Ask Cynthia Shechter, MA, OTR/L, CIMT, CLT-UE

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.


Submit a New Question

Questions:

  1. Eyelid
  2. pump side effects on surgical bed
  3. Lymphedema pump
  4. Lymphatic Enhancement Therapy
  5. Flexitouch pneumatic pump used for prevention of escalation
  6. Lymphatic conditions in my neck area
  7. Pumps
  8. Using Bio Compression Pump
  9. compression sleeves
  10. Severe lymphedema with axillary recurrence
  11. Post op care for liposuction for lymphedema
  12. Capri Alternative for thigh swelling
  13. Swell as soon as I move more than 8 times.
  14. Arthroscopic surgery on arm with lympedema
  15. Therapy
  16. Could compression leg wraps help with swelling related to Liver failure?
  17. MLD
  18. compression garments
  19. Can a person at risk for lymphedema receive Cupping Therapy?
  20. Care of swollen limb while waiting for Initial treatment
  21. test and other options
  22. Lymphatic arm swelling
  23. Is it time for a pump?
  24. Brand of Stocking - How to choose
  25. CLT
  26. Injury
  27. lymphedema in arm
  28. Lymphedema in back and side
  29. Mild Lymphatic Drainage
  30. knee surgery
  31. Phase 1 compression
  32. CDT Bandaging Problems
  33. Lifting weights
  34. Night Compression Garmet & Compression Pump
  35. abdominal and thigh wrapping
  36. Mrs.
  37. Acute Care Lymphedema Treatment
  38. Occupational therapy student
  39. Test Question
  40. cording
  41. therapist
  42. Breast cancer
  43. Arm and hand lymphedema
  44. Leg/Thigh Lymphedema Compression Stockings for Those With Limited Hand Strength
  45. Overview of which garments to wear when
  46. Open sores/ulsers
  47. Lymphedema treatment
  48. Exercise
  49. Lymphedema
  50. Instructions after breast surgery
  51. CDT not successful for my daughter, what do I do?
  52. Compression Strength
  53. Pre-op question
  54. Lymphatic Draining Massage
  55. Lymphedema worsened by surgery on affected leg
  56. pressure settings on compression pumps
  57. Importance of each of the 4 steps in CDT
  58. Compression wear
  59. bra for side lymphedema
  60. compression therapy
  61. Bilateral mastecmy w reconstruction
  1. Eyelid
    Question (Katie , ):
    • I have facial lymphadema and my upper eyelid is leaking fluid, trying mld but not making any difference. What should I do?

    Answer:
  2. pump side effects on surgical bed
    Question (Mostafa, ):
    • Dear a case of lymphedema of the Rt. arm after cancer breast surgery is there any hazards of using the pneumatic pump on the surgical bed , as the device garment (jacket) applies the pressure on the chest and abdomen ( beside the arm & shoulder) Thanks

    Answer:
    • Oct 2019

      There are no contraindications that I know of.

  3. Lymphedema pump
    Question (Amy, ):
    • I am 53 and have KTS left arm chest hand and lymphedema car accident 21 years ago triggered it. Can I use the flexitouch pump more than once a day?

    Answer:
    • Oct 2019

      There is no real reason that I know of dictating use of the FlexiTouch pump more than once daily. You may want to contact Tactile Medical for additional information, as well as the clinician who recommended the device for you.

      https://tactilemedical.com

      Best,
      Cynthia

  4. Lymphatic Enhancement Therapy
    Question (Marion, ):
    • Is Lymphatic Enhancement Therapy a valid and effective therapy? I am very familiar with MLD, but only recently heard about Lymphatic Enhancement Therapy. Thank you

    Answer:
    • Aug 2019

      I am not very familiar with Lymphatic Enhancement. It is often used in conjunction with manual lymphatic drainage, not as a stand alone device. Lymphedema requires evaluation and analysis to be appropriately treated prior to knowing whether or not an individual will respond to various treatment modalities.

  5. Flexitouch pneumatic pump used for prevention of escalation
    Question (Kathy, ):
    • Can you please direct me to any research supporting the use of a Flexitouch pneumatic pump in the prevention of the escalation of secondary lymphedema? I have Stage II Lymphedema in left arm/trunk and my insurance is negating what my physician has ordered. Thank you!

    Answer:
  6. Lymphatic conditions in my neck area
    Question (Robert, ):
    • I am a survivor of throat cancer but it has left me with lymphedema in my neck area..looking for advice to reduce the swelling and hardness...presently doing self massage therapy but just does not seem to work that well...would like some advice...have a blessed day

    Answer:
    • Jul 2019

      Hi,

      Unfortunately, quite often, the tissue requires manipulation by a lymphedema clinician. Do you have access to care? You need a clinician familiar with treating fibrotic tissue, scar tissue, neck range of motion and manual lymphatic drainage - an OT or PT typically. I can help you find someone if you do not have access to care at this time. My email is .(JavaScript must be enabled to view this email address) if you’d like to contact me directly.

  7. Pumps
    Question (Diane , ):
    • My insurance only covers a pump called Bio compression. Will that cause fluid to build up on top of my thigh?

    Answer:
    • Jun 2019

      There is a lot of data out there supporting use of the vaso-pneumatic pump in conjunction with therapy and compression wrapping. Although I typically use 40-45 mmHg, a study performed in 2002 found that a compression gradient of 40-50 mmHg was both safe and effective. If you would like to read the article, here is the reference information.

      Szuba A, Achalu R, Rockson S. Decongestive lymphatic therapy for patients with Breast Carcinoma-Associated Lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression. Cancer 2002; 95: 2260-7.

      I hope that helps. We generally utilize the Bio-compression pump as a preparatory treatment for MLD. It helps soften the tissue and decrease girth overall. At discharge, we try to obtain a pump for our patients as part of their self management regimen.

      Typically, we recommend that a patient wrap or use nighttime garment after to activate some lymphatic flow. Also, at times we find that the pump is more comfortable with stockinette on your leg or even a chip sleeve under the pump sleeve (farrow makes one we just order an xxl).

      Here is an article recently published.

      https://www.the-hospitalist.org/hospitalist/article/122046/lymphedema-patients-benefit-pneumatic-compression-devices

      There is no way to know if it will cause pooling in the upper thigh, but with appropriate follow up (wrapping or nighttime garment), the pooling should be controlled.

      Hoping this helps. If you need additional information, or even want to trial a device, you can always come to our office to give it a shot.

      My email is .(JavaScript must be enabled to view this email address) should you want to contact me. Best,
      Cynthia

  8. Using Bio Compression Pump
    Question (Jennifer, ):
    • Hi Cynthia, Secondary LE in right leg. 2017 completed CDT & learned MLD plus custom Juzo 20-30 thigh highs which maintained the reduction until recently. My doctor prescribed the Bio Compression pump. There are no CLT therapists nearby. Using factory setting of 45 2XDay-1Hour. Any further advice? Thank you, Jennifer

    Answer:
    • Jun 2019

      We utilize the Bio-compression pump as a preparatory treatment for MLD. It helps soften the tissue and decrease girth overall. Typically, we recommend that a patient wrap or use nighttime garment after to activate some lymphatic flow. Also, at times we find that the pump is more comfortable with stockinette on your leg or even a chip sleeve under the pump sleeve (farrow makes one we just order an xxl).

      Here is an article recently published. 

      https://www.the-hospitalist.org/hospitalist/article/122046/lymphedema-patients-benefit-pneumatic-compression-devices

      Hope this helps,
      Cynthia

  9. compression sleeves
    Question (Kathleen, ):
    • Hi, What are the guidelines for wearing compression sleeves during air travel for a person who had lymph nodes removed plus radiation. I have never had any symptoms. Thanks!

    Answer:
    • May 2019

      This is a tricky area. Personally, I do not recommend that my patients without a swelling condition utilize and arm sleeve, however, if you do, please be sure to utilize a glove as well.

      There has not been a real study on the use of compression preventively for air travel, so my recommendation is based off of what I have seen and what makes sense to me. If a system is working, I do not see why we would instruct you to stop it from functioning for an entire flight. I have seen many patients who have worn their compression sleeve without a glove develop swelling in the hand due to the nature of circulation and gravity. Below are our tips for air travel if you have lymphedema. If you do not, you will still benefit from the exercise recommendations below. I hope this helps and have a wonderful trip.

      If you are traveling by airplane and you have lymphedema:

      1. Wear compression
      • Compression includes compression sleeve with gauntlet/glove, compression stockings, and/or compression bandages
      • Wearing compression during air travel ensures you will not swell during the flight
      • Leave the compression garment on for two hours AFTER you land to allow your body adequate time to adjust from all the climate and pressure changes.

      2. Exercise
      • Take a lap around the plane
      • Ask for an aisle seat when purchasing your ticket so you can easily get up and walk around the plane without disturbing your neighbors
      • On particularly long flights, keep your limbs moving to promote circulation and blood flow.
      • Drink plenty of water to keep hydrated.

      4. Invest in a rolling suitcase to pull rather than carrying a bag on your shoulder to reduce shoulder pain and overuse.

      If you are driving for more than two hours
      1. Wear compression (see above)
      2. Drive with a friend so you can take a break from driving

      If you are taking a bus/train
      1. Keep your limbs moving to promote circulation and blood flow
      2. Get a seat on the aisle to allow room to stretch those limbs and easy access to the restrooms.

      General precautions

      • Bring an emergency first aid kit containing Band-Aids, Neosporin, Bacitracin or any other anti-bacterial ointment in case of any cuts, scrapes, or open wounds.
      • Know the signs of cellulitis: redness, pain, and increased swelling. If you experience these symptoms, please contact your Doctor or go the nearest emergency room.

  10. Severe lymphedema with axillary recurrence
    Question (Alicia, ):
    • I have a patient that had mastectomy and lymph dissection done elsewhere and developed severe lympedema of the arm. She has also developed axillary recurrence. She was told she cannot have massage of the affected arm if she has active disease as it make worse. Is this supported? Thanks

    Answer:
    • Jun 2019

      All UNTREATED metastatic disease is contra-indicated for lymphedema therapy.

      If your patient is receiving care by and oncologist/radiation oncologist/chemo, she is cleared for therapy. I would be sure to obtain a prescription for therapy from the doctor, but treatment is not contraindicated. Stage IV patients need care as well.

      Thanks for the question.

  11. Post op care for liposuction for lymphedema
    Question (Regina, ):
    • Can you offer advice or share experience with post operative compression management of Lipo procedures in the American healthcare system, as the opportunity for hospitalization, covered compression garment (s) is limited or not an option.

    Answer:
    • May 2019

      I believe you are asking about post elective liposuction surgery, correct? There are many aspects of care complications that are covered, however, in the US health system it can be very difficult to get garments covered. Therapy is covered for post surgical swelling and scar/tissue mobilization much of the time. I don’t know about hospitalization, however, compression garments may be covered depending on your insurance policy and your Durable Medical Equipment coverage (DME). Contact your insurance provider for details as every single plan is different.

  12. Capri Alternative for thigh swelling
    Question (Dana, ):
    • Mild secondary lymphedema from SLNB in groin - swelling in thigh and doesn't seem to impact the lower leg. Maintained by daily use of thigh high compression garment. Looking for summer alternative to enjoy splash pad with kids - Capri vs. no garment for temporary periods? Will capri make itworse?

    Answer:
    • May 2019

      It is difficult for me to answer this question without having met you, but generally, time in water provides a working pressure to assist in the reduction of swelling in the extremities, so it is not usually necessary to wear compression.

      A splash pad does not provide the same water emersion, so all that I can do is recommend trial and error. Try the capri, if your swelling increases, try without. You should be able to go periods without compression, especially if swelling is mild.

      Good luck and enjoy the summer.

  13. Swell as soon as I move more than 8 times.
    Question (marie, ):
    • I had a lumpectomy (no lymph nodes removed) 6 months ago. I can't lift any weight or do repeated movements above the shoulder w/o swelling. I got 3 lymph massage from certified LMT. How often should I get massages? What kind? My PT is lost as to what is happening.Anyideas?

    Answer:
    • Apr 2019

      A lymph massage differs from manual lymphatic drainage by a lymphedema specialist. You need to look for someone who is a certified lymphedema therapist. Lymphatic massage is generally used to stimulate a healthy lymphatic system, you need a clinician who specializes in lymphedema therapy - typically with the initials CLT after their name.

      It would be difficult for me to tell you what’s happening without evaluating you since this is unusual. I would see a breast cancer rehabilitation/lymphedema rehabilitation therapist to start. Where do you live? Have you asked LE&RN; to assist you in connecting with a local therapist?

      I do have some follow-up questions:
      1. Do you have full range of motion?
      2. Was the lump benign? If not, are you sure they didn’t perform a sentinal node biopsy?
      3. Did you require any additional treatment (like radiation therapy)?
      4) Do you have full range of motion in the upper extremity?

  14. Arthroscopic surgery on arm with lympedema
    Question (Janis, ):
    • I was diagnosed with lymphedema in 2015, following a complete axillary dissectionof my right arm and a subsequent bout with cellulitis. I’m now facing surgery on shoulder of same arm. Is there anything I should be doing pre and postsurgery to reduce the risk of lymphatic swelling? Thanks so much

    Answer:
    • Apr 2019

      Hi. Surgery on the affected side can be frightening, however, the surgeon will typically prescribe antibiotics to prevent another cellulitis infection. If you have any other questions, please feel free to contact me directly at 212-421-1969 to discuss.

  15. Therapy
    Question (Cynthia, ):
    • I developed lymphedema in my left leg during radiation therapy after diagnosed with grade 3c1 Endromentrial carcinoma. The next available appointment to see a lymphedema therapist is May 31st. Other them elevating my leg and wearing Teds what can I do?

    Answer:
    • Apr 2019

      Unfortunately, not very much. You can gently massage the tissue affected by the radiation to try to soften it, and perform ankle pumps and ankle circles throughout the day to increase muscle pump and fluid flow.

      Are you sure that there are no therapists available until the end of May? Perhaps contact another office if available.

  16. Could compression leg wraps help with swelling related to Liver failure?
    Question (Louise, ):
    • I have a hospice patient at home with end stage liver failure and heavy lymphorrea to lower legs. Has anyone used compression wraps to help secure dressings ,reduce drainage and reduce dressing changes? Goals are comfort, safety and to stay at home as long as possible.

    Answer:
    • Mar 2019

      There are individuals who utilize bandaging for lower extremity swelling with end stage liver failure, but I caution that with open wounds and weeping skin, it could have an alternate effect, increasing skin breakdown due to bandage saturation from fluid seeping through. I would go back and speak to your wound care specialists and your doctor to discuss options. Sorry I cannot be of more assistance. Best of luck, and if you have any further questions, I’m always here.

  17. MLD
    Question (Elsa, ):
    • Can I perform MLD on someone with Stage 0 lymphedema? Is it just not effective i.e. not yet indicated, or would it be actually harmful?

    Answer:
    • Mar 2019

      Generally, MLD is useful for any stage lymphedema. Without having met the patient I cannot make any further recommendations, however, I would contact the school where you were trained with this question.

  18. compression garments
    Question (BRENDA, ):
    • My 80 yr old mother has lymphedema after having double mastectomy 4 yrs ago. We have tried therapy, compressions but have not had any relief. Her fluid in her stomach and armpits. What we have tried in compression never really fit right. where can we get fitted products at?

    Answer:
    • Mar 2019

      I could recommend vendors offline in the NYC area if that would be of assistance. I am not sure where you live, but if this would be helpful, please email me at .(JavaScript must be enabled to view this email address)

  19. Can a person at risk for lymphedema receive Cupping Therapy?
    Question (Kelly, ):
    • I’m an LMT and have been working w a client that had breast cancer therapies including removal of lymph nodes. She comes to me for Cupping massage but I avoid using them on her upper right quadrant and stick with lighter pressure there. Could Cupping help her w lymph drainage?

    Answer:
    • Mar 2019

      Cupping is pretty aggressive for lymphedema. I utilize cellulite cups in practice for fibrotic areas and it works well. Please note, I am not a cupping specialist and have never been trained in the use of cupping.

  20. Care of swollen limb while waiting for Initial treatment
    Question (Louise, ):
    • Hello! What advice you would give someone with LE post cancer treatments, waiting to start the intensive phase of CDT? as there is a 4-6 week wait for insurance clearance. Regular LE precautions, plus might private pay MLD alone help? Thanks!

    Answer:
    • Feb 2019

      Hi. Sorry for the delayed response, technical glitch.

      Most therapists trained in manual lymphatic drainage are also trained in the bandaging technique.  I recommend private pay sessions with a therapist who can do both or MLD alone. Traditional precautions are also recommended.

      If you need anything, please message again.

  21. test and other options
    Question (Penny, ):
    • Is there any test that can help find a way to get my Lymphedema under control? The custom and non custom socks does not work and I have an allergic reaction to them also. I am having a hard time walking when bad. Please help! Thank you

    Answer:
    • Feb 2019

      Hi. So sorry for the delayed response, technical glitch.

      Have you ever had therapy for your lymphedema? Here is a link to the National Lymphedema Network’s website with a directory of websites based on zip code.

      https://lymphnet.org/find-treatment/

      Hope that helps. It sounds like you need a good clinician to help you get back on your feet.

  22. Lymphatic arm swelling
    Question (Rachelle, ):
    • I had my lymph-nods taken out for breast cancer 10 years ago, I started a new job 4 year ago an my arm has not quit swelling since. I have went to therapy an wear a bandage but only makes my hand swell.

    Answer:
    • Feb 2019

      Sorry for the delayed reply, there was a technical glitch.

      It sounds like you may not be using distal (hand) compression. There is also a technique to wrap your hand which it sounds like you need. I recommend returning to your therapist or a different clinic to learn how to self bandage the hand. They also make compression gloves to be used with the compression sleeve. The sleeve should not be used without the glove, but you can use the glove without the sleeve.

      Hope this helps.

  23. Is it time for a pump?
    Question (Susan, ):
    • HI there I have primary lymphedema in my legs. Been keeping this under control with compressionhose, periodic MLD from PT, elevation. In a flare that is not going away - PT thinks in might be time for a pump as MLD and compression aren't bringing it down. Words of wisdom?

    Answer:
    • Dec 2018

      Hi,

      So sorry for the delayed answer, computer glitch. Anyway, primary lower extremity lymphedema can be quite difficult to control. Typically, you would see a therapist for MLD, but also, compression bandaging, kinesiotaping, and/or nighttime garment fit and use. It is very difficult to control lymphedema with just MLD and elastic compression stockings. I truly believe that part of the treatment should in fact involve use of a vasopneumatic pump.

      There is a lot of data out there supporting use of the vaso-pneumatic pump in conjunction with therapy and compression wrapping. Although I typically use 40-45 mmHg, a study performed in 2002 found that a compression gradient of 40-50 mmHg was both safe and effective. If you would like to read the article, here is the reference information.

      Szuba A, Achalu R, Rockson S. Decongestive lymphatic therapy for patients with Breast Carcinoma-Associated Lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression. Cancer 2002; 95: 2260-7.

      When looking for the right device, look for a pump that contains multiple chambers, operates on a short thirty-second cycle time, and applies graduated compression. The body operates on a pressure gradient system, so it is imperative to obtain a gradient or graduated compression pump. Pressure at the feet is greater than the thigh.

      There are many types of compression pumps, however, I utilize the device to stimulate venous involvement in the management of swelling and to assist in softening often hard/fibrotic tissue. There is nothing wrong with using compression stockings after the pump, but I personally find a better result with a garment that provides a working pressure.

      I hope that helps. If you need anything else, please feel free to contact me.

  24. Brand of Stocking - How to choose
    Question (Christine, ):
    • Hello - How do I know which stocking brand is right for me (Juzo, Sigvaris, etc)? Lower extremity thigh highs run about $100/pair and often aren’t returnable. I have a hard time finding stockings that dont crease behind my knee. Any suggestions? Thank you.

    Answer:
    • Dec 2018

      Thank you for your message. Unfortunately, there is really no way to know which compression garment brand will work best for you. The only thing that I can suggest is that if you have a problem with irritation behind your knee crease, that you discuss it with your fitter to find a garment that will work for you. Do you have a good garment fitter?


      I am attaching an online article that discussed some differences in garments that may be of assistance to you.


      https://themighty.com/2018/01/compression-wear-brands-pain-swelling-circulation/


      If I can be of any further assistance, please let me know.

       

  25. CLT
    Question (Krista, ):
    • Hello, I'm and Occupational Therapist and became a CLT a couple of years ago. I work in a SNF and haven't had any patients with active CA that have had Lymphedema needing my tx until now. I currently have a patient with active blood cancer who has BLE Lymphedema. How do you proceed with tx for patients having active CA? During my CLT certification course I'd recalled my instructor saying she didn't do MLD on patients with active CA. I was under the impression that compression was not contraindicated, but MLD is. However, in our textbook, it indicates that you can do MLD on patients with active CA. I know we can do it on those patients who have had CA, such as those with breast CA that have had radiation tx, but those with active CA would be very concerning. I researched online and most said they wouldn't do it. Please let me know what you do for patients who have active or recent CA. I want to help my patients, but am very concerned that the tx could result in metastases. Thank you!!!

    Answer:
    • Sep 2018

      Hi,

      So the rules are gray as always. What they mean in the certification courses is that you cannot perform manual lymphatic drainage on a cancer patient NOT under the care of a physician to treat the disease. Meaning that, the patient must be receiving some sort of chemotherapy. I am curious regarding the blood cancer, and you may want to follow up with the patients oncologist prior to treating.

      Hope that helps. If you have any further questions, feel free to contact me.

  26. Injury
    Question (Kathy, ):
    • I have lymphedema in my right leg and recently sprained it very badly. My doctor seems unconcerned by it. I'm worried about the extra swelling and healing. It just does not feel right.

    Answer:
    • Aug 2018

      I would recommend seeing your lymphedema therapist to get the swelling controlled. Do you have one? If not, LE&RN; has a directory of clinicians as does the National Lymphedema Network. Unfortunately, sprains can cause terrible swelling and it’s better to get it controlled early.

  27. lymphedema in arm
    Question (Jeanette, ):
    • Hi there - I have lymphedema in my left arm. Not sure how I acquired it, trauma at some point is all the doctors can figure. After being told to deal with it and wear a compression sleeve from a vascular dr, I was able to get into a therapist that worked with Lymphedema. We did bandaging and I got fitted for garments. Bandaging did not go so well, but I went to MLD sessions weekly for a couple of months and wore my sleeve at times. My therapists has told me that my lymphedema is very mild, as my arm only measures about 1.5cm more then the right arm. I am a thin person, so obviously its very noticeable to me that I have one arm a little larger then the other. At this point therapist says it is stable and for a few years now, I go once a year for maintenance MLD and usually go for about 6 sessions. I wear my sleeve and glove when I fly. I do manual lymph massages every day and that is how I control it. I do replace garments yearly as I do not use them very often. I have a couple of one piece garments that are sleeve and glove in one. I also have two that are sleeve and glove separate. My therapist has now retired, So my question is, do you think this is a good plan of care for my lymphedema? What other advice or management can you give? Thank you

    Answer:
    • Aug 2018

      Hi,

      Unfortunately, having never met you or evaluated your swelling it would be very difficult for me to say whether or not your plan of care is “correct”. There are many components of lymphedema treatment that may be of assistance, for example, you could add self bandaging, use of a vasopneumatic pump, etc.

      Is there another clinician near you who you can see for an evaluation? If you are not satisfied with the reduction of swelling obtained, then I would certainly see someone else and hear what they can offer.

      If you read through some of the other questions and answers on this site I have answered many questions regrading treatment, my beliefs and theory, and treatment tips. Please read through and see if any of the other answers can help.

      Reduction-wise, I believe that most patients with very mild swelling should be able to have their arm girth within .5 cm of the other side.

      Hope this helps, but if you want to speak further, please feel free to contact me directly. I’m here to help. http://www.shechtercare.com

  28. Lymphedema in back and side
    Question (Lori, ):
    • I was diagnosed with Triple Negative Breast Cancer in 2013 and had a lumpectomy on my right breast. I developed lymphedema in my right arm and a lump/pocket is on my back and right side. I use a pump with arm sleeve at night, wear custom fit compression sleeve during the day and go to lymphedema massage therapy. My arm swelling has improved where during winter months I did not have to wear my sleeve. However, the swelling in my back and right side are very bothersome and cause me discomfort and bloating pain. Is there any type of compression garment to help with this area of swelling?

    Answer:
  29. Mild Lymphatic Drainage
    Question (Felicity, ):
    • Hello I have just been diagnosed with mild lymphatic drainage in both my legs. Have you heard of any mild cases being reversed through proper care? I am presuming it occurred when I had treatment 2 years ago as swelling started from there on in my legs. However I only have been diagnosed today as I had a Lymphoscintigraphy test that revealed this. Thank you Felicity

    Answer:
    • Apr 2018

      Hello Felicity,

      Unfortunately, if your swelling has been present for 2 years, the likelihood is that it is not reversible. Have you gone for therapy yet? This can help to reduce swelling, and, if treated properly, though you will always have a propensity to swell, the swelling can be reduced to an unnoticeable state.

      Hope this helps,
      Cynthia
      .(JavaScript must be enabled to view this email address)

  30. knee surgery
    Question (sylvia, ):
    • I am having a TKR next month. I have lip edema on the surgical leg. What advise do you have regarding post op healing, treatment and expectations. I am not having much success with anyone knowing what is best post op. I am a Registered Nurse and want to do whatever is best for my healing and recovery. Thanks

    Answer:
    • Apr 2018

      Hi. Sorry for the delayed response.

      After total knee replacement, you will likely be given an ice machine that will provide circumferential cool therapy to control post-op edema. This machine requires a ton of ice so have a loved one get bags of ice and keep some as a backup in a cooler. Once you feel like you can be out of the house, I would recommend getting to your lymphedema therapist for manual lymphatic drainage and modified bandaging (based on comfort). Utilization of a vaso-pneumatic pump could be of assistance as well, but you probably will not be able to tolerate the pressure until at least 6 weeks post-op. Do you have anyone who can wrap you at home? Compression bandaging will definitely assist.

      If you have any further questions or even need to follow-up post-operatively, feel free to contact me directly at .(JavaScript must be enabled to view this email address)
      http://www.shechtercare.com

  31. Phase 1 compression
    Question (Tina, ):
    • Hi smile I'm a 59 yr old woman who has had primary LE all my life. Been through years of being told there was nothing that could be done until recently. I am now going through phase I of treatment with compression bandaging. My question is , how painful is this supposed to be, I feel like my legs are on fire all the time, can't sleep. The initial wrap they did was foot w/o toes because I asked them not to bandage my toes, she wrapped a 2 inch bandage around my foot about 10 wraps, I felt like my foot was falling off, now they dont wrap my feet, I wear a compression sock ( my feet don't swell normally and with the sock they are still fine) but the bandage feels like its way to tight, I'm in pain (7 out of 10) all the time, is this normal? When they wrap them they pull the bandage as tight as possible, is this normal?

    Answer:
    • May 2018

      Hi,

      Bandaging should not hurt. There are many ways to modify the way in which we wrap for the comfort of the patient.  I never pull the bandage. Once it is rolled firmly, I simple unroll the bandage along the extremity trying to keep contact with the skin at all times.This helps make the bandage more comfortable. If you require additional info, please feel free to contact me at 212-421-1969 or via direct email, .(JavaScript must be enabled to view this email address)

  32. CDT Bandaging Problems
    Question (Nan, ):
    • Hello: I have a new LE-PT under a new health plan. I am currently undergoing CDT bandaging. This PT has less than a year experience. I am having several issues. My most pressing one is hand pain on the outside edge of my R hand on the pinky finger side and on the fleshy part of my thumb also on the outside edge. I researched what she could try for the outside edge of the pinky finger, a piece of foam that wraps around the edge. This has been fairly successful, but not always. On the outside of my thumb? Not so much success, despite a bandage, and several pieces of foam in the painful area. I am now at the end of my 3rd week of bandaging and the pain from her bandaging means I wake up at night in pain that ranges from a 4-6 to a 6-8. I have had to take off the bandaging about 4-5 times now because of the severity of the pain. And then it means I am sleep deprived during the day & miserable. I do put on one of my compression sleeves and gloves when I must take off the bandaging. I don't know what she should be doing differently, but since I have had CDT bandaging in the past, I am concerned about what this PT is doing wrong. My first LE-PT that bandaged me botched it 100%. I had no reduction in my arm. I was left instead with an upper arm that ballooned to 27.5" and multiple cellulitis infections. The second PT was in private practice and she was amazing. Wonderful results in under 3 weeks. My care was then transferred back to my health plan and once again, I ended up with a big arm and more cellulitis episodes. BUT -- neither of these first two LE-PTs caused my hand to hurt so badly I woke up crying in agony. Is my latest PT wrapping too tightly? What is going on? To date, my new PT hasn't been too keen on seeking advice. I have had to do it. She is the only LE-PT in my health plan. There is an LE-OT, however, but she has no more experience than the one I have now. I am beside myself over this issue. Can you shed some light on this perplexing problem.

    Answer:
    • Apr 2018

      Bandaging should not hurt. Can you call me to discuss? This is a very personal and specific issue and I want to be able to answer all of your questions. I am happy to discuss a plan with your therapist to see if we can get things under control. Again, bandaging should not hurt and there are many ways to modify the way in which we wrap for the comfort of the patient. I never pull the bandage. Once it is rolled firmly, I simple unroll the bandage along your arm trying to keep contact with the arm at all times.

      I follow my mentor Linda Miller, so these are her directions, slightly modified. Also, I would like to share the self wrapping instructions.

      Self-Bandaging Instructions
      1. If necessary, wrap the white underwrap (cotton-like material) beginning at the wrist and taking it up to just below the armpit. Overlap about 1 /2 way for each turn (or just use to protect the elbow crease.
      2. If the fingers are to be wrapped, anchor the white finger-wrap (gauze-like) at the wrist.
      3. Continue with the stretch wrap: Begin the 6-cm (smallest in width) at the hand.
      4. Go around the palm and the back of the hand to anchor the end of the bandage.
      5. On the next turn, go around the palm and back of the hand below the thumb (i.e., closer to the wrist).
      6. Repeat steps 3 and 4, alternating around the palm through the webspace, making figure-eights. You should have at least 3-7 layers of bandage on the hand.
      7. Continue up the arm, ending just below the elbow. You should not cross the elbow with the 6-cm wrap. If you have some excess wrap, go back down towards the wrist, but do not pull wrap
      tightly as you go back. Use tape or elastic catch to secure end of bandage in place.
      8. If you are to continue with another wrap, begin with the next size (usually the 8 cm) wrap at the wrist.
      - Continue up the arm, overlapping each turn by approximately half the width of the turn before it
      - As you approach the elbow, secure a piece of underwrap (puff-piece) at the crook of the elbow.
      - When you wrap over the elbow, make sure that you overlap enough so that your elbow does not pop out between the bandage layers in the back. )quite often I make an “x” so that the wrap doesn’t rub the elbow crease
      9. If you are to continue with another wrap, begin with the next size (usually the 1O cm) at the wrist.
      - Continue up the arm again, overlapping each turn by approximately half the width of the turn before it.
      - End the bandage just below the armpit, securing it with tape.
      - If there is any excess bandage, go back down towards the elbow, but do not pull the wrap tighUy as you go back down.

      - The wrap should be tightest at the hand and become slightly looser as you go up your arm towards your armpit
      - When completed, the wrap should feel “firm” but not too tight.

      Your compression comes from layering, not from pulling the wrap tightly!

      - Make sure to perform your exercise program with the bandages on to get maximal results. Performing exercises in the wrap improve your muscles’ ability to pump lymphatic fluid and wil;l optimize your reduction.

      My contact is 212-421-1969, .(JavaScript must be enabled to view this email address)

  33. Lifting weights
    Question (Sandra, ):
    • I am a 20 year breast cancer survivor with a mild case of lymphedema. I was told at the time not to lift more than five pounds. Is that still true? Also is there a difference in lifting or pushing the weights and the amount of weight? I do wear a compression glove and sleeve when exercising. Thank you.

    Answer:
    • Mar 2018

      Hi. The simple answer is no, most clinicians no longer believed that you cannot lift more than 5 pounds. If you were a mountain climber in the past, you should still be a mountain climber! It’s not really about the amount of weight/added resistance you use, it is about making sure that your body is ready for the increase.

      It is important and beneficial to exercise after breast cancer surgery in a safe and controlled setting once you are medically cleared. Although we like to restore range of motion prior to strengthening muscles, there is no reason that you cannot lift weights. You do, however, have to start very light and slowly and gradually increase the weight. Most of my patients use a weight for at least two weeks prior to increasing.

      There is no real difference between exercises as long as your form is correct. Without knowing about your surgical history, I cannot recommend exercises, however, I will say listen to your body, and your arm. Pay attention to how your arm responds to the workout. If you have increased swelling, then something isn’t working.

      Studies have shown that exercise after breast cancer surgery and axillary node dissection can help to prevent and reduce lymphedema occurrence (Lacomba, 2010). Additionally, repeated muscle contractions (with the limb bandaged) accelerate lymph drainage (LeDuc, 1990).

      Most importantly, working out and feeling better helps to maintain inner strength and a positive attitude.

      Hope this helps, and wishing you the best.

      Regards,
      Cynthia Shechter
      .(JavaScript must be enabled to view this email address)

      References:
      Lacomba M, Sanchez M, Goni A, Merino D, Del Moral O, Tellez E, Mogollon E. Effectiveness of early physiotherapy to prevent lymphedema after surgery for breast cancer: randomized, single blinded, clinical trial. British Medical Journal 2010; 340: b5396.

      LeDuc O, Peeters A, Bourgeois P. Bandages: scintigraphic demonstration of its efficacy on colloidal protein reabsorption during muscle activity. Progress in Lymphology XII, 421-423, 1990.

  34. Night Compression Garmet & Compression Pump
    Question (Lori , ):
    • I have Lymphedema in my left arm, breast, and trunk. I manage my beast and trunk Lymphedema wearing a compression bra and compression camisole around the clock. On my left arm I wear a compression sleeve and glove at night and if my schedule permits throughout the day otherwise I do not wear the sleeve and glove during the day. I do stretch exercises, yoga, and massage with a Lymphedema massage therapist. I do not think my arm is increasing in size but it is not reducing either. I have read of night compression garments and compression pumps. My primary goal is to decrease the size of my arm but I would also like to be able to move about the day without a compression sleeve and glove, do you think a night compression garment or compression pump would benefit me as a maintenance therapy in decreasing the the size of my arm.

    Answer:
    • Feb 2018

      Hi,

      Generally, you do not want to sleep in your elastic sleeve and glove. These items are typically used during the day to prevent increased fluid from moving down the extremity, however, do not reduce the swelling. Have you been treated by a lymphedema therapist? Have you been taught self bandaging or been provided a nighttime garment to provide a working pressure?

      Sorry to answer your question with questions. Please feel free to email me directly at .(JavaScript must be enabled to view this email address).

      Thanks,
      Cynthia

  35. abdominal and thigh wrapping
    Question (Stephen, ):
    • My husband has systemic lymphedema. We can easily wrap the two legs and arms and toes. We tried to wrap the thighs but the bandages always slide down. We have problems wrapping the thighs and abdomen which are also heavily affected. Our physical therapist does not know how to wrap the thighs and abdomen and which products to use. Please advise. Thank you

    Answer:
    • Feb 2018

      Hi,

      Without knowing your husband, it is difficult to make a recommendation that will work, but here goes. Your PT may want to try using Rosidal soft 12 cm rolled foam for the thighs and abdomen and it will help to prevent the bandages from slipping.

      Otherwise, I often recommend a compression short, even a “spanx-type” garment to help control the abdominal and thigh swelling as well. This can be used under the compression wrapping if comfortable.

      I hope this helps,

      Cynthia
      .(JavaScript must be enabled to view this email address)

  36. Mrs.
    Question (Eileen, ):
    • I am a 72 year old widower. My husband had a heart attack at the age of 39. We adopted a boy at the age of 5 days old and he died at the age of 33. Six months after my son’s death, I was diagnosed with breast cancer. I had four lymph nodes and a tumor removed from the left breast. My cancer journey started in August 2016 and September 7, 2017 I completed chemo and radiation treatments. I had the HER-2 factor which involved more chemo. My question is that about a month later I developed severe lymphedema in my left arm and leg. I have been with a physical therapist for lymphedema; I have a compression sleeve and glove that I wear almost 24/7. I have the lymphedema pump with the arm and leg sleeve. I have been pumping twice a day for at least an hour or more each time since November 22, 2017 and I have not seen any improvement. What else can I do to release the swelling/fluid especially in my hand? The hand is so tight. I try to elevate it but it is not the easiest thing to do. Looking for some relief! Thank you

    Answer:
    • Feb 2018

      Hi.

      I’m sorry that you have been struggling. Although with traditional lymphedema treatment therapists work to reduce the swelling and fit with a garment, however, this does no work for all.

      The problem is that not all patients react the same way to treatment. What kind of pump do you have? If it is the flexitouch, use it as directed, however if you have a more traditional device, you do not need to pump more than 30-45 minutes a day.

      Have you been taught self bandaging? Do you have a nighttime garment? Does your therapist do manual lymphatic drainage with you? Do you have an individual exercise program to assist in lymphatic flow?

      I’m sorry that I have so many questions, but lymphedema can be treated differently and I think we need to fill the gaps in care.

      Thanks so much,
      Cynthia

      Feel free to contact me directly: .(JavaScript must be enabled to view this email address)

  37. Acute Care Lymphedema Treatment
    Question (Mel, ):
    • Hi Cynthia, I am a physical therapy student finishing up a rotation at a large acute care hospital. This hospital does not have a lymphedema certified PT on staff, and I am planning an inservice to better educate the therapists on lymphedema. That being said, I was wondering what you thought was the most beneficial thing that PTs/OTs can do for patient's with lymphedema in the acute care setting especially when you may only be seeing them for a few days before they are discharged to a new floor or setting. Is education and referral to an outpatient specialist most realistic, or would teaching a patient upper or lower extremity exercises be beneficial? From what I have gathered from asking other providers/professionals in our hospital network, the hospital I am at does not have immediate access to treatment garments and would most likely be unable to receive them in time for patient discharge if ordered. Thanks in advance!

    Answer:
    • Jul 2017

      I am sure that every clinician would have a different answer to this question, but I truly believe that education about the risk of lymphedema post-surgically is of the utmost importance.

      Teaching active range of motion exercises, precautions, and a little about lymphedema therapy would be helpful.

      I do not believe in fitting patients with compression garments in the acute stage of care as much of what you are seeing is post surgical swelling, NOT true lymphedema. If a patient is non-surgical than they likely have been hospitalized for an infection, and the swelling would need to be reduced prior to fitting someone with a garment to prevent future infections.

      If a therapist is trained in lymphedema therapy, they can bandage to encourage increased lymphatic flow.

      Hope this helps.

  38. Occupational therapy student
    Question (Delta, ):
    • Dear Ms. Schecter, I am a future OTR in training, I am interested in lymphadema, ,specifically the treatments, exercises, and compression garments. I am nearing graduation and wondering how I can get more exposure in this area. I live in San Antonio TX, but any help on how I can proceed will be greatly appreciated.

    Answer:
    • Jul 2017

      Congratulations and welcome to a wonderful profession. As a new graduate, you can try to find facilities offering lymphedema therapy in your area and ask to observe. If you have a full time job lined up, look for a private facility with flexible hours.

      You could also, proactively, attend a continuing education or certification class. I also suggest completing a breast cancer rehabilitation course so that you can completely assist in a patients recovery.

      There are many certification programs for lymphedema therapy, and, LE&RN; is actually running a scholarship program for therapists looking for financial assistance with training.

      I hope that this helps, and I wish you the very best.

  39. Test Question
    Question (Steve, ):
    • Hi Cynthia, This is just a test question. When you have a chance, can you forward me the email that you get about this question? Thanks so much! Steve Palmer

    Answer:
    • Jul 2017

      never received

  40. cording
    Question (Belinda, ):
    • I'm 5 months post op mastectomy, ALND and reconstruction. I had severe cording that extended down to my thumb which has improved a lot due to physio I received. I have had to change my physio and I am getting conflicting information. I wonder if you can help. My previous therapist was gentle with the cording, advising strongly against heating and aggressive massages. The current therapist I am seeing believes the exact opposite. She says that cording requires a brutal approach and that if the cording isn't treated it could lead to lymphedema.I do have strange sensations in my affected arm and hand with mild swelling that comes and goes. I am concerned.

    Answer:
    • Apr 2017

      Hi,

      Therapists differ which can become confusing for patients, but that is because often we go based off of our experiences. Patients are treated particularly cautiously in the early stage post-operatively. Initially patients are provided with gentle stretching exercises, soft tissue mobilization, manual lymphatic drainage, and gentle joint mobilization.  Therapists use their judgement in terms of the amount of pressure to use with manual techniques and often manual fixation of the web in the arm accompanied by stretching can produce a non-painful, breakage of the web which results in increased mobility of the shoulder.  Often axillary web is accompanied by scar formation and adhesion which increases pain and movement limitations which can be helped with scar mobilization and stretching. Personally, I do often employ a more aggressive manual technique depending on patient tolerance.

      I hope this helps.

  41. therapist
    Question (Barbara, ):
    • I am 80 years old and am traveling on a plane in April. What precautions can I take ? Have you heard of Medshoola Compression Pump? I found this on the internet. It is not FDA approved but it is portable and weighs less than 3 lbs. I runs on battery. I would appreciate any information you can give me. thank you so much. Gratefully yours….Barbara Galler  Thanks again.

    Answer:
    • Mar 2017

      Hi Barbara,

      Although I am unfamiliar with the Medshoola, I have used other very similar devices in the past. My issue with these pneumatic devices is that they do not have a foot/toe/ankle component which has a tendency to cause fluid pooling in the distal extremity. Have you looked at other devices? They are not as light and portable, however, they do compress the distal extremity so the issue of fluid pooling does not exist.

      Here are a few of devices for you to research:

      http://biocompression.com/
      http://www.lympha-press.com/
      http://www.tactilemedical.com/products/flexitouch/
      Huntleigh Healthcare Flowpress Hydroven Fpr Pump, 5.25 lbs
          (I have never used this device, but it appears to be more portable                                     than any others and it has 4 chambers which is ok)

      Hope this helps,
      Cynthia Shechter
      http://www.shechtercare.com

  42. 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:
  43. 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.

  44. 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.

  45. 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

  46. 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

  47. 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

  48. 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?

  49. 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!

  50. 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.

  51. CDT not successful for my daughter, what do I do?
    Question (Mary, ):
    • My daughter is 16 and around 3 years ago her groin swelled slightly. They thought it was a number of things but blew it off. A few years later, her right leg swelled dramatically. We went through everything, cancer, arthritis, etc. She has had only one incident where her foot swelled. Most of the problem is above the knee in the thigh. We did the bandages for weeks on end and she got close to the same on each side. But both times we have tried special garments they don't hold her even though she wears them all day. She is a fit and healthy athlete other than this. The garments do no more for her than the off the shelf stockings which also don't really work. We are both devastated that her weeks of bandaging herself were for nothing and that the therapy didn't work. She had a therapist but she is out on a medical emergency and we don't know if she'll be back and really the vascular surgeon doesn't seem to know anything. I don't know what to do to help her. Please help me, what do I do? Do the pumps make matters worse and cause dependency? I can't stand the thought of putting her in bandages again. She is a really cheerful kid but this is getting to her.

    Answer:
    • Feb 2016

      Response from Cynthia Shechter

      I believe that use of sequential compression pumps, in conjunction with manual lymphatic drainage, multi-layer compression bandaging and exercise, are quite useful. Individuals respond differently to different devices, and there are many devices available on the market.  At my clinic, prior to treatment, many clients go on a different compression pump for 15-20 minutes prior to manual therapy to help decrease tissue fibrosis, assist in breaking down protein molecules and stimulate the veins to work better. We find that this helps increase responsiveness to manual lymphatic drainage. There is a lot of data out there supporting use if the vaso-pneumatic pump in conjunction with therapy and compression. Although I typically use 40-45 mmHg, a study performed in 2002 found that a compression gradient of 40-50 mmHg was both safe and effective.  I have never heard of “dependency from pump use. If you would like to read the article, here is the reference information. Szuba A, Achalu R, Rockson S. Decongestive lymphatic therapy for patients with Breast Carcinoma-Associated Lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression. Cancer 2002; 95: 2260-7.

      Many clients are discharged from therapy with a self bandaging regimen because bandages (short stretch) are applied to provide a working pressure to the tissue. While the bandages are on, the muscles pump against them, stimulating lymphatic flow and decreasing overall girth. The hope is that the body will learn that there are different drainage points that can help the inefficient ones. I do modify the wrapping to increase a patients ability to tolerate them, and try to utilize as little padding as possible to make them more tolerable. I am also flexible with the amount of time an individual stays wrapped. Sometimes, leaving the bandages on for 2-4 hours is enough. Many of my patients wrap at night before bed, and wake up in the morning and remove them. My overall theory is to assist patients in living with lymphedema, not for it. What I mean by that is that it is important for a clinician to listen to what each individual says regarding their care and tolerance of bandages, including time spent wrapping and being wrapped. Nothing in this world is all or nothing, lymphedema is no exception.

      I am so sorry that you and your daughter are struggling and hope that this answer is helpful and if you need any further information, please let me know.

      Take care,
      Cynthia

  52. Compression Strength
    Question (Tia, ):
    • I was just diagnosed with primary lymphedema of both legs 6 months ago after being misdiagnosed for 6 years. I started seeing a lymphedema therapist and learned the basics in regards to bandaging, proper compression and MLD. I also received a pneumatic pump (Flexitouch) that I use on one leg a day for 60 minutes. It seems that once I was diagnosed the problems with my legs have only gotten worse. The legs are well maintained and regain a softer feel when in bandages but long term they are not feasible for me. Bandaging both legs up the thigh is extremely time consuming and limiting. But as soon as I put on thigh high compression stockings of 40-50 mm/mg my legs progressively get bigger day after day. They decrease a bit at night (I do not have a night garment) but get larger and harder as the days go by until I put the bandages back on. I even tried putting a second compression stocking (lighter weight 30-40 mm/mg) over the 40-50. Should I be looking at an alternative like the CircAid, Solaris, or Farrow full leg velcro options to wear on at least one leg in place of the time consuming bandages? Will a night garment help so I can remain in a compression sock without the relapse? Also, how many times a day should I be doing MLD? Is once a day sufficient and should it be done before the pump? All things concerned with the bandaging, pneumatic pump and 45 minutes of MLD the day is quite full. Thank you.

    Answer:
    • Feb 2016

      From Cynthia Shechter

      1) Flexitouch:

      I believe that use of sequential compression pumps, in conjunction with manual lymphatic drainage, multi-layer compression bandaging and exercise, are quite useful. Individuals respond differently to different devices, and the FlexiTouch is one of many devices available on the market.
      At my clinic, prior to treatment, many clients go on a different compression pump for 15-20 minutes prior to manual therapy to help decrease tissue fibrosis, assist in breaking down protein molecules and stimulate the veins to work better. We find that this helps increase responsiveness to manual lymphatic drainage.
      2) Self Drainage:

      If you do not notice an improvement in your swelling after performing self MLD, I recommend stopping. Try wrapping and exercising instead. As your muscles pump against the bandage they stimulate lymphatic flow and assist in the reduction of swelling. If you find that self drainage works, 1x daily is plenty. That said, since the FlexiTouch is supposed to mimic manual lymphatic drainage, I’m curious if you notice a difference between using the Flexi before/after manual lymphatic drainage vs. not performing manual drainage at all.
      3) Wrapping and Nighttime Garments:

      I find that for many clients, it is easier to bandage at night, before bed, and remove the bandages in the morning. If that doesn’t work, I recommend exploring some of the garments that you mentioned above. I generally prefer garments without velcro as there is less room for human error (ie: pulling velcro too tight in certain areas and not others can cause pooling of fluid and protein.) A night garment or nighttime wrapping should prevent an exacerbation of swelling as long as you are using appropriately fitting compression stockings. For more info on these garments, I suggest that you follow up with your therapist.

      4) Stockings:

      40-50 mmHg should be high enough compression, actually, most of our clients use 30-40 mmHg at the highest as the stockings can cause skin irritation at the instep and knee crease. Stockings are meant to stop increased fluid from coming down the legs, but do not reduce the swelling in your legs. Do yours maintain your legs to any extent? If not, they may not be a good fit. If your skin is being irritated, sometime, that can lend to increased swelling as it can cause inflammation.

      5) Summary
      Treatment of lymphedema involves a lot of trial and error and patience. You and your therapist may have to come up with creative ways to manage your condition, taking into account that you need time in your day for things other than lymphedema. This tends to be the hardest part of therapy, however, once you find out what your body needs to control your swelling, things will seem much more in control.
      Last year I did a webinar for LE&RN; about manual lymphatic drainage and exercise for the treatment of lymphedema. I have attached the link below. Please feel free to watch and listen so that you can get a basic understanding of what therapy will be like.
      http://datab.us/Videos/aY50SnMKrAc


      I hope this information was helpful.

      Take care,

      Cynthia J. Shechter

  53. Pre-op question
    Question (Dana, ):
    • I am 42yrs old and just had a bilateral masectomy and reconstruction. My surgeon was not able to locate my sentinal node during surgery and I am now faced with going back to surgery for an axillary node dissection. I am devastated. I was a very active person with sports and weight training. And am very worried about never getting back to the old me. Can you give me any advice? Things I can do right away to reduce my risk? Thx

    Answer:
    • Feb 2016

      First and foremost, this is a difficult time, but will certainly not prevent you from getting back to feeling like yourself and being active. If you were a mountain climber before breast cancer surgery, there is no reason that you cannot be a mountain climber after.
      After surgery, it is important that you work with a skilled therapist who will create an individualized exercise program to alleviate your pain, while increasing your mobility and strength. Shortly after surgery scar tissue may form which can impair the flexibility of your chest, armpit and abdomen. Scar mobilization will help break down the scar tissue and provide relief during stretching.

      Studies have shown that early therapy after breast cancer surgery and axillary node dissection can help to prevent and reduce lymphedema occurrence (Lacomba, 2010). Additionally, repeated muscle contraction actually helps move fluid, which can reduce the risk of swelling.

      Most importantly, working out and feeling better helps to maintain inner strength and a positive attitude, so please, do not, even for a moment, think that this part of your life is over or has changed permanently as this simply is not the case.
      References:
      Lacomba M, Sanchez M, Goni A, Merino D, Del Moral O, Tellez E, Mogollon E. Effectiveness of early physiotherapy to prevent lymphedema after surgery for breast cancer: randomized, single blinded, clinical trial. British Medical Journal 2010; 340: b5396.

      LeDuc O, Peeters A, Bourgeois P. Bandages: scintigraphic demonstration of its efficacy on colloidal protein reabsorption during muscle activity. Progress in Lymphology XII, 421-423, 1990.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163073/

      I hope this information was helpful.

      Take care,

      Cynthia J. Shechter

  54. Lymphatic Draining Massage
    Question (Elissa, ):
    • I am 70 years old and had a lumpectomy in Sept. of 2014 followed by 3 weeks of radiation. No chemo. In April of 2015 I noticed swelling in a couple of fingers of the hand on the same side as the lumpectomy followed by swelling near the underarm. The latter swelled to the degree of pinkness, redness and finally weeping. That was a staph infection. Got over that with 4 days in the hospital on IV antibiotics. In any case, the fingers are still swollen and the oncologist recommended lymphatic drainage massage therapy which I was going to do in April but the infection stopped that. I am going to resume this month. What are your feelings about this type of therapy?

    Answer:
    • Sep 2015

      Hi.

      Manual Lymphatic Drainage is a primary component of Complete Decongestive Therapy (CDT), which is the current International Standard and therapy of choice for treating lymphedema endorsed by the American Cancer Society and National Cancer Institute (Mayrovitz, 2009).

      That said, manual lymphatic drainage as part of CDT is not the same as the lymphatic massage provided at a spa, unless the massage therapist has been trained and specializes in the treatment of lymphedema.

      Last year I did a webinar for LE&RN; about manual lymphatic drainage and exercise for the treatment of lymphedema. I have attached the link below. Please feel free to watch and listen so that you can get a basic understanding of what therapy will be like.
      http://datab.us/Videos/aY50SnMKrAc

      If you have any questions along the way, please contact me. My email is .(JavaScript must be enabled to view this email address).

      You are on the right track and therapy should help to reduce the swelling and risk of infection, and you will be taught things to manage on your own.

      Good luck and I’m here if you need me.


      http://www.play.tojsiab.com/dlB4N3Vhb0RrU0Ez

  55. Lymphedema worsened by surgery on affected leg
    Question (Debra, ):
    • I've had lymphedema since 2001 from radiation/surgery for a large retroperitonral liposarcoma. I had it under control until I broke my femur and hip last year. Since then, nothing has worked to bring the lymphedema back to my normal. I wear 30/40 Juzo stockings and have worn them for over 14 years. I have a lymphedema pump, a CircAid juxta fit non elastic sleeve. I also exercise. Nothing is working. It's huge and heavy. Is this my new normal? Any advise is greatly appreciated. Kindest Regards, Debra

    Answer:
    • Jul 2015

      Hi Debra,

      It is not abnormal that your swelling was worsened initially by surgery, but it should be responding to treatment. Have you been back for MLD/CDT since you broke your hip and femur? Did you have surgery to repair the breaks? Where is your surgical site?

      Sorry to answer your question with additional questions, but I look forward to hearing from you.

      Cynthia

  56. pressure settings on compression pumps
    Question (Brigitte, ):
    • I have Stage 2 secondary lymphedema, diagnosed about a year after a mastectomy w/lymph node removal and radiation. It is concentrated in my hand and lower arm, with some fibrosis in my lower arm. My therapist recommended that I obtain a compression pump for home use. I've seen reps from 2 different companies. Both offer a sequential gradiated pump with a sleeve and vest. While the products are similar, the companies suggest very different compression settings -- one is at 20-25 mmhg and the other is around 40-45 mmhg. Is there no established medical protocol for what the proper compression setting should be? Could a higher pressure setting actually worsen my lymphedema?

    Answer:
    • Jun 2015

      Hi Brigitte,

      There is a lot of data out there supporting use of the vaso-pneumatic pump in conjunction with therapy and compression wrapping. Although I typically use 40-45 mmHg, a study performed in 2002 found that a compression gradient of 40-50 mmHg was both safe and effective. If you would like to read the article, here is the reference information.

      Szuba A, Achalu R, Rockson S. Decongestive lymphatic therapy for patients with Breast Carcinoma-Associated Lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression. Cancer 2002; 95: 2260-7.

      I hope that helps. If you need anything else, please feel free to contact me.

  57. Importance of each of the 4 steps in CDT
    Question (Jacquie , ):
    • Thank you for making yourself available to answer our questions! It is a relief to know that there is an expert to turn to when the doctors in my area are not as versed about Lymphedema. How important is each of the 4 steps in CDT if someone has Stage II, Primary Bilateral Lymphedema of the lower extremities? I just started CDT and was wondering when MLD should take place and on average, how much time should be allocated to this procedure? Is MLD done each time the bandages are removed if fluid is still present in the limb? Is it a waste of time to do MLD when transitioning to compression stockings? When you have a patient who is initiating CDT, in which the entire lower limb is effected, how long should each CDT session last? If you can break it down as to the amount of time within each of the 4 steps (MLD, bandaging, exercise, skin care) that would be helpful. If someone has bilateral lymphedema is the required time doubled? Do insurance companies regulate the amount of time each session is in CDT or if someone has bilateral lower extremity lymphedema, can the therapist bill for both limbs and twice the amount of time or number of procedures? I am trying to get a handle on standard of care and what I should expect from a CDT session. Thank you for your help! It is much appreciated.

    Answer:
    • Apr 2015

      1)  How important is each of the 4 steps in CDT if someone has Stage II, Primary Bilateral Lymphedema of the lower extremities?

      It is important to understand that each individual with lymphedema is different, and the condition should be evaluated as such. Each step to CDT is important, but what is even more important, in my opinion, is that a treatment regimen that is realistic for each individual be established. For example, my practice is in NYC, and many of my lower extremity patients have difficulty wearing bandages to the office. I modify therapy to what is realistic for them, and, although visit frequency may increase a bit, we are still able to get the swelling under control and patients are discharged to a home self management program.  In addition to manual drainage and compression wrapping at each session, I do stress the importance of skin care and exercise to achieve the best results.

      2) I just started CDT and was wondering when MLD should take place and on average, how much time should be allocated to this procedure?

      Many therapists follow the theory that treatment in the acute stages of lymphedema, should be daily over a 3-4 week time span. This becomes quite difficult for the patient and insurance does not typically approve therapy visits in that way. Session times vary, but on average MLD should be a 45-60 min session. Please note, a therapist can typically only see a patient for about 60 min total, so if there is a lot of wound care required, MLD may be performed for shorter periods of time.

      3) Is MLD done each time the bandages are removed if fluid is still present in the limb?

      If you are seeing a therapist who tells you not to remove bandages yourself, until your next session, then certainly MLD should be performed when they are removed. That said, many clients are discharged from therapy with a self bandaging regimen, and MLD does not need to be performed when bandages are removed. MLD is a manual technique to re-route fluid from the affected area to the healthy lymphatics, in it’s most simplistic form.  After MLD is performed, bandages (short stretch) are applied to provide a working pressure to the tissue. While the bandages are on, the muscles pump against them, stimulating lymphatic flow and decreasing overall girth. The hope is that the body will learn that there are different drainage points that can help the inefficient ones.

      4) Is it a waste of time to do MLD when transitioning to compression stockings?

      No, not at all. MLD is helpful in the reduction of fluid. While waiting for compression stockings to come in, it is imperative to continue with MLD to ensure that your measurements do not change drastically, which would make your new custom stockings an ill-fit. Additionally, clinical research has shown that using both compression and manual lymphatic drainage is the optimal combination to achieve a positive effect on reducing pain and volume of a lymphedema limb (Johansson, 1999).

      Reference:

      Johansson K; Albertsson M; Ingvar C; et al. Effects of compression bandaging with or without manual lymphatic drainage treatment in patients with post-operative arm lymphedema. Lymphology 32: 103-110, 1999.

  58. Compression wear
    Question (Roberta, ):
    • Hello, I am 54 yrs old and was dx with lymphedema tarda in my 20s. I have been very diligent in using compression wear with great success. However over the years the edema has been getting worse. I started with knee highs bilat 30-40 and now have to wear thigh highs. I am very active enjoying yoga, hiking, and biking. I live in New England and during the winter I can "take" wearing the stockings. However during the warmer weather I don't know what is worse, the pain from the swelling or the heat of wearing the stockings. Do you have any suggestions or links to resources perhaps for compression for athlete? Or compression wear that can be worn during the hotter months.

    Answer:
    • Feb 2015

      Hi Roberta,

      Lower extremity swelling is very difficult to manage in the summer months. What I typically recommend is that people try 20-30 mmHg of compression for the summer months, rather than 30-40, simply because the garments are lighter weight.

      I also have several patients who, despite distal swelling, utilize open toe compression in the summer months so that they have more flexibility with shoe choice. I tend to recommend stockings rather than thigh highs, both for comfort and for proximal compression.

      There is a company called rescue legs that advertises summer weight compression garments, however, I have not used their products with my clients as of yet.

      I hope that helps at least a bit, sorry I have nothing more concrete. Garments and treatment are so individual.

  59. bra for side lymphedema
    Question (Melanie, ):
    • I had breast cancer, had separate mastectomies, one with with axillary dissection (18 lymph nodes removed because sentinel node was cancerous). I have lymphedema in my hand, arm an side. I also had delayed bilateral diep flap reconstruction. I am in search of a bra that has a wide band under the breasts so the bra doesn't ride up, something with adjustable shoulder straps, side of the bra that comes high under the arm, and something that will give me compression on my side or where I can put a "swell spot" or something in without compressing my breasts. Do you know if such a bra exists? I've looked at the compression bras and I don't want to compress my breasts. Other bras I've seen just don't come up high enough under the arm to give comfort because of the side lymphedema. Another problem I have is that I am small. I wear between a 32 and 34 with a small "b" cup.

    Answer:
    • Feb 2015

      Hi Melanie,

      It is very difficult to find a bra meeting all of your needs, but I think I was able to find something. Have you ever looked at Leonisa bra’s? I have never seen one myself, but it looks like it will give good support, accommodate the swell spots as needed, and has an adjustable back to help prevent riding up. Please let me know if this works for you so that I know if it is a good option for others. Please see the link below:

      Best of luck and if I can help with anything else, I’m here.

      http://www.leonisa.com/en/products/perfect-everyday-posture-corrector-bra/

  60. compression therapy
    Question (Pamela, ):
    • Do you believe in compression therapy to help lymphedema? I have heard that compression pumps are very helpful. Where can I find one? Thanks, Pamela

    Answer:
    • Dec 2014

      I believe that use of sequential compression pumps, in conjunction with manual lymphatic drainage, multi-layer compression bandaging and exercise, are quite useful.

      At my clinic, prior to treatment, many clients go on the compression pump for 15-20 minutes prior to manual therapy to help decrease tissue fibrosis, assist in breaking down protein molecules and stimulate the veins to work better. We find that this helps increase responsiveness to manual lymphatic drainage.

      While there have been clinicians and patients who have not had good results with pumps and do not recommend their use, hundreds of people have experienced great results with the proper use of the right pumps. Pumps are not for everyone, and success does depend on which pump is used, and the proper application of pumps.

      When looking for the right device for you, look for a pump that contains multiple chambers, operates on a short thirty-second cycle time, and applies graduated compression. The body operates on a pressure gradient system, so it is imperative to obtain a gradient or graduated compression pump. Gradient or graduated means the pressure at the feet or hand is greater than the thigh or shoulder.

      In my clinic, we quite often order a compression pump as part of a home management program for our clients. Typically we obtain authorization, etc for our patients, so I recommend contacting your rehabilitation therapist or physician to discuss.

      I hope that helps, and if you need any further information, please let me know.

  61. Bilateral mastecmy w reconstruction
    Question (Reba, ):
    • I have Lymphadema in R arm not in left . Unfortunately I'm one those % wasn't told I could get Lymphadema from surgery Q: if had 2 lymphnodes removed Fr left arm chances of getting Lymphadema & what to do to prevent ?

    Answer:
    • Oct 2014

      Well, the data states that you have between an 8 and 14% chance of developing lymphedema in the left arm. (at least when I last checked) All that you can do to prevent lymphedema is increase your range of motion, loosen as much scar tissue as possible and get on a strengthening regimen. Also, be sure to use SPF 30+ and have neosporin handy if you get a scrape/cut/bite. Do you have a rehab therapist near you who can do an evaluation and see how your motion, scar tissue, etc is?