Compression garments for lymphedema

Hints and tips

Compression garments for lymphedema

By Mona Al Onazi and Rachel Wang

Using a compression garment is essential in helping you manage your lymphedema on a daily basis.1 Most of you will have been told to wear your garment during waking hours, from the time you get up until bedtime, or a minimum of 12 hours a day.2 This recommendation is supported by research that has shown that adherence to a well-fitted compression garment can help reduce and/or control swelling.3

We recently completed a study that showed that many women with breast cancer-related lymphedema did not wear their daytime compression garment every day, all day.4 We were surprised, so we conducted a second study involving a survey and focus group sessions to find out why.5 In the second study, women reported many reasons for not wearing their garment.6 Two of the main reasons included discomfort and difficulty with function.7

In our quest to find some solutions to these issues, we explored the hints and tips compiled from previous Pathways articles, and also reached out to patients and clinicians for their thoughts and ideas. In this article, we share some suggestions to help you manage your lymphedema.

Discomfort

An ill-fitting or poorly applied compression garment can cause discomfort. Not surprisingly, many women reported that discomfort was one of the main reasons for removing their compression garment. A number of issues were reported including poor fit of the garment, tension or tightness in the limb that increased over the day, and discomfort that was due to heat or humid weather. Four regions of discomfort were commonly reported including at the hand, wrist, elbow and upper arm (Table 1).

TABLE 1 Discomfort

Poor fit of the garment Fit at the hand (e.g., irritation of thumb and web spaces)

Fit at the wrist (e.g., overlap of compression)

Fit at the elbow (e.g., nerve compression and chafing in elbow crease)

Fit at the uppermost aspect of the arm (e.g., band too tight, top of sleeve sliding down, and blistering due to silicon band)

Poor tolerance to compression An increased feeling of tension/tightness in the limb causing removal of the garment earlier in the day.

Heat and humidity/ weather Heat-related discomfort and increased heat due to hot flashes or from activity and exercise. Hints and tips •After every wash, place a thick pen or dowel in, (e.g. the finger holes to stretch out the material. •Ask your fitter if a seamless glove is appropriate for your lymphedema. •Try alternating the glove above and below your compression garment at the wrist to see if one method improves tolerance. •Be refitted so that the compression level is not excessive at the wrist. •Talk to your fitter and/or therapist regarding the use of inserts, or different types of garments with specialized elbow stitching, or liners. •Try applying talc-free powder or cornstarch at the elbow crease to reduce friction. •If the band is too tight, discuss with your therapist or fitter options for a garment with a different shape or method to keep the garment in place. •If the top of the sleeve is sliding down, try using a body adhesive product. If the garment is sliding a lot, you may need to check the fit or style of the garment. •If there is blistering due to the silicon band this may indicate an allergy or skin sensitivity. Sometimes turning the sleeve inside out or changing to a garment without a silicone top can solve this. •If you have problems with the fit of your garment, it is best to address issues right away. Ask your therapist or fitter about other options to increase comfort such as a custom-made garment. Hints and tips •Pace your activities through the day to ensure that you can rest and elevate your limb. Practicing deep breathing exercises along with elevation may be helpful. •Sometimes the material of the garment (too elastic) may cause the feeling of tension in the limb.

Discuss options with your therapist or fitter about switching to a firmer, less elastic material. •Replacing your compression garment regularly is important to ensure the correct level of compression is being applied to your limb. Hints and tips •Try wetting your compression garment with a spray bottle, or putting a frozen gel pack or frozen peas on your limb (not more than 15 minutes). Place your garment in the freezer for about 10 minutes before wearing it to keep your body temperature down and your limb cool. •Try, if possible, to complete your activities (e.g., gardening) in the shade or in the early or late hours of the day when it is cooler outside.

TABLE 2 Function

Hand function Using a glove/gauntlet caused difficulty with hand function (e.g., manipulating objects, meal preparation, and writing). Hints and tips •Don a large kitchen rubber glove (or other waterproof plastic glove) that will go over your compression glove. •Wear an old compression glove that you can get dirty or wet while washing dishes or doing other household chores. •Try layering a thinner glove under the gauntlet to allow for more finger flexibility and function during the day (e.g., typing on the keyboard).

Hygiene Keeping the garment clean was difficult especially when using a glove or gauntlet. Hints and tips •Daily washing of your compression garments is important to avoid the buildup of residue from dirt, lotions, and sweating. •Use old garments for dirty work such as gardening. •Keep a “going out” glove that looks clean and new.

More Helpful Suggestions...

Talk about how you feel

This is a time to stay connected with the people that you love. Set up a time to call a friend or family member every week to catch up and talk about what you are feeling. It’s also a great time to give each other any new book or TV recommendations, as the days get shorter!

Keep moving

The cold weather does not mean you should be discouraged from moving as much as you can. Try some yoga with a guided YouTube video, or set aside space

Difficulty with function

Most of the women reported that wearing the compression garment impacted their ability to use their hands for daily roles and activities. The issues related to this barrier included hand function and hygiene (Table 2).

Other strategies to help control your lymphedema

Some of the women interviewed reported other ideas to help self-manage their lymphedema.

n Nighttime compression: Many women find that bandaging or use of a night garment, on a regular or as needed basis, are an effective strategy to keep the lymphedema in control.

n Exercise: Many women reported that exercise was helpful for their lymphedema. Wearing a compression garment during exercise and activities can help your muscles to more easily move the fluid out of the limb.

n Avoiding salt foods and alcohol:

Some women have found that ‘eating out’ caused more swelling the next day.

Their advice included watching intake of salty foods and alcohol.

n Watch for triggers: Be aware of triggers that make your lymphedema worse (e.g., Driving long distances was a common trigger for increased swelling among patients. Exercise using a squeeze ball and moving your arm in your living room to do some simple exercises and stretching. You can refer to recent Pathways articles for suggested arm exercises (Spring 2020) and leg exercises (Fall 2020).

Listen to a podcast

During the colder months when there are fewer opportunities to connect with people outside, why not try listening to an informative podcast? One suggestion is called ‘The Lymphedema Podcast,’ hosted can help with that.) When you can’t avoid those triggers, plan in advance (e.g. use night bandaging in the week before and after a long road trip). LP

A full set of references can be found at www.lymphedemapathways.ca

We would like to thank and acknowledge the help and input we have received from women with lymphedema (Iris, Ans, Jane, Val, Diane, Jean, Janet, and Mary Anne), and physiotherapist and occupational therapists at the Cross Cancer Institute in Edmonton (Rita Wannechko-Koenig), Central Alberta Cancer Centre in Red Deer (Kelsey Kenway), and Tom Baker Cancer Centre in Calgary (Tracy Smith and Lori Radke).

Mona M. Al Onazi is a physiotherapist, certified lymphedema therapist, and doctoral candidate in the Faculty Rehabilitation Medicine at the University of Alberta.

Rachel Wang is a practicum student at the Cancer Rehabilitation Clinic in the Department of Physical Therapy, University of Alberta and pursuing her Bachelors in Kinesiology

with a major in adapted physical activity. by a lymphedema therapist, which can be found on the website: www. lymphedemapodcast.com

You are in control

In my experience, people with lymphedema who have the best outcomes, in terms of circumference, pain and function—are those patients who concentrate on overall health (physical, mental and social) in what they can control in their lives. LP

Jennifer St. Michael, PT, CDT Renfrew, Ontario

Did You Know?

The burden of lymphedemarelated hospitalizations

This study aimed to describe hospitalizations due to lymphedema and identify factors associated with poor outcomes. Design: We performed a retrospective analysis of the Healthcare Cost and Utilization Project National inpatient sample for lymphedemarelated hospitalizations from 2012 to 2017. All adults admitted with a primary diagnosis of lymphedema or a primary diagnosis of extremity cellulitis and secondary diagnosis of lymphedema were included. Results: Between 2012 and 2017, there were an estimated 165,055 lymphedema admissions in the United States. Most hospitalizations were for cellulitis (92%), lower extremity disease (88%), and were admitted through the emergency room (77%). Median length of stay was 3.61 days and inpatient mortality was 0.03%. Conclusion: Although mortality is low, lymphedema-related hospitalizations are a significant burden to the US healthcare system. Counseling older lymphedema patients with comorbidities on early symptoms and signs of infection and prompt treatment of same may reduce mortality.

Source: Surg Oncol. 2020 Sep 09;35:249-253 PMID: 32932222

Lymphedema: a review of fundamental concepts

Lymphedema has historically been underrated in clinical practice, education, and scholarship to the detriment of many patients with this chronic, debilitating condition. For this review, we conducted a literature search using PubMed and EMBASE and summarized the evidence related to the fundamental concepts of lymphedema. This article aims to raise awareness of this serious condition and outline and review the fundamental concepts of lymphedema for physician and other clinicians.

Source: Mayo Clin Proc. 2020 Aug 20;: PMID: 32829905

Body mass index and lymphedema morbidity

Obesity is a risk factor for the development of secondary lymphedema after axillary lymphadenectomy and radiation therapy. The purpose of this study was to determine whether obesity influences the morbidity of lymphedema in patients who have the condition. Methods: Two cohorts of patients were compared: group 1, normal weight (body mass index ≤25 kg/m); and group 2, obese (body mass index ≥30 kg/m). Outcome variables were infection, hospitalization, and degree of limb overgrowth. Results: Sixty-seven patients were included. Disease duration did not differ between groups. Group 2 was more likely to have an infection (59%), hospitalization (47%), and moderate or severe overgrowth (79%), compared to group 1 (18, 6, and 40%, respectively). Multivariable logistic regression showed that obesity was an independent risk factor for infection, hospitalization, and moderate to severe limb overgrowth. Conclusions: Obesity negatively affects patients with established lymphedema. Obese individuals are more likely to have infections, hospitalizations, and larger extremities compared to subjects with a normal body mass index. Patients with lymphedema should be counseled about the negative effects of obesity on their condition.

Source: Plast Reconstr Surg. 2020 Aug;146(2):402-407 PMID: 32740596

Discovery of a novel gene in primary lymphedema

Scientists have identified a novel gene responsible for primary lymphedema along with mutations that alter the function of a protein that is known to play a role in vascularization. They also found how these mutations result in loss of the protein’s normal function. Samples were collected from almost 900 patients (and family members) suffering from primary lymphedema. By using wholeexome sequencing, the team was able to discover mutations in a gene called ANGPT2 in five families with occurrence of lymphedema. ANGPT2 had previously been shown to influence lymphatic development in mice, but this is the first time that mutations in this gene are found to cause a disease in human being. Whether they induce development of too few or too many lymphatic vessels, these mutations result in primary lymphedema in patients. Until now, 28 genes have been found to cause primary lymphedema and/ or predispose to the secondary form, but these account only for less than a third of the patients, each gene explaining a defined percentage of cases. This important discovery, is essential for the proper diagnosis of patients suffering from primary lymphedema, and opens a novel pathway for developing treatments. LP

Source: Leppänen and Brouillard et al, Science Translational Medicine 2020

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