Swelling of the hand - lymphedema?

lvtwoqlt

Sher, I feel for you, when I learned to wrap my hand, I had the same frustrations. with practice you will get better. just try to relax when you are doing it.

Sheila

Binney4

Hey, Sher! The bandage-flinging is all part of the process. (When you feel a need to heave bandages across the room, do try to keep them off the floor, because they tend to pick up pet fur and you have to pick it off by hand.) GOOD for you for unwrapping and rewrapping and getting it right. Very courageous! I still forget one layer or another and have to reroll a wrap or two, so I always try to give myself enough time. But it truly does get easier. Taping is a bit of a trick, for sure -- make sure you cut enough pieces before you start and stick one end of them on whatever piece of furniture is handy so you can grab them easily as needed.

Brava!
Binney

kira66715

Sher, throwing rolls and getting frustated to the point of tears just seems to be the universal experience.

 My LE therapist is highly trained and created some gorgeous pictures to describe wrapping: I posted the hand wrap 

http://community.breastcancer.org/forum/64/topic/707625?page=1

Polly always folds the gauze in half, and she doesn't believe in pulling tightly, she just makes extra rolls if more compression is needed.

Another hint: I kneel next to the bed to wrap, because I can use the side of the bed to maintain the roll, and there's no dropping them. Another position is to sit at a table and wrap with the arm on the table.

I've had therapists trap fluid in my hand--ARGHH. I felt like Minnie Mouse, only with five fingers.

It's an art, and less is more, and it's nothing any of us wanted to learn, but once we learn it, we have the tools we need to manage this problem.

I can do the wrap relatively quickly now, but I used to take a LONG time--and recently Polly did remedial wrapping with me as I was putting way too much pressure on it, and creating problems.

Sher, hang in there! Congratulate yourself again and again for doing this hard work.

Kira 

Sher

I just looked at the pictures again, Kira and that is how my therapist taught me to do this, including the half folding.  But she uses a second gauze roll to go over the webs between fingers.  And for some reason when she wraps, the knucle area at base of little finger hurts like crazy......not immediately, but after awhile.  Maybe it's my arthritis? 

My therapist taught me to work seated at a table since I can't kneel and to put the rolled bandage under my arm, then rolling my arm over it to complete the loop around arm.  Works rather well for me, since my table is the perfect height.  

Today there was still increased swelling in my hand (Minnie Mouse is a perfect description), so she worked on it, actually kind of compressing and forcing the fluid up and out.  Thankfully, I'm still at the soft squishy stage, but I've never heard anyone mention this being done. 

How in the world do we know what is too tight and what is not tight enough?  It has to be somewhat tight for it to be compression, right?  Should it feel some uncomfortable and possibly even terribly annoying and distracting without being terribly painful?  Is slightly painful okay?   If the hand swells more with compression bandages, does that always mean the fluid has been trapped?  My bandages are mostly evenly tight all the way up - is that how it's usually done?  Once I get to the ready for daytime compression garments stage, I'll likely go with night garments as well instead of continuing to wrap.  But is wrapping for maintenance different than wrapping for treatment?  Sorry to have so many questions!  My therapist is great about answering lots of questions for me, but it helps so much to have questions answered by those who know first hand what it actually feels like to be going through this.  Likely, our therapists training inclued having themselves bandaged, etc, but they still can't know what it feels like for sure, unless they also have LE.

kira66715

Sher, I don't think a bandage should cause pain--although I've had therapists wrap me to the point of pain, but my current therapist is strongly against that.

Right now, I'm wrapped, and it's bulky, but no pain.

But, when there is fluid trapped in tissues, it hurts, and the arthritis hurts also. If the finger wrap through the web space on the pinkie hurts, then I'd tell her, and skip it.

An ideal wrap is a pressure gradient: more at the hand and less at the top--to drive the fluid up.

Many people do incredibly well with night garments, and they sure are easy and comfy. I have both a Solaris and a jovipak and because they just don't do enough for my hand, I wrap a lot, but use the Solaris for a break and a change, and it sure is nice to just slide it on and slide it off.

I think the general idea of wrapping for maintenance is the same--I never had the intensive CDT--but likely there is a bit more pressure in these first therapeutic wraps.

I think if your hand swells more with compression, that the bandage is driving some excess fluid up, and it's good to mobilize fluid, but it would be ideal if it didn't go into the hand.

If you squeeze the bandages, hopefully they feel the most dense at the hand and the least at the upper arm.

I completely agree with you about therapists who wear a bandage for a few hours. My LE therapist has LE in her legs, and her SIL has severe LE in her legs after melanoma surgery, and she worked at an in patient clinic in NYC with some of the big names in LE, so she gets it.

The first therapist who wrapped me too tight actually said something like "Some days I'm just horrible at putting on bandages:--what???

So, I vote for mild to moderate pressure without pain. I hope Binney comes along--she really is the expert.

Kira 

Sher

Thanks Kira!  One thing I forgot to mention is that the swelling in my arm decreased all the way up and therapist said the tissue was softer.  Just my hand that hasn't responded well, but then treatment just started 3 days ago, so I'm probably expecting too much too soon.

Binney4

Sher, I soooo get this. Of course you "forgot" to mention that there's been real improvement in your arm all the way up, because there's STILL swelling in your hand. Aaaaugh!!! This stuff just has a way of making us all obsess.

I have arthritis too, and the wraps can make bad knuckles hurt. Let your therapist know -- she may want to pad it with extra Artiflex or a foam pad, or she may want to wrap a tad looser in that spot.

We don't know what's too tight and what's too loose without a bit of trial and error (sometimes heavy on the "error"). And even now, if I'm tense or frustrated I may wrap tighter than I should, or if I'm in a hurry I may wrap too loosely. This is a work in progress, and your progress so far sounds good.

Hands are a bummer. Always harder to conquer than the nice, cylindrical arm. You and your therapist will get it, just takes a bit longer.

Wrapping should feel supportive and snuggy but, as Kira says, never painful (which defeats the purpose because pain draws lymph fluid to the site). It also feels clumsy and bulky and (for me at least) pretty bizarre. It's not something you do and forget about it. We're used to not thinking about our arms at all, but wrapping them in five or six layers of bandaging material makes it difficult not to think about it constantly. I walk through the mall wrapped (or sometimes even with just a sleeve on) and wonder why everybody else's arm is working when mine isn't. Then I wonder how my lymph system could have functioned all these years without a bit of thought on my part. So, annoying, distracting, frustrating, clumsy-making, humiliating? Yes. Painful? No.

As Kira points out, the point of wrapping is to apply the most pressure at your hand and less going up. A related but strictly practical point, however, is that if the top is not tight enough the stupid thing will fall down your arm after an hour or so. There's an ideal involved here, and we do the best we can every time to get as close to that as possible, but the principal is: more pressure at the hand and less as you go up.

If my hand swells after wrapping it MIGHT be because I wrapped too tight higher up and trapped fluid in it, or it might be because I wrapped my hand too tight (there is nothing simple about LE). If I wrap too tight my lymph system rebels and rebounds with more swelling. So you have to consider all the angles. Only right now (since you're right at the beginning of your therapy intensive) it's your therapist, not you, who has to try to figure it all out.

My maintenance wrap is the same as my therapy wrap. Sometimes that's not the case. For instance, if you had a stray area of swelling that had become fibrotic you might need a chip bag (sort of a home-made Swell Spot) over that area until the fibrosis was softened. Later on you might never need a chip-bag there at all. So in that case your maintenance wrap would be different. The degree of compression you'd need for both wouldn't be likely to change, though, unless you started out with extreme swelling, which we bc gals rarely do.

I agree that therapists don't get it about how bandages feel, even though all through their training they're constantly practicing wrapping one another. They don't have the same degree of dread about it that we do, and just knowing it's not forever would make it so much less of an insult. On the other hand, there have been times when I've been glad my therapist was not in a position to empathize too closely with me -- I need her matter-of-fact approach to solving my dilemmas. And besides, I have all of you to commiserate with me. THANK YOU, ALL YOU SISTERS OF SWELL!

Hugs,
Binney

WifeWBC

I am no expert, but what the OP describes sounds an awful lot like De quervains tenosynovitus. Trapping of the nerve in the wrist bone area. Extremely painful, but often temporary (few weeks). Perhaps exacerbated by swelling in arm and in particular the wrist. Not sure how the two would be treated together. Assume the swelling has to be reduced. If arthritis is chronic, then the trapped or bruised nerve might be chronic too. Worth looking up. Old thread