● Limb constriction: ○ If possible, avoid having your blood pressure taken on the arm at risk. If both arms are at risk, have the cuff attached to the thigh. ○ Wear loose-fitting jewelry and clothing. ● Compression garments: ○ Be sure any compression garment you use fits well. ○ Support the affected limb with a compression garment during strenuous activity, such as weight lifting, prolonged standing or running. ○ Wear a well-fitting compression garment for air travel. ● Extremes of temperature: ○ Avoid exposure to extreme cold, which can induce rebound swelling and chapping of the skin. ○ Avoid prolonged (greater than 15 minutes) exposure to heat, particularly hot tubs and saunas. ○ Avoid immersing the affected limb in water hotter than 102 degrees F. ● Lower extremity prevention practices: ○ Avoid prolonged standing or sitting. lymphedema, so in diagnosing lymphedema, clinicians must consider other potential reasons for edema, such as congestive heart failure, renal insufficiency, hepatic insufficiency or a tumor in the lymph node basin. Although lymphedema is a permanent condition without a cure, the symptoms can be reduced and managed. In many cases, with early intervention and if the patient adheres to a recommended program, the symptoms may disappear, although the underlying condition still exists. A number of interventions are used to manage lymphedema, and no single approach is considered the standard of care. Approaches may include compression bandaging or garments, manual lymphatic drainage, and patient education regarding skin care, elevation, exercise, and lifestyle. Manual lymphatic drainage, also called the Vodder technique , that is used in Phase I is a specialized massage technique originally developed by a Danish practitioner named Emil Vodder. The massage methods in the Vodder technique are specially designed to facilitate lymph flow and drainage. The techniques include very gentle stretches of the skin and superficial fascia, accompanied by effleurage. Kneading strokes may be used to soften hardened tissue. Specific education in manual lymphatic drainage is needed to use this technique. The most comprehensive instruction is taught in courses that culminate in certification as a lymphedema therapist by the Lymphology Association of North America. At the end of the Phase I treatment, the patient is fitted with a compression garment. Without the continued use of the compression garment, the treatment results from Phase I and the long-term effects of Phase II will be significantly limited. 5 In Phase II, the patient assumes responsibility for maintaining skin health, including appropriate cleansing and moisturizing all affected areas, to help prevent infection over his or her lifetime. The compression garment is worn during the day, and the garment fit should be checked at least every six months (sooner if the patient is having difficulties). The patient continues with her or her exercise program, usually while wearing the compression garment. ○ Avoid crossing your legs. ○ Wear shoes that fit well.
○ Use care with razors to avoid nicks and skin irritation. ○ When manicuring your nails, avoid cutting your cuticles and tell your manicurist this. Cuticles are especially sensitive and at risk for injury. ○ Wear gloves when gardening, working with tools or using chemicals, such as detergent. ○ Wear gloves while doing housework, gardening or any type of work that could result in even a minor injury. ○ If you sustain a scratch or cut, wash with soap and water, apply antibiotics and watch for signs of infection, such as redness, heat, or swelling. ○ If you have a rash, itching, redness, pain, increased skin temperature, or fever or flu-like symptoms, contact your physician immediately. ○ If possible, don’t allow an injection in or drawing of blood from the affected arm. Wear a “lymphedema alert bracelet,” which alerts emergency care workers to your risks. (This is available from support groups such as the National Lymphedema Network.) ● Activity/lifestyle: ○ Gradually build up the duration and intensity of any activity or exercise. ○ Take frequent rest periods during activity to allow for limb recovery. ○ Monitor your affected extremity during and after any activity, checking for any change in size, shape, tissue, texture, soreness, heaviness or firmness. ○ Maintain optimal weight. Diagnosis and treatment Early diagnosis, patient education, and treatment of lymphedema are critical to reduce the morbidity and dysfunction that can accompany the condition. If no treatment is given, individuals are at risk for repeated infections, cellulitis, impaired wound healing and increased swelling and loss of motion. Every person at risk for lymphedema should receive adequate education about prevention and control of symptoms. Health professionals do not have an objective tool or specific criteria that accurately diagnose lymphedema. Usually the clinician can diagnose the condition using the patient’s clinical history and physical examination. Sometimes imaging studies are also used, especially when the diagnosis is made more difficult because of confounding conditions such as morbid obesity or repeated infection. Edema can occur for reasons other than Complete decongestive therapy Patients with lymphedema may participate in a two-stage approach for managing chronic lymphedema that goes by several different names: complex decongestive therapy, combined decongestive therapy, complete decongestive physiotherapy, and combined physiotherapy. We will use the term complete decongestive therapy (CDT). Phase I of CDT is an intense treatment stage that typically involves daily clinical visits for three to four weeks for arm lymphedema and four to six weeks for lymphedema of a lower extremity. Phase II of CDT is self-management. Phase I includes education about meticulous skin care and monitoring, light manual massage (manual lymph drainage), and bandaging for 23 hours a day. Bandages or devices with compression pumps should initially be applied only by a trained professional, because incorrectly applied bandages can be harmful or useless. 9 Patients are taught the accurate and safe way to apply lymphedema bandaging, so that in the self-management phase they can self-manage their condition. During Phase I, the patient also learns and uses range of motion exercises while wearing the lymphedema bandaging. These exercises are later used in Phase II, when a compression garment is worn.
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