Although lymphoedema cannot be cured once it has developed, the arm-raising exercises can help to reduce the swelling and to prevent it getting worse. It may be controlled by a combination of regular, gentle exercise, massage (which you will have to be taught), general skin care and, when appropriate, by the wearing of an elastic compression sleeve. Although you can carry out most of the measures to control lymphoedema yourself, you must ask your doctor’s advice before starting any form of treatment.

*      Skin care. Germs can enter the body through dry, cracked skin, and you should therefore use a simple moisturizer after every bath. If your skin has become very rough, your doctor will be able to prescribe a special cream to treat it.

You should always protect the hand and arm on your affected side from injury and possible infection, for example by wearing gloves while you are gardening or using strong cleansing agents, and a thimble when sewing. If your hand or arm is cut or grazed, however small the injury, make sure it is thoroughly cleaned, treated with antiseptic, and covered with a clean dressing. If persistent inflammation or swelling follows an injury of this sort, ask your doctor’s advice as soon as possible.

Blood pressure measurement, blood tests and injections should be done on the other arm whenever possible.

*     Movement and exercise. Gravity tends to cause the lymph to pool, and its effect can be counteracted by raising the arm whenever possible. This can be done by resting your affected arm on a cushion – on the arm of a chair when sitting, and beside you when you are in bed – so that it is above the level of your heart.

Although too much exercise will cause the swelling to increase, gentle regular movement of the arm helps the lymphatic fluid to drain away. The exercises described above should be done gently at least once a day, while wearing a compression sleeve if you have one.

*     Massage. Massage of the affected arm and armpit, as well as of the lymph glands in the neck (and of the chest if fluid has started to accumulate here), will help lymphatic drainage away from the arm. A nurse or physiotherapist should be able to advise you about this, as specific lymph drainage massage must be done to ensure that it is effective. Massage clears the way ahead of the swelling so that fluid can drain from the swollen area. It should be gentle but firm, just enough to move the skin.

*     Compression sleeves. In some cases of lymphoedema, an elastic compression sleeve may be worn which prevents fluid building up in the arm and provides support to the muscles. These sleeves can be obtained from a hospital appliance officer, to whom you must be referred by your consultant or breast care nurse.

Compression sleeves should be put on in the morning when the swelling is least, and can be removed at night. Moist skin makes them more difficult to apply, and it is therefore best not to have a bath immediately before fitting your sleeve. Once the sleeve is on, it should be smooth and creaseless. It should never be rolled back as it will act as a tourniquet. The elastic gradually loses its strength and the sleeve will need to be replaced every 3 to 4 months.

It is important that you wear your elastic sleeve in hot weather, even though it may be uncomfortable, as this is a time when your arm is likely to swell.

*     Compression pumps. The use of a compression pump is not always suitable in every case; your doctor will be able to advise you about this. The pump is attached by a small tube to an inflatable cuff, and is powered from the mains electricity. Air is pumped in to inflate the cuff and is then gradually sucked out to deflate it again. The effect is a gentle squeezing of the arm which assists the drainage of lymph away from it. Compression pumps are normally used at regular intervals throughout the day to help reduce swelling.

Your pump should not be used if you have an infection in your arm, swelling in your chest, or if it causes pain.

If you are attending a lymphoedema clinic, your progress will be regularly monitored and you will be given advice about all the measures you can take to help control the condition.

*48/39/5*

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