Looking after yourself

It is important that we take care of ourselves. We explain the four cornerstones of Self-Management: Compression, Skin Care, Healthy Lifestyle and Lymphatic Drainage.

Healthy Lifestyle

As Professor Vaughan Keeley explained in his section about Secondary Lymphoedema, “What is Lymphoedema?” there is a growing number of people presenting with lymphoedema predominantly of the legs due to weight problems. Obesity has an impact on the venous circulation causing high venous pressure in the legs and also impairs lymphatic drainage.

On the positive side, we are seeing evidence of improvement in the lymphoedema with sustained weight loss in many patients and in some to the point where it no longer requires any compression treatment. Although this is very encouraging, it is recognised that for many people, sustained weight loss is difficult to achieve.

Perhaps then, it is no surprise that one of the four cornerstones for good self-management of lymphoedema is a healthy lifestyle incorporating a balanced diet and exercise, or movement as it is sometimes referred to now.

Rebecca Elwell, from our panel of experts, is passionate about this subject and explains why a healthy lifestyle and movement is so important when living with lymphoedema.

Unlike the heart, the lymphatic system doesn’t have a pump, so we need to help it along. When we move our bodies, our muscles pump and we breathe deeper. These actions increase the flow of lymph around the body.

This prevents or reduces any swelling, as well as helping our body get rid of bacteria and other unwanted substances.

It’s known that movement is good for our heart and lungs. It can help to strengthen our joints and bones, relieve pain and reduce fatigue; it’s also good for our mental health. However not everyone knows it’s great for our lymphatic health too.

A healthy lymphatic system is key to our overall health because the lymphatic system helps defend the body against illness and keeps our body fluids in balance. When the lymphatic system isn’t working properly, fluid builds up in your tissues, which causes swelling (lymphoedema) as well as other health problems.

Being over-weight can make your swelling worse and can restrict your activity which again leads to an increase in swelling.

It is important to eat a rainbow of coloured fruits and vegetables daily up to 10 different types a day is recommended by the government but 5 as a minimum along with lean meat or fish or non-meat-based products for vegetarians or vegans e.g. beans/pulses. Carbohydrates should be wholegrain or high fibre versions if possible, e.g. brown rice or pasta and dairy products lower fat/sugar options whenever possible. Remember not all fats are bad cut down on saturated fats and replace them with unsaturated fats e.g. oily fish, nuts. Always try to avoid processed food, cut down on salt and sugar intake as well as alcohol.

Drinking at least 6-8 glasses of water a day is recommended (water, no added sugar cordial or lower fat milk) and will not increase swelling.

With contribution from Rebecca Elwell Msc Lymphoedema
Macmillan Lymphoedema ANP and Team Leader. BLS Trustee

Being mindful of our weight is our responsibility. Losing weight is achievable. Maintaining a healthy weight, however, can be harder to achieve. We are not dieticians or personal trainers. The advice from the NHS website www.nhs.uk/live-well/eat-well is very useful and well worth a read.

Skin Care

• Keeping your skin clean

It is important to wash your skin daily but also to ensure meticulous drying. Plain water, or a non-perfumed/bland soap or soap substitute can be used. Extra care should be taken to dry thoroughly between fingers and toes and in skin folds. You should watch out for any signs of fungal infections in these areas such as itching, red, or broken skin which will require prompt treatment with anti-fungal creams or sprays which can be purchased at a pharmacy or prescribed by your doctor. When treating fungal infections on the feet, shoes should also be treated with an antifungal spray to prevent re-infecting yourself when you wear them.

• Keeping your skin supple and intact

Moisturise your skin each day by applying a non-perfumed moisturising cream or ointment. Your lymphoedema specialist will be able to advise if you require a specific cream, but most creams can be easily purchased via a pharmacy or supermarket or may be prescribed by your GP. When applying cream, go downwards in the direction of hair growth for the last stroke to reduce the risk of irritation at the base of the hairs. If you find it hard to reach to apply creams, then spray creams such as Emollin can be prescribed. Alternatively, long handled applicators or sponges can be helpful or even small, long handled rollers used to paint behind radiators as the heads can be regularly replaced.Some perfumes and perfumed creams can cause irritation which can lead to increased swelling or breaks in the skin, so it is best to avoid anything highly perfumed and to patch test new creams before using. Avoid getting sunburnt which can further dry the skin and cause irritation. Use a high factor (50SPF) sun cream or lotion.

• Taking care of hands and feet

If you have upper limb lymphoedema, wear protective gloves when washing up or gardening or performing activities which may lead to scratches or cuts.  If you wear compression garments, wear gloves over these rather than remove the garments.If you have lower limb lymphoedema, it is important to wear well-fitting, supportive footwear which covers the whole of the foot and prevents swelling accumulating on the top of your foot or between straps.  Avoid wearing ill- fitting shoes which may rub and cause blisters.  Use clippers or a nail file to maintain your nails rather than scissors to reduce the risk of cuts and, if you are unable to reach or find this difficult to manage yourself, you may wish to visit a podiatrist for this.  Avoid going barefoot, particularly outside, to minimise the risk of infection.

• Avoiding cuts and bites and breaks to the skin.

It can be difficult to avoid insect bites, but some suggested precautions include wearing long sleeves or trousers to protect areas of swelling, particularly if undertaking activities such as gardening or walking or hiking or foreign travel where you may be more likely to be stung or bitten. Use a good insect repellent making sure to patch test it first. If there is a reaction to the insect bite, you could consider antihistamine creams or tablets and your pharmacist will be able to advise regarding this.If shaving the affected area, it is best to use a battery-operated shaver rather than a wet razor or epilator to avoid creating breaks to the skin. You can use hair removal creams, but these can sometimes cause a reaction, so if you use them, it is important to patch test them first.Avoiding breaks to the skin where possible should also be considered when undergoing medical treatment.  It is not always possible to avoid injections into the affected area, but you should inform the healthcare professional that you have lymphoedema or are at risk of lymphoedema and that they should try to avoid using the affected limb for non-emergencies.  Similarly, you should avoid having blood pressure readings on the affected side.

• Swelling related to heat

People with lymphoedema sometimes experience more swelling in hot weather.  This cannot be easily avoided, and the increased swelling will usually improve as the weather cools.  However, you should avoid artificially hot settings such as saunas and steam rooms which may increase your swelling.

• Act quickly with signs of cellulitis

If you develop signs of infection such as redness or rash, increased swelling, the area feels hot to touch, or you feel generally unwell with signs of fever you should seek medical advice as soon as possible. If you develop symptoms out of hours you should telephone 111 if you are in any doubt and inform the operator if you have lymphoedema.

Compression

Lymphatic Drainage

Self-Lymphatic Drainage (SLD)
Self-Lymphatic Drainage (SLD) is an effective therapy that people with lymphoedema can do for themselves as part of the self-management plan. There are countless videos online providing demonstrations on how to perform SLD. However, I would suggest asking your lymphoedema therapist to demonstrate and teach you SLD correctly to maximise the effectiveness. The last thing any of us wants, is to do any harm and further damage already compromised lymphatics.

Reflexology Lymph Drainage (RLD)
Sally Kay, Reflexology Practitioner explains more about Reflexology Lymph Drainage (RLD)

Reflexology Lymph Drainage (RLD) is an award-winning reflexology technique which focuses on stimulating the lymphatic reflexes on the feet. The aim is to cause an effect on the lymphatic system in the body. It is a unique sequence that has been researched and developed by Sally Kay, whilst working in Cancer Care. The results appear to support the theory of reflexology.

Breast cancer is the most common cancer in the UK. Approximately 20% of patients with breast cancer develop secondary lymphoedema of the arm following treatment for breast cancer. Lymphoedema is defined as tissue swelling due to the failure of lymph drainage.

Manual lymphatic drainage massage (MLD) is used to treat conditions other than lymphoedema, and RLD may be used similarly.

Compression Pumps

For more information, visit Compression Therapy UK on our “Meet the Suppliers” pages.