arm lymphedema Archives - Lymphedema Therapy Source

September 1, 2025 By Rebecca Summers, OT, CLT-LANA, CSR

Can You Cheat in Lymphedema? (part 2)

We’re continuing a patient story from last month. (Click here for part 1)

The patient we’ve been following received a daytime CCL 2 sleeve & glove (she also wanted to try a gauntlet). She also received her CCL 1 sleeve & glove which she wanted to try for night use (instead of the recommended protocol of bandaging or a foam sleeve).

What Happened?

Five weeks after getting her daytime sleeve/glove, she had issues with finger swelling & arm refilling. She wasn’t resting well at night either. She stopped using the CCL 1 garment & used the same CCL 2 sleeve at night. When she returned to see me, she seemed angry (with me) for her outcome. When there’s a deviation from the protocol, the outcome will be affected.

I noted the likelihood of using a CCL 2 daytime sleeve/glove at night, especially when sleeping with elbow bent, as contributing to her forearm swelling & worsening fibrosis. While resuming bandaging was the best idea, she was adamant she wasn’t going to do that again. I said the next best option would be to get a nighttime foam sleeve. It should help reduce the forearm fibrosis which would help reduce the swelling. She agreed.

(collaboration with a local garment rep on best night garment in this case)

Intervention

This patient chose to continue wearing her daytime CCL 2 sleeve/glove (23-32 mmHg) before being fit for the night garment. (She hadn’t been re-reduced with bandaging.) That meant, the nighttime garment would likely be bigger than it should be. The fitter tried to compensate for this by decreasing the circumferences. (I had the manufacturer’s local rep do the fitting.)

Outcome

It took several weeks for the nighttime garment to arrive. The patient continued wearing the CCL 2 sleeve & glove during this time. (She did come in for bandaging one session prior to the arrival of the night garment.) The night garment was a little short & a little big, but the patient agreed to try it at night. After a few nights, she felt she was doing well & seeing progress.

(photo sent by pt after removing the night garment in the morning; she had worn it several nights)

When she returned to see me, she was happy with her status. Because the night sleeve wasn’t quite as long as it could have been (or the patient hadn’t been able to keep it up near the shoulder because it was a too large around the upper arm), there was some refilling around the shoulder. But her other numbers were improved as her fibrosis softened with the chipped foam sleeve.

(final visit after wearing night foam sleeve: volume 26.3 cm)

Can You Cheat the System?

Short answer: No. The protocol for lymphedema treatment exists to maximize the best outcome by softening fibrosis & decongesting tissue. Once this process is complete, a patient is ready for their maintenance day & night garment fitting. They should remain bandaged until both garments are in place.

This patient’s course was prolonged & a bumpy ride to get to her conclusion. But in the end, she was happy with her status. That’s what matters most. Sometimes a patient’s goals aren’t solely to maximize reduction. Convenience or interference with daily routines may trump the “ideal outcome.” It’s important to ask a patient what their goal is & to monitor this goal during the course of therapy as it may change.

August 1, 2025 By Rebecca Summers, OT, CLT-LANA, CSR

Can You Cheat in Lymphedema? (part 1)

Many people are tempted to shortcut the therapy process in lymphedema. Instead of bandaging, they only want manual lymph drainage (MLD). Or instead of MLD, they only want to bandage. Or they may stop treatment early (or skip therapy & go right to a compression garment). Is it possible to “cheat” in therapy? Yes, it is. But just like shortcutting or changing a recipe, the outcome will be affected.

Protocol

The recommended protocol for lymphedema treatment (according to Foldi) is to bandage daily during the decongestion phase.¹ Once volume plateaus & a patient is not expected to make further progress, they are fit with a custom, flat-knit, daytime sleeve/glove & they are to bandage at night for the maintenance phase.² (Or, alternatively, a special nighttime garment like a foam sleeve might be used.)

A patient with left arm lymphedema due to breast cancer was tiring of bandaging & driving to appointments after ~10 sessions of daily treatment. Her arm fibrosis hadn’t maximized in reduction nor had the swelling, but she had made decent progress.

(evaluation – visit 1: total left arm volume 27.9 cm)

(after 10 sessions: total left arm volume 26.9 cm)

She wanted to proceed with getting fit for her custom, flat-knit sleeve & glove in a class 2 (23-32 mmHg). She would continue working on her arm fibrosis herself. In addition, she didn’t want to bandage at night (or get an alternative night garment like a foam sleeve which looked hot & bulky). She wanted to try using a daytime sleeve and glove at night in less compression instead – a class 1 (18-21 mmHg). I wasn’t wholly supportive of this idea, but I agreed to try it.

Waiting for the custom sleeve & glove

Custom garments can take 2-3 weeks to receive. During the waiting period, a person should remain bandaged. However, therapy sessions can usually reduce in frequency. In this case, the pt remained bandaged 3x/week until the daytime garments arrived.

What was the outcome? Find out next month.

References
¹ Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2^nd ed.), p. 272. Germany: Urban and Fisher.
² Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2^nd ed.), p. 273, 574-581. Germany: Urban and Fisher.

March 1, 2023 By Rebecca Summers, OT, CLT-LANA, CSR

Breast Cancer: Why See A Therapist

One word no one wants to hear is “cancer.” And when the diagnosis is given, a million thoughts run through a person’s mind. “Am I going to die?” “Will I lose my hair?” “Will I lose my breast?” As if the questions aren’t enough, the bombardment of medical terms and doctor specialties may ensue.

What’s lymphedema got to do with it?

In this early stage, the thought of potential lymphedema development is not a high priority (if it’s even discussed at all).

I’ve heard many stories from patients who were not told about the potential risk of developing lymphedema after lymph node removal and/or radiation. At a minimum, anyone going through cancer who has a lymph node removed and/or radiation should at least be given a handout on the signs and symptoms of lymphedema, what it is and what to do if signs and symptoms appear. Being given education about cellulitis and receiving baseline limb measurements would be an added benefit.

Photo by Pexels / Anna Tarazevich

How to recognize lymphedema onset

If you’ve been diagnosed with cancer, and you’ve had one or more lymph nodes removed (and/or radiation), you are at risk for developing lymphedema. How do you recognize this swelling condition? Here are signs and symptoms of lymphedema development according to stage:

stage 0 (latency): no visible swelling but the involved area may feel heavy or achy
stage I (reversible): protein begins to accumulate, visible swelling is present, elevation reduces swelling
stage II (spontaneously irreversible): fibrosis (firmness) develops, pitting becomes more difficult, cellulitis infection may occur
stage III (elephantiasis): tissue no longer indents (non-pitting) & becomes more firm, skin changes occur (hyperkeratosis, papillomas), lobules form, cellulitis infections may be common

Next month, we’ll look at recommendations to prevent lymphedema. Is there any science behind those recommendations?