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GUIDELINES ON LYMPHEDEMA

TWENTY FOUR WAYS TO PROTECT YOURSELF

1. Keep the entire at-risk quadrant spotlessly
clean. Natural gentle cleansing products are
strongly encouraged. Dry skin in a gentle but
thorough non-vigorous fashion. Pay special
attention to creases in the skin and the areas
between toes and fingers.

2. Make certain all fabric making contact
with the skin is regularly laundered. This
includes bandages and compression
garments.

3. Use a top quality moisturizing lotion to
help maintain the integrity of the skin. The
lotion you choose should not contain alcohol,
dyes, lanolin, mineral oil, petroleum products,
talc, or perfumes. (Note that pure essential
oils have a fragrance, but are not considered
perfumes.) The lotion should also have
antiseptic properties and correct ph. If you
have lymphedema, apply it before and after
removing bandages or compression garments
and after bathing.

4. Avoid chemical hair removers. If possible,
use a well maintained electric razor, replacing
the heads regularly. Because of the danger of
cuts and nicks, we do not recommend using a
regular razor. If you do use one, wash the
blades in hot soapy water, and change them
often.

5. Avoid extreme temperature changes when;
a. Bathing, showering, swimming.
b. Washing anything; dishes, floors,
laundry, etc.
c. Receiving therapeutic treatments.
d. At the gym; no sauna or hot tub.

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6. Protect the affected quadrant from weather extremes;
a. In hot weather seek air conditioning and keep the limb cool.
b. In cold weather seek central heating. If you must go out, have
the at risk quadrant well bundled, but not sweaty.
c. In sunny weather, protect the limb with sun screen and/or
covering.

7. Medical care, such as injections, blood pressure, drawing blood,
allergy tests, etc., needs to be performed on an unaffected limb.
(Note: A leg can often be used if both arms are at-risk.) Any
procedure which punctures the skin in the affected quadrant is to be
avoided, including acupuncture.

8. Avoid all tight clothing, jewelry, and elastic bands on the affected
limb, including watches, rings and binding stockings.

9. Be careful cutting nails. Do not nick skin or cut cuticles. If
someone does your nails for you, inform them of your risk. If you
must push back cuticles, use a cuticle stick covered with cotton.

10. Avoid all types of trauma; cuts, scrapes, bruises, burns, including
sun burns, sports injuries, insect bites, all animal bites and scratches,
and forceful impact. This does not mean withdrawing from living,
but be sensible and protect yourself; use seatbelts, use a thimble if
you sew, wear rubber gloves when washing dishes or gardening, wear
closed shoes to avoid foot injury for an at-risk leg. Wear insect
repellent when outdoors, sunscreen and clothing to cover an at-risk
quadrant. Any measure you can take to prevent the onset of
lymphedema is worth the effort, as it can mean avoiding a lifetime of
maintenance and pain.

11. Avoid pushing, pulling, or lifting with the affected limb. Do not
kick or slide heavy packages with an affected leg. Do not use over the
shoulder straps on an affected arm. Do not lift anything over 15
pounds, less if you are out of shape or the weather is hot and humid.
This includes the lifting of babies, children and pets. Carry
packages, purses, or briefcases only on your unaffected side, and ask
baggers at the store to place your bags in the car for you.

12. Exercise is important. However, if the affected limb begins to
ache or feels tired, rest it immediately, and elevate it if possible.
Consult a lymphedema specialist before proceeding with an exercise
routine. Safe recommendations are walking, swimming or water
exercise. If you have lymphedema, it is important to be bandaged
during exercise.

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13. Avoid any repetitive movements, especially those against
resistance.

14. Never do anything to exhaustion. Your at-risk quadrant will
fatigue more quickly than the rest of your body, and will take longer
to recover from physical exertion. If your arm or leg begins to ache,
rest and elevate the limb. If elevation does not alleviate the symptoms,
see your physician.

15. Barometric pressure is reduced at high altitudes, and can lead to
the onset of lymphedema, or exacerbate the condition. Therefore, a
compression garment is extremely important if you travel by air, or
hike in high altitudes. This is recommended even if you don't have
lymphedema. It becomes essential if you have lymphedema, even if
the swelling has subsided. In this case, you should consider wearing
bandages when flying, as they offer greater protection than a
compression garment. For an at-risk limb, over the counter garments
are available for a modest cost. This small step may prevent a lifetime
of maintenance.

16. If you have had an axillary dissection you may want to wear soft
pads under your bra straps, as this protects the lymph nodes and
vessels around the collar bone. Avoid wearing a heavy prosthesis, or
under wire supports.

17. If you live in a damp or humid climate, and your skin is
frequently moist, try dusting the skin with cornstarch. This also
works for feet during the summer months. Keeping the skin dry
helps reduce fungi.

18. Maintain your ideal weight and drink plenty of pure water. The
recommended quantity of water is one ounce for every two pounds of
body weight. Example: If you weigh 128 pounds, drink 64 ounces, or
two quarts of water daily. If you do not normally drink this much
water, increase intake gradually until the recommended quantity is
acheived.

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19. Many patients have a misunderstanding about protein. They believe that because lymphedema is a
high protein edema, they should avoid eating protein. This is not true. While we do not recommend a
high protein diet, a no protein diet will weaken connective tissues and cells. This in turn will make the
condition worse. We recommend a diet in which easily disgestible proteins make up between 10 and 30
percent of your total caloric intake. Know when to get help.

20. It can be helpful to have a professional assessment annually. If you have a leg at risk, visiting a
podiatrist can insure that your feet stay healthy. Be sure to inform him or her that you are at risk for
developing lymphedema.

21. MLD, manual lymph drainage, is a recognized therapy not only as a treatment for lymphedema, but
for prevention as well. If you have had lymph nodes removed, your immune system is compromised.
MLD helps to increase immune response. Other forms of massage therapy should be avoided on the
at-risk quadrant, because they temporarily shut down the lymph vessels in that area. These include deep
tissue, reflexology, rolfing, shiatsu, Swedish, etc.

22. Thoroughly examine the affected quadrant monthly. Do not ignore
any swelling in the affected arm, leg, chest wall, armpit, back, groin,
abdomen or genitals. Report any swelling immediately. Or, if any of
the following are present; redness, inflammation, blistering, rash,
warmth in the limb, fever, change in the texture of the skin, or lymph
leakage through the skin, see your oncologist or physician immediately.
Any of these can be the onset or worsening of lymphedema.

23. The lymph system is an important part of your immune system,
and removal of lymph nodes compromises your immune response in
the at risk quadrant. If you get a cut, scrape, or other break in the skin,
use a topical antibiotic, and notify your physician at once. He or she
will probably prescribe an antibiotic to reduce your risk of developing
an infection. Remember, an infection in an at-risk limb or quadrant
can lead to the onset of lymphedema if it is not treated promptly.

24. Lymphedema is often preventable, or at least can be postponed
for many years. If you notice any slight increase in fingers, hand,
arm, chest wall, back, toes, feet, ankles, abdomen, or genitals, see
your physician for a proper diagnosis. If you are diagnosed with
lymphedema, seek treatment. Lymphedema is easier to control at
its onset, as further deterioration can be prevented and often an
initial reversal is possible. Your limb will still be at risk, but you
will remain symptom free. Remember what renowned lymphologist
Dr. Foldi has written, "There is no insignificant swelling."

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