Swelling when wearing bandage

[lymphite]

I had LVA surgery on my left arm for secondary lymphedema 3 weeks ago. I am wearing a short stretch bandage since surgery which I never used before. I had immediate softening of the skin and decrease in size with even more decrease after 2 weeks. I have very deep wrinkles on the skin which I see when I take off the bandages to take a shower each day. Can anyone tell me if that is normal? I'm worried that the only reason my arm is smaller is because of being wrapped 23 hours a day and it will just swell or be worse when I go back to a compression sleeve.

[Lynora]

It is really early days - where did you have the procedure done and are you self bandaging? Did you have pre-operative decongestive therapy (daily bandaging)? How fine are you being assessed by the clinical team?

[lymphite in reply to Lynora]

I had very mild lymphedema start last February 6 months after lumpectomy. The doctor told me to find a therapist on my own. It took three weeks before I could get and appointment. I went to a physical therapist trained in lymphedema. I started self massage before I saw her and my arm had already decreased some. She gave me a compression sleeve, watched my massage routine and approved of it. I went for 5 visits over 3 weeks and never went back because I didn't see any difference. She never used wrapping or suggested it. She never told me what would determine that I should start managing things at home. I asked if my arm would ever look 100% normal again and she wasn't sure. I went to Dr. Chang in Chicago and he said my lymphedema was very mild and I probably would do OK with massage probably for a long time and that it was up to me if I wanted to do surgery or not. I decided to have surgery because it offered help in draining the arm and from all I read that is one of the main goals of treatment. Also If things went especially well I might not need compression and daily massage at some point. I think everything is looking good and I am very happy with the reduction and softening that I have. I'm just wondering if the improvement i see is due to the bandaging or to the surgery. They measured me before surgery and my measurements in different levels varied from 1cm to 0.6 cm larger than the other arm at the same level. I really wanted to know if bandaging without MLD courses a large reduction and if the arm gets deep grooves and wrinkles when it is wrapped and if they go away by the time wrapping is stopped and compression is started.

[lymphite in reply to Lynora]

Yes they taught me how to do self bandaging in the hospital the day after surgery.

[Lynora]

Are you using a padding layer under the short stretch?

The measurements above do indicate very mild Lymphoedema, so it may be the bandaging that is speeding the loss of volume. However, like I said, it is very early days - some LVA procedures can take months to kick in. Have they suggested when would be a good time to move to a compression garment?

[lymphite in reply to Lynora]

Yes at 4 weeks, so one more week. Before massage ther was more swelling. Enough to disguise all the shape in the arm and most of my very large surface veins. I wonder why it takes time to make an impact? Thanks for the info. Have you had the surgery?

[Lynora]

It takes time as the tiny little vessels used for the anastomoses almost have to go back to school to understand what they are doing - tiny vessels and a very very slow system that is the lymphatics - which is why it takes time - it's not like connecting a hose to a faucet in the yard - more like trying to suck jello through a cocktail straw.

No, not had the surgery. I am a Breast cancer patient (2001) and lymphoedema therapist.

[lymphite in reply to Lynora]

Wow. Thanks. I never thought of it that way. I'm in Los Angeles. I know this is a site for the UK but I still use it because there is so much information. Would you say that starting treatment for a swelling of 2 cm would not usually require bandaging? Have you seen many people following this surgery? On arms that have finished the bandaging phase does the arm still have areas with a lot of indent pattern from the wrinkles in the stockinet? My bottom layer is very large and textured like used under casts. So it is loose enough to wrinkle alot. There is new thickening of my lower forearm where there are three of the incisions. If that area had much fluid in the skin before I never noticed it. Is that normal?

[Lynora in reply to lymphite]

Yep, perfectly normal. It may be that you are putting a little too much effort into the bandaging.

I have only seen one client who had LVA a few years ago in Italy - it took months to start working, and she had quite severe swelling, and is very diligent about wearing compression. It is done in some centres in the U.K., but there are quite stringent criteria - not everyone is eligible.

The bottom layer of bandaging - is it called mobiderm or is it just tubular stockinette. The wrinkles are simply due to pressure from the bandage. You may benefit from an additional layer of foam. Are you applying cream when you do self lymphatic drainage?

[lymphite in reply to Lynora]

I wassn't before but I am not to do any manual drainage until the 4 week mark. They don't want pulling on the skin which might tear the anastomoses sites. I think you are probably right about over aggressive bandaging. I have realized that myself and backed off some. I want to have the skin free of excess fluid so much. I am using the regular stockingette that was given to me on discharge from the hospital. The padding is a cotton wool.

[Lynora]

Cotton wool is aggressive under short stretch. Have a look at bandagesplus.com to see if they do a soft foam bandage which you could try instead. If you are using cotton wool, definitely don't over-pull the short stretch layer.

Also, has the surgeon said that the LVA will remove all the excess fluid? This may take a considerable time, so don't get too tough on yourself if its not happening as quickly as you expected.

[lymphite]

That's good to know. I will look into getting a foam under wrap.

When I was instructed on wrapping in the hospital the therapist told me to "pull" on each upward movement around the arm but I quickly found that to be too tight so now I try to just lay it flat and "snug" but sometimes I still have to redo it because it is uncomfortably tight.

The surgeon said that the effect was better on early stage of lymphedema and that most people get some benefit but not everyone and some people get really great benefit. He also said the care is the same after recovery as it was before surgery and that the goal is never to stop wearing compression but some people do stop. I was thinking of not going without compression at night as I used to do and that I should get a night garment that I have heard people mention. Do you know what that is and do you think it is a good idea?

By the way, thank you so much for your time and help!

[Lynora in reply to lymphite]

A couple of companies do night garments, although some of my ladies prefer the Juzo ACS Wrap - it's very soft and easy to adjust.

Solaris do a night garment I seem to remember, and I recently saw a Jobst prototype - can't remember the name - something like Jobst Relax - but I could be talking rubbish!

Time for bed. 2320 here in Bonny Scotland, and I'm pleasantly stoned after my latest dose of morphine (new knee 14 days ago!!) zzzzzz

[Chocolate-e-clare in reply to Lynora]

Yes, Jobst Relax. 😊👍 all the best with your TKR 🌸👍

[lymphite in reply to Chocolate-e-clare]

Thanks, I will look into it. Funny this post showed as written more recently than all the other entries but it wasn't at the end. I had to wash the stockinett while I had the bandages off to take my shower so I went "bare" for much longer than usual and I can really see my arm is looking good! Much less skin thickness. Way less wrinkles from the dressing as well do to using double the cotton padding. Thanks to Lynora's helpful insite.

[lymphite]

I just looked and I don't know how much to buy. One or two? How wide? How long? They mentioned 10cm and 12cm. My arm from axillary to wrist is about 20 inches (almost 51 cm) and upper arm is 27.5 cm, forearm 25cm.

[Lynora in reply to lymphite]

10cm will be fine - they usually come in 3m lengths, so get two - they are reusable - if you are incorporating your hand into the bandage, you can cut a narrow length that will fit between the base of your index finger and web of the thumb and wind round the hand a couple of times.

[lymphite]

Thanks. I didn't know that not doing the hand was OK. I didn't need any compression on my hand before surgery. There are two incisions on the under side of my wrist that might not be covered enough without covering my hand. Where are you located?

[Lynora in reply to lymphite]

I think the hand should be incorporated, otherwise the swelling may appear in the dorsum of the hand and the fingers, but if you have gone this long without wrapping it, then there should be no need to start - were you taught this by the therapist?

I am in Scotland - and live in a little village called Scotlandwell, about 25 miles north of Edinburgh.

I do home visits in certain circumstances - hee hee 😜

[lymphite in reply to Lynora]

First let me say that if you ever want to come to Los Angeles you can stay with me any time! We have a spare room with a bath and at present 2 spare cars. I think I have a Scottish ancestor somewhere. My mother's maiden name was Patterson.

Yesterday I ordered some foam but I also took an extra cotton that the therapist sent me home with and added it to my padding layer. Oh what a difference! my arm feels like it is stuffed in a pillow. the pressure seems the same on the whole arm. Before it would seem less on the lower forearm but if I tried to make it tighter in that area my hand would sell or feel uncomfortable.

I have wrapped the hand since surgery to knuckles In the teaching she said if I hadn't been wearing a glove or gauntlet before just wrapping to the knuckles and not the fingers would be fine.

I also feel a little embarrassed that i became so fixated on shrinking the size. I knew this was expected to be gradual or even not work but when I saw the improvement the day after surgery I got over excited so that you for bringing me to my senses.

Congratulations on your new knee! I hope it is going well. I have a friend who had both done and it worked well but the fleecing and straightening took time and was hard at first.

[lymphite]

Have a good night!

[lymphite]

I'm not sure which "reply" tab to hit but I wanted to say that using double cotton and pulling less hard really worked. I went to Wyoming to see the total solar eclipse. Aboulutely fantastic. And when I returned the foam I order had been delivered. I tried it one night and I must have pulled to tight because my hand was a little swollen in the morning and stayed that way most of the day. I was working again and I finally remembered what had worked a few months ago when my hand swelled. I put on a small size rubber glove and wore it for a while. Worked perfectly.

I haven't wrapped since then because I didn't before surgery and I have been so happy with my arm. It has reduced to normal size, which really wasn't that much. My therapist said 1 1/2 cm at the upper forearm was the greatest reduction. The thing that is so amazing is the texture of the skin has changed. It looks normal with the lines and wrinkles and the tendons and muscle moving show right through. I can also pinch up a fine fold of skin everywhere. The fold is still thicker than a similar fold on the other arm but not much.

[lymphite]

Just an update. 4 months after surgery I was able to stop wearing a sleeve and doing massage only occasionally just for the the habit of it and my arm doesn’t swell. Size was checked with the machine that measures the perimeter at the therapist and stable size was confirmed. No change with heavy lifting, hours of yard work with digging and raking or with air travel. Life is good. I feel like myself again and illness is behind me for now at least.