Together, we can make the difference in Lymphedema
Standard Treatment of Lymphedema--Sleeves, Gauntlets, Gloves
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.
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!
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!
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.
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.
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):
To add to the confusion, European compression classes differ slightly from their US counterparts, like so:
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-
Once your garments are ready to try on, a competent and experienced fitter will have a routine that includes the following:
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.
If donning your sleeve is still difficult, there are devises available to help you, such as the or the Juzo Slippie (shown on left) 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 devises.
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.
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.
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.
Manufacturers recommend daily washing for both reasons. 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.
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.)
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.
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.
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.
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.
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.
A very few people experience special problems with compression garments, but these can be managed with a little extra effort.
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!
Page Last Modified 08/23/2011
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