What is Lymphedema?
How Lymphedema is Treated at Dynamic Rehabilitation Services, Inc.
Lymphedema Strategies: Do's and Don'ts

What is Lymphedema?

Lymphedema is the swelling in one or more parts of the body, occurring when the lymphatic system malfunctions and cannot drain properly. If left untreated, the condition can worsen, resulting in decrease or loss of lymph functionality, skin breakdown, infections, cellulites, loss of function, and pain.

Lymphedema can follow mastectomy, when axillary lymph nodes are surgically removed or irradiated,or congenital deficiency of the lymphatics. The World Health Organization has estimated that some 500 million people are affected from all forms of lymphedema world-wide.

How Lymphedema is Treated at Dynamic Rehabilitation Services, Inc.

Prevention and treatment of lymphedema become a routine part of the care received by impacted patients at Dynamic Rehabilitation Services. Physical Therapists and Physical Therapy Assistants, trained in lymphedema therapy, actively work with patients as an integral part of the medical care team.

Intensive instruction is offered in lymphedema avoidance strategies, emphasizing awareness concerning meticulous skin care, blood & blood pressure testing, bathing/showering temperatures, lifting, selection of clothing, etc. Additional instruction is given in recommended strategies regarding washing, compression sleeves and stockings, nail care, exercise, sunscreen protection, shaving, etc. In both categories, the information is practical and extremely informative, focusing on vital, everyday issues.

The Lymphedema program at Dynamic Rehabilitation Services offers a comprehensive approach that involves complete assessments and individualized treatments. A clinical team evaluates patients by using assessment tools that include circumferential girth measurements, hydrostatic volumetric displacement and, in some instances, bioimpedance resistance. With these tools readily available, percentage comparisons are done of each extremity, clearly showing objective quantifications of extremity volumes.

While our treatment approach incorporates a comprehensive approach to management, we progress patients from a conservative treatment plan toward a more involved plan. Our philosophy follows the idea that if conservative treatment improves the condition, more involved care may be avoided.

Dynamic Rehabilitation Services offers the ability to dispense non-gradient and gradient static compression garments, where needed. All programs incorporate educational components of avoidance and self management as well as individually designed exercise programs.

Lymphedema Strategies

If you have lymphedema, AVOID the following:

For the rest of your life, never allow anyone to puncture the skin on the limb with lymphedema for blood or allergy testing or for injections.
Patient’s with lymphedema of the leg should avoid going barefoot. Never walk barefooted on the floor of the treatment room, in public rest rooms, or in locker-rooms of exercise facilities. Beware of injuries to the skin when walking barefooted.
Avoid lifting or moving heavy loads. Beware of heavy grocery bags. It is suggested not to lift over 15% of your body weight with your affected arm. This includes briefcases, packages, children, and pets.
Avoid frying foods as oil splashes can cause skin openings.
Be careful of steam burns when handling microwaved food.
Showers and baths should not be steaming hot to the point of reddening the skin.
Saunas and steam baths should not be used. Personal Jacuzzis may be used if the temperature is moderate, not exceeding 100° F.
Do not carry your handbag or purse on the affected forearm.
Clothing should not bind at the waist, groin, chest, underarms, wrist or ankles. Be sure underwear is loose in the groin. Avoid tight clothing, jewelry, and elastic on the affected limb, including watches, rings, tight stockings and knee-highs.
Clothing with tight elastic should be avoided. Bra straps should not dig into shoulders. If clothing is too tight, lymph flow is restricted and a “tourniquet” effect occurs.
Do not allow blood pressure testing on an affected or at risk arm. Thigh cuffs should be used following bilateral mastectomies if lymph nodes have been removed or irradiated on both sides. Be especially careful of automatic blood pressure cuffs during surgery.
Do not cut your cuticles. If someone else does your nails, inform them of the risk.
Avoid activities that involve repetitive movements, especially those against resistance. Do not fatigue the impacted limb.
Avoid extreme temperature changes when bathing, showering or swimming. Protect the limbs from extreme weather as well, keeping them warm in the winter and cool in the summer.

If you have lymphedema, DO the following:

Take meticulous care of your skin. Wash three times a day with soap for a minimum of 30 seconds each time. Dry well in all creases, between fingers and toes. Regular soap has been shown to be as effective as anti-bacterial soaps.
Use of an over-the-counter anti-fungal powder or lotion is recommended for the feet.
Put a clean layer against the skin every day. If you are bandaging, this means putting on a freshly washed stockinette layer. Compression sleeves and stockings must be washed daily.
Any breaks in the skin, no mater how small, should have a topical antibiotic ointment placed on them twice a day for five days. You should carry this with you, along with Band-Aids. Remember to check the expiration date on the antibiotic tube to be sure it is still potent.
Keep your cuticles in good condition using Aquaphor or a similar cream. Never cut your cuticles. If you have artificial nails, please make sure the salon uses instruments that are disinfected well.
Always wear gloves when washing dishes or when cleaning them off prior to putting them in the dishwasher. Wear gloves for all household cleaning chores; the chemical cleaners can irritate the skin and even cause sores. If you are doing the family laundry and if any family members have fungal infections on their feet, you should wear gloves when handling the dirty laundry.
When gardening, wear gloves to protect the skin from scratches and thorns. As gardening gloves tend to get dirty inside as well as out, either wash the gloves inside-out after each use, or wear washable cotton gloves inside the gardening gloves. Then wash the layer of gloves inside at the end of the day.
Avoid chemical hair removers. Use an electric shaver for hair removal on the armpits, the legs, the bikini line, if that area is at risk for developing swelling. Blade shavers are more likely to cause skin openings. If you insist on using a blade shaver, we suggest using a new disposable shaver each time and begin shaving at the area at risk. If you have severe lymphedema and a history of infections, try to avoid shaving that area if you can.
Use a thimble when sewing, if the dominant hand is at risk, or a finger guard if the non-dominant hand is at risk.
Use an insect repellent when in areas where bites are likely. Insect bites cause a reaction that puts more load on the lymph system in that area.
To maintain the integrity of your skin, apply low pH lotions (e.g. Eucerin, Curel, Dermal Therapy, Lac-Hydrin, Johnson & Johnson Baby Lotion) to your arm or leg on a regular basis to prevent dry skin, which is more likely to allow bacteria to cross the skin barrier. Avoid lotions that contain alcohol, dyes, lanolin, mineral oil, petroleum products, talc, or perfumes. Avoid drying alkaline soaps and cleaners. Dove, a soap that is acidic, is better for your skin than some others on the market.
Do not use a public swimming pool unless it is well chlorinated. Patients should have pool management check the water quality prior to use, if possible.
Use the affected arm or leg as normally as possible. Limping and favoring the limb leads to abnormal muscle use pattern and potential muscle strain.
Exercise moderately. Begin any new exercise program slowly, increasing gradually and monitoring the limb carefully for changes in the swelling.
Use a high SPF sunscreen on the limb and trunk quadrant at risk whenever in the sun. Remember that burns are possible on cloudy days and daily use of sunscreen is necessary year round following radiation therapy.
Use extra long, good quality oven mitts to protect hands and forearms from cooking burns.
Make sure the home hot water heater is set no higher than 120° F.
Exercise moderately in the morning or afternoon, avoiding the heat of the day. Make sure adequate warm-up, cool down, and rest are taken.
Jewelry and watches should be loose if worn on an arm or hand at risk. Remove rings before sleeping as a precautionary measure. Nothing that can compress the limb, such as rubber bands or elastics, should ever be worn.
Carry your purse on the shoulder that is not at risk, remembering to lighten the load by removing all non-essential items.
Following mastectomy, use the lightest weight prosthesis tolerated. Avoid bras that have excessively tight or non-adjustable straps.
If you travel by air or hike at high altitudes, wear a compression garment to reduce problems caused by barometric pressure changes. The same holds true for scuba diving or similar under-water sports.

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