More Answers To Your Questions

Many of our customers have submitted more questions they would like answered. I would like to share these questions with you as well as my answers.

I purchased my compression socks from a sports store. I have spider veins and am on my feet many hours. When I remove my socks I have indentions and red marks where my knee highs end. Are they too tight?
How to Measure

Without having all the facts, it is very difficult to say. The socks may not have a good release built in the top of the socks. They may be helping you and move your swelling up, but cannot move any further because the socks end. You may need a thigh high garment instead of a knee high. They may be an incorrect size. Why don’t you take your measurements 1st thing when you get up and call one of our Certified Fitters on our toll-free number, 1-844-472-8807, and let us assist in a garment that is appropriate for you?
Here is how to take your measurements:

Measurements should be taken upon arising when your legs are at their smallest.
  • Using a measuring tape measure around the smallest part of the ankle. This will be above the round bones (malleoli) on both sides of the ankle.
  • Next measure around the fullest part of your calf.
  • For thigh length styles also measure around the fullest part of the thigh.
  • *The measurement from the crease in the bend of the knee straight to the floor will also be needed.

For thigh high stockings you will need a length measurement from the glutial fold straight to the floor.

I was told by my OBGYN that thigh high stockings were not appropriate during pregnancy, because they could cut off the circulation in the groin area.

I do not feel properly fit thigh high stockings will cut off the circulation in the groin area. If you have a lot of swelling, they could move the swelling into to the vulva area. Maternity pantyhose are my garment of choice for pregnancy, because the tummy panel will give some support to the fetus and lift it off of the veins. Most maternity pantyhose have elastic in the waist band which can be adjusted or completely removed. That being said, I do have many customers who are pregnant wear thigh high stockings successfully.

I have a group of veins on one leg that always hurts, but especially when I go up and down stairs. What should I do?

Varicose veins usually do not hurt. If you are in that much pain, you should find a good vein specialist and have a complete evaluation. It may not be your varicose veins which are hurting. It could be something else and only a full evaluation can determine the true cause.

My doctor told me I have orthostatic hypotension and I should wear compression stockings. There is so many choices, what stocking should I choose.

As you know, when people have orthostatic hypotension and stand, their blood pressure drops and they may pass out. Compression stocking can help with this. The garment of choice is pantyhose, but many people are able to manage with a thigh high garment. A knee high garment is really not appropriate. The compression usually varies with the severity of orthostatic hypotension. At least at 20-30mmHg is used for this disorder, but sometimes a 30-40mmHg is required.

I have a DVT (deep vein thrombosis) should I wear my stockings 24/7 or just during the day?

You get the most benefit from your stockings when you are standing or sitting (vertical position). They are less helpful when you are sleeping (in a horizontal position). That being said, it depends on the severity of the DVT. It is very important for you start walking and getting exercise as soon as possible. If you are in doubt, consult your physician.

I have been diagnosed with lymphedema. I wear 20-30mmHg compression stockings, but I keep swelling more and more. Help! What should I do?

First you need to find a good lymphedema therapist. Your physician may give you a referral to a lymphedema therapist. The therapist will evaluate your swelling and probably wrap your extremity with layers of bandages to reduce your swelling as well as teach you some special massages you can do yourself later on. Once your swelling is reduced as much as possible, the therapist will recommend garments for you to wear each and every day. Remember you may need to go back into bandages occasionally  for a “tune up”. Lymphedema may not be currently curable, but is controllable if you follow your therapist instructions.

If you have more questions or comments, please scroll to the bottom of the blog entry to leave a comment or ask a question.

Thanks so much to those who submitted these questions,


Hope for Lymphedema Patients

A few weeks ago I heard about a lymphedema patient here in the US and I knew at that time that I had to share her story with you.

Jennifer had lymphedema of her right leg for over ten years. She had Complete Decompression Therapy (CDT), she wore compression garments during the day, and her night time compression garments at night. No matter how hard she tried and no matter how compliant she was her lymphedema progressed. She began searching for a surgeon who had the expertise to do lymph node transplants. Jennifer found her surgeon in New York.

Jennifer had the surgery 2 years ago in May. They removed 3 lymph nodes from the left thorax (not axilla) and transplanted them to the right groin. A year later she had a Lymph MRI which showed the lymph nodes which were transplanted and the very beginnings of lymph vessels. This was really exciting!

In March of this year she had her 2nd MRI. There were actually 5 lymph nodes in her right groin including the 3 transplanted nodes. Two lymphatic vessels were connected and growing. The vessel was about 1 mm in diameter and reaches half way down to the knee! Her physician considered this likened to a Highway! Her foot is no longer as swollen as it was and the ankle is beginning to show some shape. The tissue is beginning to soften, the fluid is movable and mushy, and the tissue no longer feels fibrotic.

Jennifer has progressed to bike rides, long walks and swimming. The physicians are considering a second lymph node transplant to the ankle area and some minor liposuction to remove fat deposits on the outside of the leg which was a result of the lymphedema. Jennifer also continues with MLD message therapy (Manual Lymphatic Drainage) to wake up the newly transplanted nodes and encourage the growth of new vessels. The MRIs she has had done are very valuable to the therapist because they visualize the lymph nodes and vessels and the therapist knows exactly where the fluid needs to be moved.

Her problems are definitely not ended, but there is now hope that someday she may lead a normal life.

To aide patients like Jennifer, Support Hose Plus is proud to offer a complete product line in compression stockings. As a family owned company, Support Hose Plus strives to offer you the best prices and the highest quality of customer service.

Looking forward to more news in the field of Lymphedema,


What Compression Should I Choose?

Before we discuss what compression to choose, let’s look at how the compression helps control edema and makes our legs feel better. The muscles of the legs act a pump to assist the heart in the return blood flow from the extremities. When veins and valves of the legs become damaged or incompetent, compression stockings provide a little extra “squeeze” to help reduce the diameter of distended veins and help the valves to close. When this happens, the blood flow is increased. The “squeeze” is measured in mmHg compression.

If your physician has not suggested compression of support hose (compression stockings or support socks) to purchase, it can be very confusing. A garment with too little compression for your diagnosis may not contain the swelling. On the other hand, I have clients purchase 30-40mmHg compression because they want to be certain of getting rid of their swelling. Once they receive their purchase, they are even more frustrated because they are not able to don the garment. The correct compression, correct size, and style are some of the secrets to being a successful support hose (compression stocking or support sock) wearer.

For someone with little or no swelling, an 8-15mmHg compression may give the gentle message they desire.

For someone with mild swelling or to prevent varicose veins, a 15-20 compression may give them support they want.

For someone with moderate swelling, a 20-30mmHg compression may give them all the “squeeze” they need.

Here are some guide lines we follow when fitting a new client:

  • 8-15mmHg compression is generally used for
    • Minor ankle, leg and foot swelling
    • Those who want just a little gentle massage to help their tired, fatigued legs
    • A client who is very elderly and has serious heart problems or is not able to don a higher compression
  • 15-20mmHg compression is used for
    • Minor varicose veins
    • Travel (when there is no other leg problems)
    • Prevention of varicose veins during pregnancy
    • Post Sclerotherapy
  • 20-30mmHg compression is used for
    • Moderate to severe varicose veins
    • Moderate swelling (edema)
    • Post Sclerotherapy
    • Prevention of recurrence of venous ulcerations
    • Superficial Thrombophlebitis
    • Post surgical
    • Management of Neuropathy
    • Travel
    • Prophylaxis during pregnancy
    • Burn scar management
    • DVT (Deep Vein Thrombosis) prevention
    • Healing of joint replacement
  • 30-40mmHg compression is used for
    • Severe varicose veins
    • Severe edema
    • Lymphedema
    • Management of active venous ulcerations
    • Prevention of recurrence of venous ulcerations
    • Prevention of Post-Thrombotic Syndrome
    • Management of PTS (Post-Thrombotic Syndrome)
    • Orthostatic Hypotension
    • Post Surgical
    • Post Sclerotherapy
    • Burn Scar Management.

For our returning clients, are you having problems such as your garment not containing your edema or your garment is rolling, pinching or otherwise not fitting properly? Call our Certified Fitters at 1-844-472-8807. Your problems could be due to wrong compression, wrong size, or wrong garment. For example a knee high 20-30mmHg from one manufacturer does not fit the same as the same garment from another manufacturer. Even different styles of garments from the same manufacturer (such as casual compared to dress) can fit different.

In conclusion a properly fitting compression garment of the proper compression and correct style can make your legs happy!
Our goal at has always been to help you improve the quality of your life!


Lymphedema – Causes and Control

Every one knows this is Breast Cancer Awareness month, but we have many clients who have already been diagnosed with breast cancer and are working diligently to make others aware. Another topic we need to be aware of is Lymphedema after Breast Cancer Therapy, but wait, Lymphedema can be caused by any change in the lymphatic system. During surgery for cancer, physicians may take out lymph nodes near the tumor to see if the cancer has spread. The lymph nodes are collectors of lymph (a clear fluid which contains proteins, salts, and water, as well as white blood cells, which help fight infections) and removing them makes it harder for lymph to move to areas where it enters the blood stream. If the remaining lymph vessels cannot remove enough of the lymph in an area, the excess fluid builds up in the fatty tissues just under the skin and causes swelling most often in the arms or legs. Radiation treatment can also affect the lymph flow by causing scarring of the vessels. The lymph fluid that collects in the skin and underlying tissues can be very uncomfortable. Lymphedema usually develops slowly and may be mild to severe. It can keep nutrients from reaching the cells, interfere with wound healing, and lead to infections.An example of Lymphedema from

Early on, the swelling may be relieved by raising the affected limb and the skin usually stays soft. But over time, the swollen area may become hot and red and the skin hard and stiff.

Lymphedema garments are necessary after reduction of swelling

Lymphedema Garments are Necessary After Reduction of Swelling

If you think you are developing Lymphedema, get to a MLD (manual lymphatic drainage) Therapist as soon a possible!! Your extremity may need to be wrapped in bandages to reduce the swelling and the therapist will do special massages to open up the lymphatic vessels remaining so the lymph will drain. Once the therapist has achieved results, the therapist will recommend compression garments (armsleeve, glove, or gauntlet for the arms and stockings – usually 20-30 mmHg or 30-40 mmHg for the legs).

Caresia Bandage Liners from

Caresia Bandage Liners from

Sometimes you will find you need to go back into bandages at night for a “tune-up” to maintain the control you have achieved over Lymphedema. We have a simplified solution to the bandages
Caresia by Solaris (used to replace multi-layered bandaging during the active phase of therapy and transition to a night time garment).

I would like to leave with this thought; if you are at risk for Lymphedema, wear your compression garments!! If Lymphedema does develop, get to a MLD therapist immediately. Lymphedema will never go away, but with a good MLD Therapist and following a good program of skin care, massage, and compression garments, it can be controllable.


Compression Stockings and Pneumantic Pumps for Swelling

We frequently have patients ask us at, what is the difference between a compression garment and a lymphedema pump? The simple answer is that these are two different solutions to reduce swelling in your arms and legs. As an example, let’s begin with the knowledge that humans have stretchy skin and that lymphedema is the result of the body’s retention of fluids which causes swelling of the legs and arms. In order to get rid of excess fluid in the limbs, first a controlled, external pressure must be applied to the limb, which can be accomplished with both solutions. When compression garments are utilized, several layers of materials including compression bandages, plain or paste bandages, multi-layer bandage regimens, and finally compression stockings, gantlets and gloves are placed on Caresia Bandage Liner transitions from a reduction tool to night time garement for lymphedemathe affected extremity. The number of layers required can be reduced by using the Caresia Bandage Liners under the bandages. Our good friends at tell us that there are two phases to each pump treatment.  “The preparatory phase, which must be performed first, is Manual Lymph Drainage to prepare the lymphatic vessels to receive the fluid that will be moved by the drainage action of a pumping. When the preparatory phase is not completed properly, the lymphatic system is not ready to receive and transport the lymph that is moved by the pump. When this happens, the lymph is forced into the surrounding tissues where it can cause additional damage.A pneumatic pump is sometimes necessary to maintain control lin ymphedema

In a home setting, the preparatory phase is performed by the patient as self-massage, or by a caregiver as Simple Lymph Drainage (SLD). This preparation must be carefully completed to prevent any damage to the tissues.

In the drainage phase, the pump settings are adjusted to the appropriate pressure level before the garment is donned. Then the pump is activated for the appropriate period of time while the patient rests comfortably with the affected limb in the recommended position.

The movement of the pump stimulates the flow of the excess lymph out of the affected limb as if were flowing following the movements of the muscles. When the lymphatic system has been properly prepared, this fluid will flow into the lymphatic vessels and eventually be returned to the bloodstream.

After a session on the pump is finished there are still two more step to be completed:

First: Remove the pump garment and then perform a brief M-L-D session on yourself by working from the end of the treated limb upward toward the terminus to help the released fluid return to the cardiovascular system.

Second: Put on a compression garment. If you use the pump in the evening, put on your night compression garment (the Caresia Bandage Liner transitions to a night time garment or a JoViPak garment). If you use the pump during the day, put on the knit compression garment that you wear when you are active.

Lymphedema garments are necessary after reduction of swellingUnless you complete these steps, the fluid released by the pump will flow back into the tissues instead of draining properly as it returns to the circulatory system. And, unless you don a compression garment, the tissues will soon be swollen again.”  This is simply what many of us must do in order to maintain limb size. You can take a barrel full of water pills, but excess fluid will never leave your limbs without applying external pressure.

There are many different reasons a limb or other body part can swell. If constant compressive forces are applied to a limb so as to produce higher levels of compression at some sites on the limb, and lower compression at other sites, the compression is termed gradient compression. We carry the top four major manufacturers of gradient compression stockings – Jobst, Mediven, Sigvaris and Juzo. True gradient compression stockings have the greatest compression at the ankle with the compression gradually decreasing up the limb, thus improving circulation, helping to maintain limb size, keeping excess fluid from accumulating in the limbs, and improving overall health.  Keeping the fluid off your extremities by maintaining constant compression  helps your heart, lungs, and kidneys not to be compromised. The effectiveness of compression therapy depends mainly on the exerted pressure and the knitted material the garments are made from. This is the reason that some people need flat-knit garments rather than round-knit (circular knit) products, for more static stiffness. Don’t confuse static stiffness with stiff material, as most high-end compression garments, like the Jobst, Mediven, Sigvaris, and Juzo products we carry at are soft to the touch.

What is the fluid, when I swell? This is another common question. Some refer to swelling as water retention, when in fact, what you are retaining is water and lymph fluid. Lymph fluid contains water and waste fluid, so it is of the utmost importance to rid your body of these excess fluids to maintain a healthy body and immune system. Compression stockings can help you do this.

So in order to maintain limb size, a constant force is necessary throughout the day, every day, and a lymphedema pump, or pneumatic compression device is not a constant force, is very expensive, at best only partially covered by insurance plans, and is not mobile. Perhaps in conjunction with properly fitted compression garments, a pump might be helpful but it is not constant enough in order to maintain correct limb size, and keep your limbs from swelling. Therefore the most practical way of maintaining your reduction is to wear properly sized, comfortable compression garments daily.

If you feel you are experiencing signs of undiagnosed lymphedema, consult your physician or lymphedema specialist and then call us for assistance.

Shop at for the Best in Compression Garments

Or call us at 1-800-515-4271, and one of our Certified Fitters will be happy to help you.

Vanda and the Support Hose Store Team

Specialist Who Diagnose and Treat Venous Disease

In today’s medical world a new specialty is emerging, Phlebology. The Phlebologist is a medical specialist in the diagnosis and treatment of disorders of venous origin. The specialty of Phlebology has developed to enable physicians with a variety of backgrounds such as: dermatology, vascular surgery, hematology, general surgery or general medicine, to share knowledge and experience. Not only do they share an interest in venous disease but also in diagnostic techniques used. This includes the history and physical examination, venous imaging techniques and laboratory evaluation related to venous diseases.

A significant part of a Phlebologist’s work deals with the treatment of superficial venous disease, usually of the leg. Conditions often treated include varicose veins and Telangiectasia (spider veins). Other conditions managed by Phlebologists include deep venous thrombosis (DVT), superficial thrombophlebitis, chronic leg ulceration (venous ulcer), and venous malformations.

The American College of Phlebology(ACP) is a professional organization of physicians and health care professionals from a variety of backgrounds. The American College of Phlebology holds meetings to enable the continuing education and sharing of knowledge regarding venous disease. There are other equivalent bodies of learning around the world.

There are two general treatment options for varicose veins: conservative measures (non-invasive), such as compression stockings, and corrective measures such as sclerotherapy,
endovenous procedures, and light-based treatment. In some cases, a combination
of treatment methods works best. Untreated varicose veins may lead to adverse consequences. The consequences may vary in their severity from person to person depending on the circumstances. Many people who have untreated varicose veins will experience continued symptoms of pain, fatigue and swelling of the legs or ankles. More advanced medical problems may include hyper pigmentation (reddish skin), lymphedema, venous leg ulcers, spontaneous bleeding, superficial thrombophlebitis, and a potentially life-threatening condition called deep vein thrombosis.

Phlebologists use compression stockings in the range of 20-30mmHg or greater. They know the importance of proper fitting support hose in managing their patients’ venous disease. Our manufacturers of support hose have made it so much easier for us to find a garment which fits our clients’ lifestyle and body measurements. As we always say “They don’t look like the stockings your grandmother wore”. They come in styles which range from pretty and sheer to dress socks for men and athletic socks for men and women. Just call one of the Certified Fitters at Support Hose Store (1-800-515-4271) and they will assist you in the proper garment and fit.

Be sure to check out our link above to the American College of Phlebology. It is a treasure chest of information for you in the treatment of your venous disease.


Alternative to Bandaging for Lymphedema and Severe Edema

Caresia for Lymphedema and Severe Edema

Support Hose Plus prides itself on keeping up with the latest technology in lymphedema and edema control products for our clients. We are proud to announce the addition of Solaris Products to our product line. Caresia Bandage Liners (used for reduction during the active phase of therapy for Lymphedema and severe Edema) and Swell Spots (used for those trouble spots). We are very excited about these products. We have seen positive results when standard multi-layer bandage protocols have not succeed.

Caresia uses unique foam chips in every garment which create localized tissue pressure differential to stimulate movement of the interstitial fluid and soften tissue. We have them available in ready to wear garments for the arm (Caresia Arm Bandage Liner, lower leg (Caresia Below Knee Bandage Liner) and thigh (Caresia Thigh Bandage Liner).

The Caresia garments make bandaging easy for the inexperienced patient, decrease the stress levels, and increase patient compliance. Patients simply don the Caresia and then wrap with one layer of short-stretch bandage using spiral or figure-eight wrapping with 50% overlap. The fit of the Caresia Bandage Liners gives the patient much better agility and comfort.

Swell Spots are made similar to the Caresia using foam chips to stimulate lymphatic flow. Swell Spots are now used in problematic areas of swelling, tissue fibrosis, and contouring over and around bony prominences. Wherever there is a pocket of swelling there are Swell Spots to fit the job.

After reduction has been achieved and patient is ready for compression garments, these garments transition easily to a night time garment (eliminating lengthy night time bandaging).

Caresia garments can be washed with a normal load of clothes using laundry detergent on the permanent press cycle and dried with the same load of laundry on permanent press.

Caresia is certainly an alternative to standard bandaging with foam, stockinette, and gauze because of its comfort, ease of care and donning and agility it gives patients.

Please call one of the Certified Fitters at SupportHosePlus (1-844-472-8807) for assistance,



JoViPak – One of Our New Manufacturers « Ask Vanda Weblog

At Support Hose Store we pride ourselves on keeping up with the latest technology in lymphedema and gradient compression stocking therapy for our clients.  We are excited to welcome our newest manufacturer, Jovipak to the Support Hose Store family!  Jovipak® is a leader in the field of Lymphedema Products and now owned by Jobst.

You may have read many of our Articles on Lymphedema at my blog Ask Vanda. Lymphedema can develop when the lymphatic system is disturbed and can no longer rid your body sufficiently of lymph fluid.  Lymphatic vessels cover the human body like a net.  They collect and filter waste products such as protein, metabolic waste, and inflammatory products in the body fluids.

Today, let’s focus on the effects of air travel on those with lymphedema and those who might be susceptible to lymphedema.  Air travel, including in-flight, as well as all of the walking associated with airline travel, places those with lymphedema at risk, and can also cause the onset of lymphedema in those patients who may not yet know they are at risk.  Altitude and cabin pressure can wreak havoc on the human body.  Although aircraft cabins are pressurized, while traveling at altitude, that pressure is usually much less than that on the ground.  When traveling at, say, 18,000 feet, the atmosphere in the aircraft is like being on an 8,000-foot mountain peak, causing the pressure to feel as if you are 8,000 feet above sea level.  When pressure is decreased, the air expands and occupies a greater space.  Less oxygen is absorbed into the blood at these altitudes; therefore, less oxygen is circulated throughout the body during flight.  The trigger that causes or exacerbates lymphedema is the decrease in air pressure (the force exerted on the body by the weight of the air).  In addition to air pressure, just think of the effects of inactivity on flights.  It is a well-known fact that even people with an intact lymphatic system develop swollen ankles and feet during flights.  Obviously, then, think about the effects of inactivity in addition to compromised lymphatic drainage, in addition to cabin pressure on those who already suffer from lymphedema.  This can lead to very serious consequences.  Not to mention, ruin your trip.

Compression Therapy is the most effective means to counter the effects of venous insufficiency and lymphedema.  Compression Garments increase the tissue pressure, effectively reducing the accumulation of fluids in tissues and promotes lymphatic and venous return.  Always, always wear your compression garments!  Drink lots of water, as the humidity in an airplane cabin is usually less than 20% and can cause some dehydration, which increases swelling.  C

There are many garment choices for you and your therapist in lymphedema therapy.  You are already aware that we carry daytime-specific garments such as Jobst, Mediven, Juzo, and Sigvaris.  We also carry Solaris products, Farrow Wraps, Circ-Aid, and Barton Carey.

We now have Jovipak® which offers both day and night garments – everything from custom made garments, made to fit any part of your body affected by lymphedema, ready-made (ready to ship the same day of your order) garments for any body part, and solutions for chronic venous insufficiency.  These products are known for helping to keep your body parts dry and comfortable with Polartec® Power Dry® with wicking capabilities in a silky garment.  Some even have X-Static® (a silver fiber knit into the construction of the garment) for antimicrobial effects.  The continuous flow channeling in each garment directs lymph flow to functional alternate pathways as specified by your therapist.  Wearing a better night garment, in lieu of wrapping, can significantly reduce the size of your body part affected by lymphedema.  These garments are easy to don, and much less expensive than the cost of bandages.

There are 12 Polartec® colors to choose from!  Jovipak® is a great, patient-friendly alternative to bandaging.  And so much easier to put on!

Measuring is easy and can be done by you or by your therapist.  We can assist you in your measuring!

Ready-Made Garments:

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Call us at 1-844-472-8807.  We can help you determine which garment would work best for you.  Sizing is easy, and we will simply require 3 measurements from you for an arm.  Measure your wrist at the smallest point, your elbow, and the axilla (Place a piece of paper under your arm and fold around.  This is where the top of your garment should be placed).  Choose between Pink and Royal Blue, with or without a black or white outer jacket. For a knee high garment, ready-to-wear, simply measure the circumference of the smallest part of your ankle, usually just above the ankle bone, the largest part of your calf, and the knee at the tibial tuberosity.  Choose between Royal Blue and Leaf Green.  A matching JoVi Safety-Sok with non-slip sole is included with each knee high order. Call us with these measurements.

Made To Order:

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The Made-To-Order garments are standard sized Ready-Made garments with modifications made expressly for you, and can even deal directly with leg lobules and problem areas on any body part.
Every client who has purchased a Jovipak® product has considerably been reduced within days of wearing the garments.  And comfort – this is one of the most comfortable garments on the market!

Custom Made-To Measure Garments:

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Jovipak® has Made-To-Measure garments available to everyone’s unique measurement needs.  For children, men, or women, they will create a precision pattern to fit any body part.

You may receive assistance in ordering any of our wonderful products we carry by calling us at  1-800-515-4271

We have certified fitters on staff to help you in determining what products would best suit your needs.  We can also assist you in placing your Jovipak® orders…even the custom orders.  Simply call 1-800-515-4271.  We look forward to hearing from you!  After all, We’re Here To Support You!

Lymphedema – Avoidance and Bandaging

Last month we addressed what lymphedema is, being primary or secondary lymphedema. We discussed the lymphatic system, and the factors that contribute to lymphedema.  This issue we would like to discuss avoiding lymphedema and keeping it in check should you have already developed.

Avoid Temperature ExtremesThe temperature of your surroundings is very important.  You should avoid temperatures extremes such as hot baths or shower, extended time in the sun, or travel into colder or hotter climates. You should also avoid infestations or blunt trauma.  Infection causing events include insect bites, manicures, pedicures, pet scratches.  Trauma includes avoiding lifting heavy objects, blood pressure cuffs on the effected limb, tight clothing, tennis or golf.Eat A Balanced Diet to Avoid obesity in Lymphedema

A diet plentiful in fruits and vegetables for a balanced diet is suggested.  This will also help avoid obesity.  Alcohol and nicotine should be kept to a minimum, if at all.  Meticulous skin and nail care is very important.  Sleeping with the affected limb elevated and/or wrapped is helpful. Of course, a little time spent in exercising, walking, swimming, etc will be of great benefit.  If you see any changes to the coloration or size of the effected limb or if you are concerned with changes to the body always seek medical attention.

All of the above suggestions are to help prevent the lymphedema or keep it in check. Once lymphedema has developed, many times Manual Lymph Drainage and Complete Decongestive Therapy (MLD/CDT) are required to return the affected limb to a normal or near normal size.

 There are Four Steps of Complete Decongestive Therapy

1. Hygiene and Topical Skin Products

Meticulous hygiene with or without antibiotics is essential. The goal is to eliminate bacteria or fungus on the skin which can lead to repeated attacks of erysipelas (an acute streptococcus bacterial infection of the dermis, resulting in inflammation and characteristically extending into underlying fat tissue) and/or lymphangitis (an inflammation of the lymphatic channels themselves that occurs as a result of infection at a site distal to the channel).

2. Manual Lymph Drainage, MLD

A special lymphatic decompressive massage is given for one hour once or twice a day. This involves specific manual movements along lymphatic pathways that empty and decompress obstructed lymph vessels. Such therapy facilitates the unhindered flow of lymph fluid into the venous circulation, where it is suppose to go, and allows the limb to return to normal or near normal size. Accomplished by utilizing subcutaneous lymph vessels, existing lymphovenous system and other segments of the lymphatic network which cross the midline of the body, go around the back, over the top of the shoulder

3. Application of compression dressing

Bandaging of the affected limb follows each MLD session. The bandages used for this are short stretch bandages (not ace bandages) and compensate for the diminished tissue pressure in lymphedema. This is an important component of the MLD therapy in that it augments the diminished tissue pressure and prevents the affected limb from refilling with evacuated lymph. The bandages are worn overnight until the next MLD session is about to begin. At the end of the course of treatment when the limb is normal or close to normal, a compression garment is ordered. Many times this is a custom garment which is made especially for you.

4. Remedial Exercises and ElevationExercise with Bandages in Place

Remedial exercises with the bandages in place are prescribed. This step activates each muscle group and joint of the swollen limb and results in an increase in lymph flow and, over time, in dilation of the lymph vessels. Whenever possible, it is recommended that the patient sleep with the swollen limb elevated to or just above the heart. Bandaging is one of the skills taught to each patient during treatment. When elevation is required, it is best done by using foam pad bolsters which can be readily purchased.

The effects of compression are to control the lymphedema. Compression from bandaging or stockings raises the tissue (interstitial) pressure and thereby reduces the effective ultra filtration pressure which results in less lymph fluid accumulation and less fluid having to be removed from the tissue spaces. Compression improves the efficiency of the muscle and joint pumps. As the lymph is being propelled through the lymph vessels by muscular activity, by the contraction of the vessels themselves, and by movements of the diaphragm (breathing), compression assists in the rapid flow of the lymph.

After the course of therapy is completed is not uncommon for it to become necessary to wrap in the evening as a “tune-up” and wear the compression garments during the day. If you wrap in the evening make certain your bandages are smooth and even. When you get up in the morning make certain to don your support stockings or sleeve. After four or five months of use, be certain to purchase a new garment as they loose their compression after extended use. When you wash your garments be certain to wash in hot water (about 105 temperature) and be certain to wash after every use.

Thanks for shopping at Support Hose Plus,

Lymphedema – Control and Management Intro

What is Lymphedema?

Lymphedema is a swelling of a part of the body, generally in the arm and leg appendages. The swelling is caused by an accumulation of lymph fluid in the swollen area. Lymphedema is a chronic and progressive condition but it can be controlled by proper care and attention to basic rules that can lead to a normal and active lifestyle.
Surprisingly, lymphedema affects about 1% of the population. Lymphedema generally results in a feeling of heaviness or cosmetic enlarging of the affected arm or leg, and a slight to severe discomfort. Repeated episodes of infection (erysipelas – an acute streptococcus bacterial infection of the dermis resulting in inflammation and characteristically extending into underlying fat tissue and lymphangitis – is an inflammation of the lymphatic channels that occurs as a result of infection (most common is Streptococcus Pyrogenes) at a site distal to the channel. Severe cases are associated with thickening of the skin, hardening of the limb, leakage of lymph and massive swelling.

Lymphedema is either primary or secondary lymphedema.

primary-lymphedemaPrimary lymphedema are those cases that occur without any obvious cause. Primary lymphedema may be present at birth or may develop after age 35. Primary lymphedema is generally more present in females and generally occurs more frequently in the legs. Secondary lymphedema is generally caused by an injury, scaring secondaryLymphedemaand radiation or surgery in the area of the lymph nodes. It is estimated that there is approximately two million cases of secondary lymphedema with most caused by breast cancer therapy.

So, what is the lymphatic system?

lymph-systemThe body has two circulatory systems which move liquid through the body; one is the blood system that circulates the blood in the veins and arteries and the other is the lymphatic system that which carries lymph thru the body and back to the large veins in the neck. Lymph is a colorless transparent fluid that originates in the tissue space throughout the body. It differs from blood in that it contains less protein and no red blood cells. The lymphatic systems responsibilities are to remove excess body fluids, bacteria, viruses, proteins, and waste products from the body tissues. As the lymph is passing from one part of the body it passes thru the regional lymph nodes where it is filtered. The lymph nodes, thymus gland, tonsils and spleen are all a part of the immune system. They produce lymphocytes which are important in fighting infection and enhance the body’s immune capabilities. When the lymphatic system is disrupted, the lymph pools in the interstitial spaces and swelling occurs.

The lymph is assisted in passing thru the body by muscular action, by contractions of the vessels, by movement of the diaphragm and by changes in pressure of the diaphragm (breathing). From here the lymph is propelled toward the veins in the neck where it joins with the blood on the way to the heart.

Factors that contribute to lymphedema are:

  • Surgery and/or radiation therapy
  • Post operative infections
  • Obesity
  • Infections (insect bites, athlete’s foot, paronychia – bacterial or fungal infection where the nail and skin meet at the side or the base of a finger or toe)
  • Sedentary lifestyles
  • Dependent limb position
  • Recurrent tumor
  • An inappropriately heavy breast prosthesis
  • Trauma to remaining lymphatics

There are many medications that have been tried to control lymphedema with little success. Surgery has never solved the problem. What is necessary is for you to educate yourself on lymphedema by talking to your physician or therapist. What has proven to be effective is Manual Lymph Drainage/Complete Decongestive Therapy (MLD/CDT), coupled with compression bandaging the affected limb and then followed by the application of compression sleeves or compression stockings.

Lymphedema should not be confused with edema. Edema is caused by an accident, surgery or injury resulting in the building up of excessive fluids in the tissue and can be treated by the application of a compression garment such as an arm sleeve or stockings. Untreated edema can progress to venous/lymphatic disorder which is treated as lymphedema.

Come back for the more information on lymphedema next month.

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Data and Graphics courtesy Lohmann & Rauscher.