Ask Cynthia Shechter

Areas of expertise:
  • Rehabilitation after surgery
  • Lymphedema risk
  • Axillary web syndrome
  • Exercise
  • Air travel
  • Cellulitis/infections
  • Wrapping
  • Compression garments
  • Compression pump use
  • Self MLD
  • Surgical options for lymphedema
  • Breast reconstruction
  • Lifting and risk of exacerbation or developing lymphedema
  • Radiation in relation to lymphedema and motion
  • Evaluation and treatment of lymphedema

Cynthia Shechter is an Occupational Therapist who earned her Master’s degree in occupational therapy at New York University. She has devoted her clinical practice to Breast Cancer and Lymphedema rehabilitation as well as hand/upper extremity therapy. Cynthia previously launched a Breast Cancer and Lymphedema rehabilitation program at a private facility in New Jersey and has now opened ShechterCare, a facility devoted in its entirety to treating individuals who have had surgery due to breast cancer and/or lymphedema. Cynthia has lectured on the topic of Breast Cancer Rehabilitation and Lymphedema to several Cancer groups in the community as well as to different physician's groups. Her main focus is on educating her patients on the management of Lymphedema and enabling them to return to their regular lifestyle. Cynthia is dedicated to increasing the awareness of the medical community to the benefits rehabilitation can have on patients following Breast Cancer surgery.


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  1. Breast cancer
    Question (Marilyn, ):
    • My problem that I'm running into is getting my arm wrapped. I leave in a little town that does not provide much knowledge of lymphedema. I do go to a PT in Wichita ks which is 50 miles from me. So she is not much help. I do have a pump that I use once a day for a hr ok. So my life is pretty much keeping the arm up. Medicare will not let someone come in to wrap it because I'm not home bound an don't wanto be. This is all wrong by not letting home health care do this. I had 17 lymphs removed for I'm a stage 4 cancer patient. Went threw chemo an radiation , will have pet scan Feb7th to see if they got it all. It seems like my PT in Wichita is dragging this out an keep putting me off with a compression sleeve. I have to get fluid off arm before she can put me in sleeve. What can I do? Thanks for your time

    Answer:
  2. Arm and hand lymphedema
    Question (Linda, ):
    • I am a breast cancer survivor and I have arm and hand lymphedema. I normally wear a sleeve and a full finger hand compression garment but I am a nurse and I am unable to wear the full finger hand garment during my 12 hour shift. It seems like when I wear my sleeve my hand swells up more so I'm not sure if I should wear the sleeve without the hand compression garment any advice?

    Answer:
    • Jan 2017

      Thank you for your message. The majority of my patients do not wear compression sleeves and gloves throughout the day and do quite well keeping their swelling controlled. Unfortunately, wearing a sleeve without a glove when you have hand swelling is not advised. A compression sleeve stops increased fluid from traveling down the arm, however, without a glove, the sleeve can force fluid into the hand. A general rule of thumb… you can wear a glove without the sleeve but not a sleeve without a glove when your hand is involved.

  3. Leg/Thigh Lymphedema Compression Stockings for Those With Limited Hand Strength
    Question (Pam, ):
    • Hi. I'm writing on behalf of my mom. She has been living with lymphedema for 25 years in one leg following the removal of her bladder and lymph nodes during surgery for bladder cancer. She has been wearing heavy duty compression stockings and pantyhose for the past 25 years with a waist hernia belt around her oestomy. She is now at the age (80) where she no longer has the strength in her hands to manage the stockings the tight waist bands from the garments and pantyhose are hurting her spine. In addition, her mobility is now severely reduced because of pain and the size of her leg. She can no longer walk without the aid of a cane or walker. I've read about different types of stockings with zippers but so far we haven't been able to find anyone who is knowledgable on the issues with lymphedema to help. My mom is still independent and living alone, but this is becoming increasingly frustrating for her and the series of connected issues are affecting her overall physical and emotional health. The local nurses in southern MD have limited experience in lymphedema treatment and tend to gawk more than they help. The place where she gets measured for her stocking doesn't seem to know much either and generally she ends up getting new custom stockings that don't fit right. So here are my questions, given the background above, 1) Has the issue of leg lymphedema in the elderly come up and are others struggling with similar issues regarding compression garments? My mom is a champ and has done well for 25 years... but she is now at a transition point and what used to work no longer is achievable. 2) Is there such a thing as a lymphedema RN or Physician Assistant specialist and if so, how do you find them? Ideally, it would be awesome to find someone who could help us look at the situation and help devise a new holistic management program. She lives in the southern MD/Washington, DC area but we could potentially drive elsewhere if there was someone who could really help. 3) Is there a good source for advice and a creative approach to finding a suitable leg/thigh lymphedema compression stocking that is easier to manage? 4) Do you have any other advice for us? She's also tried flexi-touch but it is way too difficult for her to manage right now. She doesn't have the mobility or hand strength to get the velcro straps in the right places and tight enough to be effective. THANK YOU SO MUCH. This is pretty frustrating but I am guessing she isn't the only one with these issues. Pam

    Answer:
    • Dec 2016

      Response as per Cynthia Shechter
      Hello Pam,
      You are right; one of the biggest problems for individuals of advanced age with lymphedema is that it is nearly impossible to don/doff compression garments. They do make donning aides, which help a portion of individuals and I am attaching a couple of links of aides for you.

      http://www.juzo.com/en/products/accessories/donning-and-doffing-aids/juzo-arion-donning-aids/

      http://www.jobst-usa.com/product/jobst-stocking-donner

      I have also found that some of my patients can more easily pull on a nighttime garment like the Tribute or Caresia, as they are easier to grip.

      As far as RN’s or PA’s I’m not aware of anyone. There are physicians who specializing in lymphedema, but I think that your mother would benefit from manual therapy to assist in reduction of swelling and associated discomfort. Here are two links of clinicians in the Washington/Maryland areas.

      Therapists WA

      http://lymphnet.org/sites/custom-scripts/stateResults.php

      Therapists MD

      http://lymphnet.org/sites/custom-scripts/stateResults.php

      As far as pneumatic compression devices, some are more simple to use and some are more difficult. The FlexiTouch has many parts which can be overwhelming. Although I do not endorse one product versus another, perhaps you can look at the BioCompression or the LymphaPress? Both of these companies make devices that are easy to use.

      I think that if you are able to find a therapist willing to modify treatment based on your mothers needs, tolerance, etc, she can get her swelling back under control.

      I hope this info was helpful. If you have any further questions, I am always here to help.

  4. Overview of which garments to wear when
    Question (Karen, ):
    • Are there general guidelines for which lymphedema management garments to wear when? I have lymphedema in my legs, pelvic area, and genitals. I am still, I believe, in stage 1, so we started treatment early on and things are going pretty well. I went through 2 weeks of wrapping one of my legs and have since been wearing thigh-high compression stockings with 30-40 mm of compression, a genital pad, and customized compression biker shorts. I wear them pretty much full time except when I exercise, where I wear the stockings and genital pad but just regular biker shorts for comfort. This seems to be maintaining things relatively well. The legs are pretty good, but I continue to deal with swelling in my pelvic area. I have recently been told I should be wearing night garments instead of the compression garments at night because it allows the protein to move. I also have a FlexiTouch that I have been using nightly. Basically what I am looking for is a "day in the life" of lymphedema garment wear. Specific questions are: 1. Should I wear a night garment instead of the compression garments when sleeping? 2. Should I wear the compression garments all day? Because my schedule has not been stable, we have not experimented with not wearing them all day to see how the swelling does, so I guess the question is, is there any harm in wearing them all day? 3. Should I wear my compression garments when I exercise? 4. Can you explain the reasoning (science) for when to wear or not wear compression garments vs. night garments? If there are written documents describing what should be used when, I would appreciate a reference to that as well. I should also mention that I have a urostomy, so that is another consideration for the shorts and how strong the compression should be, so if you have any recommendations in that regards as well, that would be welcome. What modifications are typically made to compression shorts to accommodate a urostomy bag? Thank you very much.

    Answer:
    • Dec 2016

      Hi. I am going to answer the questions in the order they are listed.

      1. You should not be sleeping in compression stockings as they provide a resting pressure to ensure that when you are upright, increased fluid does not come down the legs. The night garment provides a working pressure to actually assist in the reduction of swelling, so, yes, you should wear it to sleep.

      2. There is no harm in wearing them all day as long as they are not irritating your skin (especially at the ankle crease and behind the knee). If they are irritating, go back to your therapist and discuss the fit of your garments.

      3) Yes. When you are exercising your blood vessels open up and increase blood flow causing an increase in fluid build up. Compression will help to prevent this.

      As far as the urostomy bag, I don’t have an answer. Perhaps a Jobst/Juzo/Solaris rep would be able to assist.

      Attached is a link to a breast cancer related lymphedema and use of compression sleeve vs. wrapping or nighttime garment use. The theory behind the use of different garments are similar in both the upper and lower extremities. Hope this helps.

      https://www.researchgate.net/publication/51108589_Compression_garments_versus_compression_bandaging_in_decongestive_lymphatic_therapy_for_breast_cancer-related_lymphedema_A_randomized_controlled_trial

  5. Open sores/ulsers
    Question (Trish, ):
    • I have suffered from lyphedema for 3 years. This time I have open wounds around the bottom of both legs. They are so bad that they drain heavily, burn, and it's very painful. I use non stick pads, gauze and site bandages then wrap my legs with Ace Bandages. I can not get them to heal. My Dr gave me silvadine(Ms) and it only keeps it moist, I also tried Manuka honey and had a allergic reaction to it. I'm lost, I'm also taking antibiotics because they are so infected. Please HELP!! Thank you for your time. T.Whitman

    Answer:
    • Oct 2016

      Open wounds with lymphedema are not common and usually reflect a concomitant problem. I’m afraid that this is not a problem that can be solved by electronic communication. You should inquire whether the physicians can evaluate your venous circulation and also request a referral to a wound treatment center.

      Best wishes,
      Stan Rockson

  6. Lymphedema treatment
    Question (Paul, ):
    • My wife has stage 2 or 3 lymphedema on her arm, following a double mastectomy. The compression garments have been an exercise in frustration, and bandaging does not seem to be progressing. I have read about compression pumps. How well accepted are they? I have come across 2 makes, Flexitouch and Lympha press. Are there other leading makers? How does one evalluate which pump/sleeve is appropriate? Also, what is your view on low level laser treatment, like the RianCorp LTU-904. It seems to have extensive use in Australia, with much less penetration in the US. Thank you in advance. p.s. if this question is better directed to one of your editorial colleagues, can you please refer it to them? thanks,

    Answer:
    • May 2016

      Lymphedema is a complex disease, and, it can also be very individual.

      Each vaso-pneumatic pump works differently, and there is no “perfect machine” for everyone. Each patient responds differently to treatment and to techniques and devices. There are patients who swear by the Biocompression circ. 2004, some require the 2008 (which has 8 chambers), some the LymphoPress, and some require the FlexiTouch.

      The Flexitouch works differently than other devices in that it is supposed to mimic manual lymphatic drainage and theoretically opens alternate drainage points in the body.

      The Biocompression, and devices like it, stimulate the veins to work better and more efficiently while assisting in protein breakdown. It does not, however, remove the protein. That is why most of my clients, who utilize the Biocompression machine at home, follow up with something that provides a working pressure (either bandaging or night time garment application). The Lymphapress is similar to this device.

      As far as low level laser, I have used it in my practice, but have not seen long standing results. I no longer use the device.

      That said, lymphedema is a very individual disorder, and treatment should be modified based on each individuals needs. If the conpression sleeves are not working, stop using them. A therapist should be able to figure out a regimen that will help, without causing increased frustration.

      Does your wife have a therapist? Has she gone through CDT? Any results? Would you like to contact me directly to discuss treatment options? Even if I am long distance, I’m happy to help.

      Good luck,
      Cynthia
      http://www.shechtercare.com

  7. Exercise
    Question (Deborah, ):
    • Do you recommend specific exercise programs? Someone mentioned MELT, which seems to incorporate yoga...I am not too familiar but I read her blog post regarding lymph brushing so I believe she is aware of LE... I have LE in my dominant arm, hand and trunk due to a traumatic injury. I am ready to engage in more active motion now so I am looking for appropriate activity to strengthen my body.

    Answer:
    • May 2016

      I actually recommend an exercise program developed by Kathryn H. Schmitz, an associate professor at University of Pennsylvania. The title of the program is “The Physical Activity and Lymphedema (PAL) Weight Training Program.

      I do also recommend Pilates, as the focus of a Pilates workout is on core strengthening, which, everyone needs.

      Yoga is ok, but my issue with some Yoga programs is that they require too much weight bearing early on. With lymphedema you really have to build up your strength gradually, and, especially after a traumatic injury, your body need to progress slowly.

      Have you ever received therapy? Do you know how to wrap? Do you have a compression sleeve/glove to use during exercise?

  8. Lymphedema
    Question (Ruth, ):
    • I have lymphedema. My upper arm is about 18". I had grama arms before getting the lymphedema. I'm not totally happy with my therapist.... This is my problem.... I am a hairdresser. So I can't wear a gauntlet while working. The sleeve is so confining, I get 4 super tight banding from the sleeve, which feels like it stops the circulation in my arm. I still wear it even with the confining and discomfort. I can't wear the gauntlet, because of shampooing customers, or cutting. I have horrible pain on the under side of my arm. She tells me, lymphedema doesn't cause pain. I know better. She sized me for a 7, and I bought a 10, and it's still super tight. HELP ..... I need some suggestions. I'm so frustrated. I do have a tactile compression machine, which I use. I do manual manipulation so each day, also. Thanks so much, Ruth

    Answer:
    • May 2016

      Hi Ruth,

      I am so sorry that you are struggling. Lymphedema therapy and garments are not meant to be painful, so if your sleeve is causing issue, stop using it for now. I have many follow up questions, but think we may have to speak to troubleshoot together.

      Would you be able to call my office? ShechterCare.com

      Let e know,
      Cynthia

      Hang in there!

  9. Instructions after breast surgery
    Question (Karen, ):
    • What are the current recommendations after lymph node surgery in regards to BP measurement and needlesticks? I have found little current Evidence Based research that is consistent in recommendations. At our facility, we are telling patients for SENTINEL lymph node biopsies (1-4 lymph nodes removed), we say to avoid bp and needlesticks x 2 years (arbitrary number). For axillary node DISSECTIONS we still say to avoid for life.
    Answer:
    • Apr 2016

      As per Cynthia Shechter

      My recommendations:

      Try to avoid as much as possible for both. If an individual has a sentinal node on one side and axillary node on the other, use the sentinal node side if the MD/phlebotomist is unwilling to use the leg.