Understanding Lymphedema Treatment
So what specifically does compression bandaging do? Well, besides placing a tight squeeze on your arm, it does two very important things: 1) It prevents re-accumulation of fluid into your limb after it has just been treated; and 2) It provides an outer wall around your arm against which your muscles will press when you contract them during activity. So as your muscles press against the bandage, the bandage forces them to work a little harder to carry out the activity that you are doing, thus increasing the strength of your muscle pump in your arm and as the strength of your muscle pump in your arm increases, your muscles actually help pump lymph fluid along. So bandaging actually provides a very functional capacity to the treatment of your lymphatic, your lymphedema. It is not simply just to squeeze the living daylights out of your arm. Even though it may feel like that, it really is a functional thing that will help with the treatment and that’s why it’s important to bandage and it is also important to keep the bandages relatively tight. If you find that you are wearing your bandages for more than 24 hours, then often they loosen a little and then you lose that compressive force and you’re actually wearing them for nothing. So you want to maintain the right kind of pressure on your arm when you wear your bandages.
Daytime compression sleeves work in much the same way as bandaging. Once you have achieved as much fluid reduction as possible in your arm through treatment with your therapist, you should be measured and fitted with a compression sleeve to wear during the day. The pressure of the sleeve that you want for your arm should be 20 to 30 millimeters of mercury. That is mmHg, 20 to 30 millimeters of mercury. If you’re getting a compression stocking for your leg, the pressure should be 30 to 40 millimeters of mercury. Please be sure you have the correct pressure in your sleeve or stocking as incorrect pressures could be very detrimental to you and also render your, the wearing of the garment ineffective and you’ll be wearing it for nothing, which would be a great pity because they’re certainly not always the most delightful things to wear, so you might as well do it properly if you’re going to do it. Correct pressures are not always well known by physicians and so you might need to be your own advocate for this and this is why I’ve told you exactly what pressure you need. Your daytime compression garment will functionally help in lymphedema reduction by providing a surface against which your muscles can pump. As I explained with the bandaging, this will help move more lymph fluid in your arm as you go through your daily activities and move your arm while wearing your sleeve. What is important to know is that you do not need to wear your compression sleeve at night while your arm is still. Because you’re sleeping, you’re not using any of your muscles and so you don’t activate that muscle pump. In fact, while you sleep, the lymphatic system actually has an opportunity to kind of catch-up with itself, so by wearing your sleeve as you sleep, you may get a tiny bit of reduction but it really is designed to be used during the daytime when you’re actually moving and you can use it functionally. If you do need nighttime compression, there are special nighttime sleeves on the market that are designed to be worn at night specifically and you should consult your therapist before attempting to purchase or wear any of these. They are very expensive and often require some advice or information on how to use them.
Many of you might be using or be familiar with sequential compression pumps. Pumps can be very useful in the reduction of lymphedema, but unfortunately not really in the long-term treatment of lymphedema. The best and most effective time to use a pump is when you are concurrently going through manual lymph drainage with your therapist. This is because the manual lymph drainage treatments will support the pump forcing lymph fluid up the affective limb into the lymph nodes. Pumps, in fact, work oppositely to manual lymph drainage. Manual lymph drainage works from the top of your arm at the shoulder down to your hand. In other words, as we’re doing it with our hands, we clear from above so that the fluid that’s lower in your arm has somewhere to drain too. Pumps actually work from your hand upwards and in this way lymph fluid is forced up your arm and this is not a bad thing. It’s just that it’s much more safe and effective when it is combined with manual lymph drainage treatment, even if you’re doing it on your own.
Medications, unfortunately there are a very few proven medications to help with lymphedema. The medications are mostly protein breaking down type of medications; and while they are used in other countries, unfortunately they have not yet been approved by the FDA here. Diuretics are not a good medication to take for reducing fluid volume with pure lymphedema; and I emphasize pure lymphedema. If you have other swelling issues in your arms or your legs, then a diuretic will be addressing those issues and that is okay to take a diuretic in that case. But if you only have lymphedema as your medical cause of swelling, then a diuretic can potentially make your lymphedema worse. A very tiny dose could be helpful, but most dosages do tend to make the lymphedema worse. It will remove water from the proteins trapped in your lymph fluid and will create a high concentration of protein in your lymph and the end result will be that high concentration of proteins will actually draw more water into them and your fluid volume will increase. So please be aware that diuretics may not always be the answer. Again, there are many healthcare professionals out there who are not very clear on that fact and may prescribe you diuretics when actually it could be detrimental to you.
I often get asked: What about elevation of the affected limb? Well because of the thickness of lymph fluid and its inertia, its inability to move very quickly, sometimes elevation doesn’t do all that much to help the situation. You tend to have to elevate for quite some time to affect a change. However, often when you have lymphedema there is also a change in your veins on the affected limb and some of the swelling can be caused by poor blood circulation. When this is the case, then elevation can most certainly help. So those of you who find it helpful, keep going; but those of you who find that it doesn’t really do very much for you, it’s probably because you don’t have too much wrong with your blood circulation and you more or less just have a pure lymphedema, which is difficult to drain with elevation.
Another burning question is: Can exercise help lymphedema? Well, yes it can. Swimming is one of the best forms of exercise you can do. The hydrostatic pressure of the water almost acts like a compression sleeve, so performing light to moderate aerobics in a pool or joining a pool exercise class is an excellent idea. I have had many patients gain great benefit from doing pool therapy, so I encourage those of you who like water to consider doing that.
