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HIGHLIGHTS OF GARMENT FITTING PAGE

How Should They Fit?

Sleeves

Gloves/Gauntlets

Examples of Good Fit

Examples of Poor Fit

Is just a sleeve enough, or do you need hand protection as well?

Off the Shelf/Custom Made

Circular Knit/Flat Knit

Millimeters of Mercury and Compression Class

What else should a fitter do?

Helping you "don" (put on) Your Garments

Instructions in Garment Care

What To Do If It Does Not Fit

When You Should Order New Garments

How Should Garments Feel

What It's Like to Wear Compression Garments

 

   

 

 

PROPER FITTING OF AND CARE FOR SLEEVES AND GLOVES/GAUNTLETS

Brand new to compression garments? How hard can this be? After all, we've spent our lives trying on all sorts of garments, even unfamiliar ones. It's always an occasion. The first flowery dress-up hat and little white gloves. That longed-for (or dreaded) training bra. A wobbly maiden voyage to the theater in a new pair of high heels. Braving the mysteries of Victoria's Secret for a silky black negligee. You may never have owned anything like it before, but you know it fits because it feels right, and it looks right too.

But immediately you know this time is different. All those other milestones were predictable, rites of passage that you knew were coming. Everybody else did too. Lymphedema is different. You didn't expect it, and the chances are nobody you know did either. But here you are, needing compression garments, wondering what this new experience will hold. A few words of warning and encouragement are in order.

HOW SHOULD THEY FIT?

A good garment fitter is a real gift. S/he can ease your transition to compression garments with careful measurements, a wise selection of brand and style, simple instructions for donning and laundering, and lots of encouraging words along the way. If your garment fitter is like that, make the most of it. Bake her a batch of brownies as a thank-you, or drop her employer a letter of commendation. Either will be appreciated.

But what if you're not that lucky? In that case, it pays to be smart instead. Maybe your fitter is first and foremost a shrewd businessperson, only secondarily concerned about doing what's best for you. She has a bunch of garments on hand, and one or more of them are close to what you need. Close, but not quite. The sleeve you need is long, but she's only got it in regular. The gauntlet doesn't quite cover your knuckles. Your upper arm is a bit more swollen than the size chart indicates, but the rest of the sleeve fits fine. The sleeve you need is a 20-30mm/Hg compression level and all they've got in your size is a 30-40. There's a gap at the wrist where the sleeve and glove don't quite meet – just about, but not quite.

Close enough, right? WRONG! You're not there to close out the fitter's stock, but to get the garments that are exactly right for YOU. Have no pity!

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Insist on a Sleeve that:

  • reaches comfortably from wrist to axilla

  • does not bind anywhere along it's length

  • does not cause bulging at the wrist or top of arm

  • does not leave long-lasting indentations at wrist or top of arm when removed

  • is not so loose at any point that it gaps or overlaps itself

  • does not slip down the arm when active (this can be achieved with either a non-slip top band or an application of a liquid adhesive such as It-Stays)

  • does not cause pain

  • see examples of properly fitting sleeves below

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Hold out for a gauntlet or glove that:

  • comfortably covers your knuckles

  • overlaps the sleeve by at least an inch or two so there is no separation even with movement and exercise

  • does not turn your fingers any shade of purple, blue, bright red, or white

  • does not cause your fingers to tingle or turn cold

  • does not cause your fingertips to swell like mini-sausages

  • is not loose at any point around wrist, palm, or (for gloves) fingers or thumb

  • does not cause pain

  • see example of properly fitting sleeves below

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Here are some examples of properly fitting sleeves, gauntlets and gloves:

With the arm extended, sleeves are smooth along their entire length, axilla to wrist, with no wrinkles and no excess fabric.

Gloves and gauntlets are long enough to cover the intended areas comfortably, with no gaps between glove and sleeve.

 

 

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Below are some examples of poorly fitting sleeves, gauntlets and gloves:

This sleeve is too short, leaving the upper part of the arm unprotected.

The bulging skin at the top of this sleeve indicates that the sleeve is too tight at the top.

 

Wrinkling, such as this in the wrist area or elbow area, can block the flow of lymph instead of promoting it.

Bunching of the sleeve will restrict lymph flow.

A gap between sleeve and glove will allow the exposed area to swell; the two garments should overlap at the wrist.

Gauntlets should cover the knuckles of the hand. Falling short like this can push fluid into the fingers and top of the hand.

 

IS JUST A SLEEVE ENOUGH, OR DO YOU NEED HAND PROTECTION AS WELL?

The answer to that question will depend on several factors. If you are wearing garments to reduce your risk of developing lymphedema, you'll definitely want a gauntlet or glove to prevent any swelling from becoming trapped in your hand. If you already have lymphedema in your arm, and your hand is not yet involved, the decision to use hand protection or not is one you and your therapist should discuss. If you choose to wear the sleeve alone, be alert for signs of new swelling, tightness or heaviness in your hand, and move quickly to using hand compression (either garments or hand wrapping). This article by Dr. Andrea Cheville from the LympheDivas website explains your options in more detail.

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 WHAT IS EVERYBODY TALKING ABOUT?

The world of lymphedema garments has a language all its own. Here's a partial list of terms to help you speak it like a native!

 "Off-the-shelf" and "custom made"

Sleeves, gloves and gauntlets come in pre-made sizes, referred to as "off-the-shelf" (or "ready-made") that fit an average hand or arm in a range of sizes. There are small, medium and large sizes as well as categories for short and long hands and arms and for extra fullness in the upper arm. Off-the-shelf garments are frequently used for those who are at risk for developing lymphedema and wear their garments only for travel, exercise and strenuous activities. If the fit is good they're an efficient and relatively inexpensive choice. Several brands of off-the-shelf garments in a variety of colors and patterns can be ordered on-line without a prescription. Be sure to see a skilled garment fitter or lymphedema therapist for measurements before you order on-line.

Of course many people can't get a good fit with off-the-shelf garments. And there are also many therapists who prefer sleeves and gloves fitted exactly and precisely for each individual lymphedema patient. These specially fitted garments are called "custom made." Naturally they're more expensive than buying off-the-shelf, but they can be adjusted with every order to meet your on-going compression needs.

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"Circular knit" and "flat knit"

Most off-the-shelf garments are "circular knit," which means they're knitted continuously in a circular pattern that results in a roughly cylindrical shape with no seams. Custom made garments, on the other hand, are most often "flat knit," or cut to the proper size from a flat piece of knitted fabric and seamed into shape. Circular knit garments are generally lighter in weight, and many people prefer the seamless look. Flat knit garments can be cut from a wide range of breathable fabrics and may include such features as zippers or extension panels to ease joint flexibility.

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"Millimeters of mercury" and "compression class"

Unfortunately, size is not the only consideration in fitting a lymphedema garment. The amount of compression your garment applies will vary according to your specific needs and the stage of your lymphedema. This compression level is measured in units called "millimeters of mercury." It's written in scientific shorthand like this: mm/Hg. (The "mm" stands for millimeters, and the "Hg" is the chemical symbol for mercury.) Compression garments are ordered by "compression class," or the range of compression you need, stated in millimeters of mercury.

Here's a run-down of compression classes recognized in the United States, along with their usual uses (which may vary with individual circumstances):

  • Class 0: 15-20 mm/Hg – used for those at risk for lymphedema

  • Class I:  20-30 mm/Hg – used for those at risk, or for early or mild lymphedema

  • Class II:  30-40 mm/Hg – used for moderate or severe lymphedema

  • Class III:  40-50 mm/Hg – used for severe or hard-to-control lymphedema

To add to the confusion, European compression classes differ slightly from their US counterparts, like so:

  • Class I: 18-21 mm/Hg

  • Class II: 23-32 mm/Hg

  • Class III: 34-46 mm/Hg

There is a Class IV as well, with higher numbers of millimeters of mercury, but they are rarely used for arm lymphedema.

The fabric used in your garment may be soft (like Juzo's "Varian Soft") or sturdy (like Jobst's "Elvarex"), or somewhere in between. It may feel flexible or stiff, smooth or rough. All these factors add to your sense of the fit of your garment, and to its effectiveness for you as well. An experienced fitter takes fabric choice into consideration in order to provide you with the garment best suited to your specific needs. A compression sensitive person may need a softer fabric to prevent her fingertips from turning an unhealthy shade of purple, while a person who tends to develop fibrosis easily may do better with a firm and sturdy fabric –even if they both require the same compression level-

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WHAT ELSE SHOULD A FITTER DO?

A good fitter is crucial, and usually a reputable lymphedema therapist will have a relationship with a fitter or be one themselves. Coverage for lymphedema garments varies by insurance, but almost always requires a prescription. You should clarify your insurance coverage before placing an order. In the past, the internet was a source for discounted garments, but one by one the manufacturers are forcing the internet distributors to raise their prices. Usually internet sites will not be "in network," so you should check with your insurance carrier about what is covered and what providers of durable medical equipment (the classification for compression garments) are in network.

Unfortunately, the quality of a fitter's knowledge and training can vary widely.  Also, many therapists and fitters will have a favorite brand, and tend not to consider the whole scope of available garments, or may not even know about them.  Additionally, lymphedema garments are not universally stocked at durable medical equipment companies, and while they may be in plan for leg stockings, they may know nothing about how to measure and order for upper extremity and chest and trunk lymphedema.

So, check with your therapist.  Check your benefits with your insurance carrier.  And if your insurance coverage is minimal or none, compare internet site prices.

If you choose to order your garments through the internet, do so only after being measured by your fitter/therapist for the proper size, and be sure to have your therapist check the fit when you receive your garments.

For insurance coverage, the reason for the garment needs to be coded correctly: here's a link to coding from Lymphedemapeople.

Once your garments are ready to try on, a competent and experienced fitter will have a routine that includes the following:

Helping you don (put on) your garments

The first time out, wrangling your way into a skin-tight glove or sleeve can be a daunting job.

Always "promote" your lymph flow with manual lymph drainage massage before donning any of your compression garments.

The fitter will show you how to fold the garment down and work it into place. It will need to be smoothed into position, wrinkle-free and without twisting, so it won't irritate your skin. Sleeve seams should run straight and lie in a comfortable line (preferably not directly over your elbow). Getting it smooth and perfectly aligned is easiest if you wear a sturdy rubber donning glove (with grips on the palms/fingers) on your opposite hand. (Shown on the right.)  In fact, the effectiveness of a rubber glove with grips on the palms/fingers in smoothing and aligning a compression garment is almost magical. Many fitters supply these as standard donning equipment; if yours doesn't offer you a rubber glove with grips on the palms/fingers during the fitting, be sure to ask for one.

 

Jobst has recently put out a wonderful new donning glove in a soft knitted fabric that has a gripping surface on the palm.  We have found this even easier to use than the rubber donning gloves.  Many fitters also recommend that you place your hand against a wall, palm flat on the wall, to make it easier to smooth your sleeve evenly, wrinkle free and without twisting, while using your donning gloves.  Once you get the idea, practice taking your garments off and donning them again, with the fitter watching and coaching, before you take them home.

 

 

 

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If donning your sleeve is still difficult, there are devises available to help you, such as the or the Juzo Slippie (shown on left)  Arion  for Jobst Easy-Slide (shown on right). These are sturdy tubes made of a slick fabric, with fabric loops attached to one end. You put the tube on your arm with the loops hanging off your hand, slide the sleeve into place on top of it, then use the loops to haul the tube out from under the sleeve. Since it works best if you're holding the top of the sleeve in place with your other hand while removing the tube, you can either ask someone to pull the loops for you or hook them over your foot or a handy door knob for pulling. Some women have succeeded in using plastic grocery bags as donning devices.

 

Another option for donning sleeves is the Ezy-As, a sturdy plastic framework you can stretch your sleeve over (rubber gloves or donning gloves make this easier), then apply the sleeve in one smooth movement up your arm. With a minimum of practice this device will gently lay the fabric smoothlly and exactly where you want it. There is no tugging necessary to remove the Ezy-As, which makes it a good choice for those with fibromyalgia or other skin sensitivities, as well as for application over wound dressings.

We once again reviewed this product at the 2012 NLN Conference in Dallas and were indeed impressed not only with ease of application and smooth, wrinkle free application of the sleeves on the arm, but were impresssed that it worked just as well on heavy, custom made and even Elvarex® sleeves with or without gauntlets attached.

We also found it fabulous for donning compressios stocking (which many of us survivors, with or without lymphedema, need to wear when flying because of the cancer preventative drugs we take which could cause blood clots or DVT's.)

The only way to see just how this product actually assists in doning compressioin garments is to go to their website and watch the videos of garments actually being donned.  You can see the videos at http://www.eastcoastinnovativeconcepts.com/ezyas.html toward the left of the page.

If the sleeve style you've chosen does not have a silicone band at the top to keep it in place and prevent slippage, you may need to use a skin-safe adhesive, such as "It-Stays," to keep your sleeve where it belongs throughout the day.

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Checking the fit

Your fitter will check all the points discussed above. You can help by bringing up any questions or concerns as soon as you notice them. Some problems won't become obvious until you've worn the garment for a while, so have your fitter explain the return policy on your garments before you sign for them or take them home. Return policies are generally more generous for custom made garments than off-the-shelf, but either way you should be clear about the time frame and conditions for returning your sleeve or glove if problems develop.

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Instructing you in garment care

Compression sleeves and gloves will never be your favorite fashion accessories, but they're likely to be among your most expensive. So caring for them properly and extending their useful life will save you time, trouble and expense.

Garments need to be washed frequently to maintain their effectiveness.  The frequent washing restores the compression that gets stretched out from wearing, and it also ensures that they're as sanitary as possible.

Different garment manufacturers have varying suggestions for laundering their garments, but most allow for gentle machine washing at warm temperatures on a gentle cycle, using a mild laundry soap. Do not use bleach or other laundry additives. Air drying is usually recommended.

Another handy way to wash bandages without them getting all tangled in the washer is a standard netting laundry bag and using hem tape sew channels into the bag.

 

Ingredients in some skin lotions can damage the stretchy fibers of compression garments, so bring your favorite lotion brand along with you and ask your fitter to check the ingredients for compatibility. (Some garment makers sell their own brands of laundry or skin-care products as well. You may wish to purchase these since they are specially made for your garments, but they can be expensive; suitable substitutes are readily available as long as you read labels carefully and are aware of the ingredients to avoid.)

  • The fitter I had told me when the silicone on the top of the day sleeve seems to be slipping to use rubbing alcohol on the silicone. This will sort of renew it so it will do its job again. - Jennifer

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 WHAT SHOULD YOU DO IF IT DOESN'T FIT?

A compression garment that doesn't fit properly is not only useless for controlling your lymphedema, it's downright dangerous. Please insist that the professional who fitted you accept the responsibility for assuring your garments are safe and effective. If they refuse to replace a poorly fitting garment, contact the garment company representative responsible for your area and explain your concerns. Request that they replace the offending garment and retrain the fitter so that the problem will not be repeated. It's a battle none of us wants to fight, but fighting it returns some much-needed control to our lives, and it sets precedents that others with lymphedema can build on.

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WHEN SHOULD YOU ORDER NEW GARMENTS?

Many garment manufacturers suggest replacing your compression garments every six months, and most insurance companies will not pay for replacement garments more often than twice a year. But the actual useful life of your garments depends on several factors. When you receive your garments, use a fine-tipped permanent marker to write the date on the tag. That will help you keep track of when to re-order. If your insurance will be paying, you may also need their approval before the order can be processed, so allow extra time when you re-order.

You'll need to monitor the fit of your compression garments all along, because even minor weight gain or loss can affect their usefulness. A gradual improvement or worsening of swelling in any specific area can also cause garments to sag or constrict, losing their ability to control your lymphedema. 

Some fabrics wear better than others. Softer fabrics may need to be replaced more often, while sturdier sorts may last beyond the "magic" six-month mark. 

Darker-colored garments don't show the grubby ground-in dirt and food stains that lighter garments do; that may be a consideration in how often you'll want to order new compression wear. As with any other kind of clothing, wear and tear varies depending on the types of activities you do and the degree of care or abandon you do them with.

It's a good idea to be re-measured each time you order new garments, even if you think the old ones still fit. This will alert you to any changes you may not have noticed over time. But even if there are no changes, be prepared for a surprise when the new ones arrive. Your old ones have stretched out a bit, but so gradually you haven't noticed, and the new ones will likely feel impossibly tight. Stay calm, and use the fitting guidelines above to assure yourself of the perfect fit all over again.

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HOW SHOULD GARMENTS FEEL, AND WHAT CAN YOU DO ABOUT IT?

Comfort

A compression garment is a thing of amazing precision and brilliant engineering. It combines all that's best in modern fiber technology, physics, and medical science. After several weeks of being wrapped in yards of short-stretch bandages, it's even a source of tremendous relief. But let's face it: it's not real comfortable. If you don't like the feeling of being squeezed into your clothes, then a compression garment isn't going to feel quite right. In fact, it may feel all wrong, especially if it fits correctly and is not too loose to provide the compression you need. A compression garment that fits you well should not gap or bind or cause you pain, but don't expect it to have that welcoming feel of a worn flannel shirt on a brisk winter day. Give yourself time to get used to the feel: wear it only for an hour or so the first day, gradually increasing the time each day until you can wear it with relative ease throughout the day.

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Skin irritation

A well-fitting garment is practically guaranteed to cause a bit of irritation at first in the bend of your elbow or (in the case of a glove) on the web of skin between your thumb and first finger. It should not rub those areas raw, so if it begins to bother you, remove the garment and give your skin a break before trying it again. With your therapist's permission, you might find that an application of a bit of cornstarch on those trouble spots will help sooth the irritation. To apply it without mess, dump some cornstarch into the toe of a clean cotton sock. Close the top with a sturdy rubber band and pat the cornstarch right through the sock onto the areas that need it. Store your cornstarch-sock in a pretty bowl or small basket in your bedroom or bathroom. (A word of caution: keep these trouble areas clean and the skin well moisturized to avoid any chance of fungal infection in the irritated skin.)  Allergies are another possible skin concern. Many (but not all) compression garments contain latex. If you have a latex allergy you'll want to inform your fitter about it each time you order. Other skin reactions may be caused by the dyes used in producing your garments. Your fitter should work closely with you to find the source of any allergic reaction and a garment that can address the problem.

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Day or night?

Because of the nature, fabric, and design of compression garments, they are not recommended for nighttime wear. Their efficiency in increasing lymph flow depends on the action of your muscles as you go about your daily activities. Sleeping in them reduces their efficiency and runs the risk of causing constrictions that can cause a worsening of lymphedema. Instead, wrap your hands and arms at night in layered short-stretch bandages, or order special night garments designed to help maintain fluid flow when you are inactive.

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Special Concerns

A very few people experience special problems with compression garments, but these can be managed with a little extra effort. 

  • If your lymphedema is bilateral and you wear sleeves and gloves on both sides, your entire sensory surface is suddenly limited to the tips of your fingers and you may experience something akin to sensory deprivation. It can be straightforward and simple: you simply can't get the information you're used to about the texture or temperature of the world around you. Walking through the sewing department at your local crafts shop, you reach out to touch the bolts of fabrics and find yourself frustrated and even anxious because the quality of your tactile experience is severely limited. Take a moment to remove at least one glove, tuck it safely into your pocket or purse, and use your whole hand to ground yourself in the familiar. Or the sensory loss can be less apparent but just as frustrating: you begin to feel and act detached from your surroundings, depressed and short on motivation. Try removing both gloves and sleeves for a couple of hours every evening when you're not doing anything strenuous. Make a point of rubbing your hands and arms on a variety of surfaces and being aware of the stimulation that provides. 

  • Especially with the added insult of chest compression for chest or breast lymphedema, some people may feel claustrophobic in their garments. There's an urge to rip them off and a sense of being smothered. A pause to breathe deeply can restore a sense of calm, and an effort to engage your mind with some engrossing activity can help you keep going until the feeling passes.

  • Some people (usually small-boned, petite women) find that even low compression levels cause their fingers to turn icy and blue, or their arms to tingle and become painfully sensitive to touch. When they remove the offending garment their arm or hand may swell dramatically. In an attempt to control this rebound swelling, they and their therapist may decide to try a sturdier garment with a higher compression level, only to find that the problem worsens. In some cases, a lower compression level and a very soft fabric can solve this kind of compression sensitivity. Fabrics such as those used for neonates or the very old are good choices. They don't hold up well and may have to be replaced more often, but the therapeutic results may be worth the extra care.

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WHAT'S IT LIKE TO WEAR COMPRESSION GARMENTS?

Finally, you've worked out all the kinks. You've brought your new garments home, gotten used to the feel and fit, and mastered all the fine points of garment care. All that's left is to wear them consistently for all the uses you and your therapist have decided on. It fits like a dream and you're pleased with your accomplishment, but it still doesn't feel quite right. No surprise there. Have you ever gone out before and bought any piece of clothing that you were ashamed and humiliated to wear? Of course not.

And there's no point starting now. So inhale deeply, hold your head high, take your sense of humor firmly in hand, and make it your goal to step out with pride and purpose. After all, you're not alone, because TOGETHER WE CAN MAKE THE DIFFERENCE!

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Page Last Modified 02/15/2014

All information presented on this page is the opinion of
our Editorial Board and Experts.  See our "
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