About Lymphedema Sleeves/Garments
Most people do not know what lymphedema is until they have it. Once they receive the diagnosis they are shocked and concerned about what to do. There are several different options for the treatment of lymphedema including various kinds of compression garments. They often are recommended to prevent swelling when flying on an airplane. The Simms/Mann - UCLA Center for Integrative Oncology at UCLA has pamphlets on this topic. There are a few people around the country that specialize in this treatment.
Commonly asked questions and answers about lymphedema:
Lymphedema is a swelling caused by an accumulation of lymph fluid in an area of the body. It typically occurs in a limb. For women who have had breast cancer the most common site is in the arm on the affected side. It can also occur in the leg; this tends to be associated with pelvic surgeries.
The lymphatic system is a part of the circulatory system. It acts as a sewage system of the body to remove and filter the metabolic wastes from the body's cells by transporting the lymph fluid a clear, high protein fluid from the spaces between the cells. The fluid is transported through a network of lymphatic vessels and pathways to the lymph nodes where the filtering and detoxification occurs. It then is returned clean to the circulatory system. Lymphedema or swelling occurs when there is an impairment of the lymphatic system that radically reduces its capacity to transport, filter and detoxify the lymph fluid.
Lymphedema often occurs after surgery or radiation to that area in which vessels may have been damaged or lymph nodes removed. Men and women who undergo surgery that includes removal of lymph nodes and/or radiation in connection with the treatment of breast cancer, gynecological cancers, prostate and testicular cancer, colon, bladder and kidney cancer and lymphoma and melanoma are at risk for developing lymphedema. The leading cause of lymphedema in the United States today is cancer and its treatments.
Lymphedema usually begins with swelling in the hand or the foot. If you notice swelling (even slight swelling) that seems to persist in a limb, you should seek medical advice. If the problem is diagnosed and treatment begins early, the prognosis for improving the condition is greater than if it goes untreated. Do not ignore the problem. When lymphedema remains untreated, the limb becomes more swollen and the skin hardens and loses elasticity. Untreated lymphedema can lead to infection and sometimes to complications that cannot be reversed.
Individuals who have had surgery or damage to their lymphatic system should be aware of the recommendations made by The National Lymphedema Network (1-800-541-3259 or www.lymphnet.org) in their position paper on “Lymphedema Risk Reduction Practices” which was approved by their board of directors. They make the following recommendations:
Skin Care - Avoid trauma/injury and reduce infection risk
Keep extremity clean and dry.
Apply moisturizer daily to prevent chapping/chaffing of skin.
Attention to nail care; do not cut cuticles.
Protect exposed skin with sunscreen and insect repellent.
Use care with razors to avoid nicks and skin irritation.
If possible, avoid punctures such as injections and blood draws.
Wear gloves while doing activities that may cause skin injury (i.e., gardening, working with tools, using chemicals such as detergent).
If scratches/punctures to skin occur, wash with soap and water, apply antibiotics, and observe for signs of infection (i.e. redness).
If a rash, itching, redness, pain, increased skin temperature, fever or flu-like symptoms occur, contact your physician immediately.
Activity / Lifestyle
Gradually build up the duration and intensity of any activity or exercise.
Take frequent rest periods during activity to allow for limb recovery.
Monitor the extremity during and after activity for any change in size, shape, tissue, texture, soreness, heaviness or firmness.
Maintain optimal weight.
Avoid limb constriction
If possible, avoid having blood pressure taken on the at risk arm.
Wear loose fitting jewelry and clothing.
Should be well-fitting.
Support the at risk limb with a compression garment for strenuous activity (i.e. weight lifting, prolonged standing, running).
Wear a well-fitting compression garment for air travel.
Extremes of Temperature
Avoid exposure to extreme cold, which can be associated with rebound swelling, or chapping of skin.
Avoid prolonged ( > 15 minutes) exposure to heat, particularly hot tubs and saunas.
Avoid immersing limb in water temperatures above 102° F.
Additional practices specific to lower extremity lymphedema
Avoid prolonged standing or sitting.
When possible, avoid crossing legs.
Wear proper, well-fitting footwear.
If lymphedema is caused by an infection, doctors usually prescribe antibiotics. If it is not caused by an infection, then compression will be needed to help reduce the swelling in the affected limb. Surgical compression stockings or sleeves can apply compression. A specially trained therapist may also perform special massage techniques, which are known as Manual Lymph Drainage. The therapy will focus on gently massaging with a pumping motion connective tissue rather than muscle tissue. This stimulates the weakened lymphatic system by pushing the stagnant fluid through the vessels, allowing the venous system to reabsorb the fluid and helping to develop channels through which the lymph can begin to flow. Some physicians may prescribe a pump. There is controversy over this treatment so you may want to seek out as much information as possible and get more than one opinion before choosing your treatment approach. The National Lymphedema Network (www.lymphnet.org) has a detailed position paper on treatment and is available on their web site.
Many patients will be prescribed garments that will provide compression for the affected limb. The garments help to keep fluid from accumulating in the limb. These garments have specific amounts of pressure and can be worn on the legs, hands, feet, or arms. The garments are made of a tight stretchy fabric. An expert fitter must fit lymphedema garments (sleeves). Measurements are taken, and a patient must try on the sleeves to make certain that they have a comfortable fit. Sometimes custom sleeves must be made, but most people are able to find a pre-made sleeve in a suitable size. The sleeves prevent the accumulation of more fluid in the limb; they do not pump fluid out of the limb. The garments are usually used in combination with therapy or as a preventive or maintenance measure.
Lymphedema sleeves and treatment can change the size of the affected limb as can various activities. Sometimes patients need more than one sleeve during this process because of the changing size of the limb. There is a tendency for patients to think that their sleeve has been fit improperly. Sometimes it has been, but more often than not, the limb has changed in size.
Note these sleeves wear out with continued daily use and must be refit and replaced on a regular basis (approximately every 3-6 months). Over time with washing and wearing they lose their compression. Different levels of compression are used for prevention versus maintenance.
Yes, a prescription is needed even for a prevention sleeve. Your doctor or nurse practitioner may write your prescription. A typical prescription for a lymphedema sleeve reads as follows:
"Compression garment for (leg, arm, hand, foot) (right, left, bilateral), for (diagnosis - type of cancer or other condition). Compression of (amount of pressure to be specified by doctor)."
The information provided by the physician on the prescription for a lymphedema garment should contain the ICD-9-CM diagnostic code for lymphedema, and not the cancer or other condition which necessitated the treatment which resulted in lymphedema. The preferred wording would be: "...for lymphedema ICD-9 code 457.0 or 457.1 secondary to ..."
The garment is not used for nor covered for the treatment of cancer. It is used in the treatment of lymphedema secondary to cancer.
Even if your insurance company does not reimburse for the cost of these products, a prescription from your doctor will allow you to purchase the item without paying sales tax. Your doctor may fax the prescription directly to Reflections (310-794-9088) and we will hold it until you come for your fitting.
Medicare does not cover the price of lymphedema garments; however, many other insurance plans do. It is important to talk to your insurance company to determine whether these are covered items and what kind of authorization may be needed.
Your doctor may be required to provide a medical justification for your compression garment in order for your insurance company to reimburse for the product. Many doctors do not fully understand these sleeves, how they work or what may be required by your insurance company. Talk to your doctor about these issues at the time your referral is made. Inform them that you may need a letter justifying the need and that they may need to provide this on an ongoing basis as your garment needs to be changed or renewed.
We are preferred providers for many insurance and medical groups including Blue Cross, Blue Shield, and UC Medical Group. Please call to find out more about your own insurance and how we can assist you (310) 794-9090.
The products vary in price. Those that are custom made are more expensive than those which are stocked as part of our regular inventory. The following listing will provide an approximate idea of the range of prices for these products. The most important concern is to obtain the best product for your particular condition, which should be assessed by the physician/treatment team who is involved with the care of your lymphedema.
Over-the-counter and customized lymphedema sleeves, gloves and stockings $50 - $300
Reflections is a non-profit organization and is operated by the Simms/Mann - UCLA Center for Integrative Oncology at UCLA. The Simms/Mann – UCLA Center for Integrative Oncology provides many free psychosocial services to patients with cancer including groups, a lecture series, and a library of information. All proceeds from sales support the operations of Reflections and the Simms/Mann – UCLA Center for Integrative Oncology. See other parts of this web site for more information or call (310) 794-6644.