation of fluid and
consequent onset or worsening of oedema. However, with regard to arm
lymphoedema, it could be argued that, if it is the inactivity which is the
precipitating factor, why then do equally long periods of inactivity, such
as when sleeping, not have the same effect? Those who have
lymphoedema are advised, therefore, always to wear their compression
garments when flying, even on flights of short duration, in order to
provide adequate external support to the limb. Similarly, those who are
at risk are advised to wear a low to medium compression garment on
the affected limb to reduce the risk of developing lymphoedema. Both
groups are also advised to practise frequent deep breathing exercises
and gentle arm or leg exercises to stimulate their lymphatic system
without overloading it. Walking up and down the aisle and having a
stretch is also recommended.

OTHER TRAVEL TIPS

Much of the advice given in the section on “Advice when flying” is
equally applicable to those who embark on a long journey by coach, car
or rail, with the exception of the effect of reduced cabin pressure.
Frequent gentle exercising, combined with deep breathing within the
confines of your seat and also when there are rest breaks in your journey
will stimulate the lymphatic drainage in the swollen limb or the limb that
is at risk. It is important to remember that immobility results in slowing
of the lymphatic flow, which in turn encourages stagnation of fluid in the
tissues while movement has the opposite effect.

When travelling long distances, particularly interstate or overseas, it is
advisable to take a third garment with you in case you lose or damage
one and are unable to purchase a replacement.

If sitting in direct sunlight, avoid overheating your limb by covering it
with a coat or a towel.

Wear appropriate clothing to suit the climate. Avoid overheating.