Be careful not to wear clothes that prevents the lymphatic outflow; it is not uncommon that de-haematisation is significantly slowed or even prevented by clothing fastenings.
Garments responsible for this are:
- Bras with straps that are too thin or tight;
- Breast prosthetics (sometimes too heavy) can cause constriction in the region of the edge of the trapezoid, decisive for the de-haematisation of the arm
- Watch and jewelry straps worn on the affected arm may result in injury or compression: It is recommended not to wear them
- Underwear, such as underpants which are too tight, corsets, etc. may represent garments which block the lymphatic outflow in patients with lymphedema of the leg or who are subject to this risk
- With shoes or even with socks that are too tight there is a danger of pressure zones or the formation of blisters on the feet, which can very easily lead to inflammation and thus worsening the patient’s condition
Since, by experience, the arm or leg affected by edema tends to be subject to inflammation, it is absolutely necessary to devote much attention to its hygiene.
The products to be used for the care and cleaning of the part, must not load the skin further:
- By destroying the acid mantle
- Leading to allergies caused by addictive substances
- Products used in the medical field are recommended, which are usually suitable to the pH of the skin (slightly acidic, about pH 5.5)
- A risk of injury not to be undervalued is represented by the care of fingernails and toenails. Under certain conditions foot care should be left to an expert
- By exposing yourself to heat sources, even unwittingly, as in the case of hot baths or showers, or even hair dying apparatus which are too hot at the hair salon, may be, in some cases, a cause for the formation of edema; they are absolutely contraindicated in the case of lymphedema manifest. This should be explained to the patient in an appropriate manner, so that he understands the reason why the excessive heat is detrimental. Quality of life should not be affected by the lukewarm temperature of a shower.
Hazards in domestic and professiona life
Obviously it is not possible to list and evaluate all of the sources of danger in everyday life that may aggravate existing edema or possibly cause it here. Only the more frequent dangers and observed in the medical history will be cited by way of example.
It is also not recommended to load the patient with too many restrictions and prohibitions, but make to him/ her aware of the particular position the patient is in. It is important to keep the edema affected limb as elevated as possible, rather than sit for hours with this leg dangling or crossed. Patients with edema need more pauses than healthy subjects, so that there is the ability to activate the muscle pump. It is very important to explain the danger that comes from injuries caused during activities such as gardening (thorns) or housework (cooking with gas) to the patient and instruct precautionary measures, such as gardening gloves, grips for the kitchen, etc.
Walking barefoot should be absolutely forbidden, both for those suffering from and those at risk of developing lymphedema.
Excessive fatigue should be avoided.
In many cases sporting activity should be limited to:
- taking short runs (with breaks)
- slower-paced swimming
- Patients should not stay too long in the sun, because sunburn can bring unintended consequences.
Even the often suggested proposal to cover the lymph-edematous limbs during sunbathing should be avoided, pointing to the danger of sunburn on the whole region of edema outflow- important on a therapeutic level – and recalling that the effect of the sun increases skin temperature with negative consequences. Also it is very important to recommend the use of protective aids during leisure activities (embroidery, DIY, etc …).
The cooperation of the patient is also expressed by:
- Wearing a bandage
- Wearing a protective compression sheath
- Following a brief exercise and respiration program.
In the case of rehabilitation measures or when prescribing additional implementations in Physical Therapy it should be noted that:
- they do not conflict in combination with Manual Lymphatic Drainage.
Therapies such as:
- Classic massage or mechanical therapies in the edematous region as well as in the outflow areas or for those at risk of edema are to be avoided.
- Even the exercise treatments that lead to excessive stress and pain to the affected extremity, represent a serious danger.
- Use of heat such as soaking, medical bathing at temperatures above the lukewarm level, use of hot air, irradiating heat, saunas and solariums.
- The above mentioned fall into the category of absolute contraindications, regardless of the type and location of the application.
The patient should also be made aware about:
- Injections and transfusions
- Blood samples
- Pressure measurements
- Acupuncture, etc.
which should not be exercised on the affected limb.
It is also advantageous that the patient brings with him a preventive means against inflammations (ointments prescribed by a doctor) and a set of sticking plasters or spray plaster, in order to take immediate action in case of injury (even trifling things have to be taken into account) and prevent further spreading of the wound.
There is an additional responsibility for overweight patients, when dietary counseling on the type of diet to follow is recommended.
Everything that limits the outflow of lymph vessels and could give rise to the formation of new edema liquid should be avoided in general