In focus: lymphoedema - compression garments and bandages

[OvacomeSupport]

Hello

In last week’s post we looked at what lymphoedema is and why it can happen following treatment for ovarian cancer. Today we’ll start to look more closely at how lymphoedema is managed.

As we said in the last post, lymphoedema develops when the lymph fluid can’t move freely through the lymphatic vessels so it starts to leak into the surrounding tissues causing swelling. The aim of most lymphoedema management is to help the lymph to circulate.

One of the main ways of doing this is compressing the affected area using bandages or a special garment like a sleeve or a stocking. This applies even pressure and helps to reduce swelling. It also helps the lymph to move to an area that’s draining well and supports the muscles to move the lymph through the vessels.

As people with ovarian cancer most often experience lymphoedema in the leg, we will focus on compression stockings in this post.

Compression stockings will be fitted for you by your lymphoedema specialist to make sure that they’re the right size and apply the right amount of pressure. You will usually be given two stockings, so that you can wear one while the other is in the wash.

Depending on where you live, you may be given both at once or, for example, get one from your specialist and have the other prescribed by your GP. At first your specialist will measure you every few months, as the amount of swelling may change.

Once your leg has reached a stable size, you can get the stockings from your GP on repeat prescription. If your leg changes size because of swelling or weight loss or gain, you should be measured again to make sure your stocking is the right size for you.

The stockings should be replaced about every three to six months, as they lose their elasticity and don’t apply even pressure any more. You should aim to wear both stockings equally, so that one doesn’t wear out more quickly than the other.

You can wash them by hand or with mild laundry detergent at 40 degrees or lower and dry them flat and away from direct heat. Your garment will have washing instructions.

You should wear your stocking all day, especially when you’re moving around or exercising, and take it off at night. If you find it uncomfortable at first, you can start by wearing it for a few hours each day and build up the time over a few days. It’s best to put it on in the morning, when your leg is at its smallest. Wait until your skin is dry after washing or moisturising, as this will make the stocking easier to put on.

Your lymphoedema therapist will show you how to put on and take off your stocking. You can roll up the stocking or turn it inside out as far as the knee or ankle, pull it over your foot up to the ankle or knee and then unfold it up to the top of your leg.

You should unroll it a little at a time rather than pulling from the top of the stocking. Some people find it helpful to use some unperfumed talc or wear a rubber glove to help with putting on the stocking. You may also be able to get an applicator.

It’s important that the stocking doesn’t have any wrinkles or loose areas, so make sure that it’s fitted smoothly and don’t turn the top over. After removing the stocking at night, it’s a good idea to use some moisturiser to help keep your skin healthy.

The stocking should be comfortable to wear and not restrict your movement. If you develop pain, pins and needles, numbness or a change of colour in your toes, your garment may be too tight and you should remove it and contact your lymphoedema specialist straight away.

Compression garments must only be used on healthy skin. If your skin is fragile or damaged, if lymph fluid is leaking through the skin or if you have cellulitis (an infection of the skin), you should not wear your garment and contact your lymphoedema specialist for advice.

Compression garments may be uncomfortable to wear in hot weather. Some manufacturers make special garments designed for use in warmer weather. You can also put your garment in the fridge to cool down before you put it on and spray cool water on it during the day. Your lymphoedema specialist will be able to advise you on other options if you’re still finding hot weather uncomfortable.

If your lymphoedema is severe or has caused your leg to change shape, or if your skin is damaged or fragile, you may need treatment before you can have a stocking. In that case, your lymphoedema specialist may start by bandaging your leg in layers that put pressure where it’s needed to reduce the swelling. Bandaging is often combined with massage to drain the fluid and exercises that your specialist will teach you to do at home.

Usually this treatment is given every day or two by a specialist in clinic over a period of about three weeks. The specialist will remove the bandages, give the massage treatment then reapply the bandages. At the end of treatment, you may be able to have a compression stocking.

You can shower and bathe at home but will need to keep the bandages dry. You may also not be insured to drive with the bandages on, so it’s important to check with your car insurer if you’re planning to drive during your therapy.

You can find more information about compression garments and bandaging at:

macmillan.org.uk/cancer-inf...

royalmarsden.nhs.uk/your-ca...

about-cancer.cancerresearch...

If you would like to share your experiences of compression therapy or have any tips on it, please comment on this post. If you would like information or support, please contact our Support Line on 0800 008 7054 or email [e-mail].

Best wishes

Julia (Support Services Officer)

[Solange]

Hello Julia.

Thank you for this helpful post. I would just like to give a tip that I found helpful. I had read that rubber gloves help with putting on compression garments so when I had compression tights prescribed I was confident that I'd get them on. Armed with my rubber gloves I sat down to start putting them on and just couldn't get them past my feet. I struggled and struggled and got nowhere so in the end, in desperation, I called my husband for help. At first it was funny, rolling around on the bed with him wearing the gloves and I saw the funny side but every time he tried to pick up a piece of the tights to pull them up it was agony and we abandoned it for the day. I tried again for 3 mornings then Googled for ideas to help. I found lots of advice and it seemed that you gently stroke them up your legs, using the palms of your hands. Ordinary nurse-type gloves didn't help but soft, rubber washing up gloves with non-slip patterning on the palms worked like a miracle. It can still be a bit of a struggle but at least I can get them on. I found that thicker rubber gloves didn't help but cheaper, softer more flexible ones did. I do hope this will help others,

Best wishes, Solange 😊

[lesleysage in reply to Solange]

Agree with Solange - fold the leg part down over the foot part so that's there to pull on first and then ordinary 'Marigolds' on both hands as you gently smooth the stocking up your calf and then onto the thigh!

Agree with Julia's summary of not being comfy but with self massage (from NHS & spoecialist lymphodema nurse) each morning plus the stocking, mine is now just a sllightly swollen thigh but am keeping my ankle, foot and calf much the same size as the 'healthy leg', so am now signed off and onto prescription repeats.

The only other things we have done is put a small wooden block under the castors at the bottom of the bed (an idea suggested on this site a few months ago...thank you) - only an inch or two at the most so its noticeable when sleeping.

Warm wishes, L

[lesleysage in reply to lesleysage]

Forgot to add that of all the exercise we do, I've read that swimming helps reduce the swelling or keeps it at bay the best because the water acts as a 'compression' by its own nature. I was able to swim between two and four times per week for the first six years after the last operation and had no lymphodema...within four months of not being close to a swimming pool, the lymphodema developed. It maybe a coincidence, but ??? Lx

[OvacomeSupport Partner My Ovacome Team in reply to lesleysage]

Dear Solange and lesleysage

Thank you very much for taking the time to share your experience and for these really useful tips.

Best wishes

Anna

Ovacome Suport

[Solange in reply to lesleysage]

I'mglad your leg has improved and hope it stays better, Lesley. Thanks for the bed tip, must find something to use under our castors. I was never referred to a Lymphadema clinic, even though it was the hospital that diagnosed me. Just told to go to the GP to be measured for the tights. My leg has improved quite a lot but still a bit of a way to go to match the other. Had five lots of Radiotherapy to my pelvis last November and I think it has helped the swelling - but not my bowel ☹️ I get even worse embarrasssing wind and also need to rush to the loo more than ever. Hope it improves soon. 🤞 😊 Xxx

[lesleysage in reply to Solange]

Hi Solange, yes, certainly hope the bowel improves soon. Did the radiotherapist say how long it would be before things settled down? Is it worth contacting your CNS or oncologist, as I must admit, I'd be feeling quite depleted after three months (at least) of these side effects. Or if you can't get hold of your CNS or oncologist, maybe ring Anna on the helpline at Ovacome and she maybe able to help? Hope today is a good day. Wish I knew how to get these little emojis on this laptop as can on my phone and pc!! But as I'm not 'in the know' just sending warm wishes, L x

[Solange in reply to lesleysage]

Hello again, Lesley. Thanks for your reply, sorry I didn't see it earlier. I'm not too worried at the moment. Thankfully, I can always contact my CSNs for advice, plus the Hospice , who ring me regularly and I'll see my Onco in a couple of weeks. Hopefully she'll have the report of my last CT Scan. She didn't have it when I saw her the end of January.

I'm sorry you can't get any emojis up on your laptop. I can't advise you unfortunately. One of my sons set these up for me as I'm not very computer-literate!!

Sending warm wishes back, Solange 😊

[lesleysage in reply to Solange]

You sound very well looked after - great. I'll take my laptop to our daughter & son-in-law as we're seeing them this afternoon & see if they can help. It's only on HealthUnlocked I can't find it - fine on my emails. Hey-ho. WW, L x

[Hidden in reply to Solange]

Solange that made me laugh because I am ready to divorce my hubby over helping me with the thigh length sock. He leaves the sock snap against my skin, even the dog moves away from us both when doing the socks operation. I have a knee high on the good leg and can manage that, but my left hip is damaged from radiotherapy so cant do that one myself. I will of course take your advice on board

[Solange in reply to Hidden]

Your poor dog - I might report both you and your hubby to the PDSA, Lol!!! I do feel for you, though. I'm exhausted before breakfast, fighting my tights, even with the gloves, as I was told to put them on first thing. I get washed first though. How do you get on with the full length stocking? Any trouble keeping it up? I remember having awful trouble keeping mine up after my varicose vein op. years ago, which is why I was glad to have the tights - can't bear the thought of having them in Summer, though. I used to dread the walk to pick the children up from school, trying to discreetly hitch them up every few yards.

Keep smiling, Solange 😊 Xx

[Hidden in reply to Solange]

Have pippa long stocking just a few weeks, there are little studs at the top of the band to keep it in place, what worries me most is that my oncologist never prepared me for this. I had radiotherapy last year then surgery for kidney stent and following on that chemo. My left leg is actually protesting so being sent for an mri. My lesion is on hip muscle hence mobility issue. Part of the ovary was left on the left side because it was connected to blood vessel and nerves. I bought a stick and that helps with balance and hoping that physio will sort the rest for me

[Solange in reply to Hidden]

🤞Fingers crossed that the physio WILL do the job. Xxx

[Janice252]

Hello ladies. I have lymphoedema in both legs, one worse than the other. It was caused by my ovarian cancer spreading to my lymph nodes. I was diagnosed in June 2017 although the lymphoedema only became a problem about 10 months later. I attend a very good physiotherapist and initially had the bandage wrap for 4 weeks. Since then we have tried various options. I have had full length stockings which always slipped down. The tights were a disaster, really struggled to get them on and then they slipped down to my knees ! I'm currently wearing knee length stockings on both legs which I'm managing better. I recently found out about a trial which Action Cancer is running. This involves getting reflexology from a qualified physio once a week with the aim of reducing the swelling in the legs. I've only had 2 sessions but the better leg is looking quite normal again. Haven't had as much success with the other leg but I'm hopeful. It's actually the best treatment i have ever had and so relaxing. I'll let you know how it all turns out. It would be wonderful to wear a skirt or some cropped trousers in the summer ! Best wishes to everyone xx

[OvacomeSupport Partner My Ovacome Team in reply to Janice252]

Dear Janice252

Thank you for sharing your experience. It's really interesting to hear how reflexology has helped you. I'll look forward to hearing the results of the trial.

Best wishes

Anna

Ovacome Support

[Hidden in reply to Janice252]

I am also interested in your reply, I was told I cant have reflexology because of the lymphodema in our cancer support centre nearby, I can only have hand and head massage

[Solange in reply to Janice252]

🤞Fingers crossed for you, too,Janice. The thought of not having to be squashed is lovely......... and how carefree we'd feel, too. 😊Xx

[Janice252]

Hello ladies. Hope you are all as well as you can be. Not sure how successful the reflexology is . My feet are a lot smaller ! But I don't think my leg has improved much. I have 3 more sessions to go so I'm still hopeful. The massage is so good though. Last week I fell asleep. It's a very specialised type of reflexology , Solange. Only physios trained in lymphatic drainage can do it. Has anyone tried to do self massage ? I watched the video mentioned by Julia above and it was very interesting. Xx