Sudden swelling/warmth of hand

KS1

Hi all,

When I woke up yesterday morning, the dorsum of my hand (primarily ulnar side) was puffier than it has ever been and warm to the touch.  My arm looked fine.  This AM, when I took off my Tribute, the dorsum looked a bit better, but within minutes the puffiness was back.

Historically, this is a problem area for me, so chances are this is just an inexplicable flare.  That said,  the onset was very sudden (just this weekend, I remarked how great my hand looked ...) and I don't remember my hand ever being warm with LE.  Is warmth part of a flare?

My hand is warm, not hot, and there are no breaks in the skin and it doesn't look infected.  My fingers and knuckles are a bit pink, but it seems consistent with my hand being warm.  I am at very high risk for blood clots and went off anticoagulants a couple of months ago, but this doesn't look like one.

As luck would have it, this afternoon, I see an onc nurse this afternoon for a shot, and then a few hours later, I have a garment fitting appointment with my LE therapist.  Should I ask the nurse to evaluate my hand?  Or should I wait and see what my LE therapist thinks?

Arghh -- KS1 

kira66715

KS1--the more eyes on it, the better, IMO. When my LE flares, it can get warm, but this is concerning.

Please let us know how you're doing

Kira 

Binney4

KS, ask them both. When you see the onc nurse say the word "cellulitis" outloud in case it doesn't occur to her.

If anything changes before you see them, get help immediately. Here's the page about infection, just as a refresher:
http://www.stepup-speakout.org/Emergencies_and_Medical_Care_lymphedema.htm

Anxious to hear how it goes!
Binney

KS1

I took Kira's and Binney's advice and had both the nurse and LE therapist evaluate my hand. The good news is that neither think it is an infection or blood clot. My LE therapist said that my axilla is tighter than last time she saw me so she did myofascial release and applied kinesiotape to the axilla. She also taped my hand, arm, and side.

I'm following her advise to the letter -- drinking like a fish, doing MLD 3x a day, and wearing my axilla-to-fingertip Tribute as much as possible. My axilla and side seem to be improving. I've been wearing an axilla to fingertip Tribute round the clock except for MLD.

My hand does look a bit better when I take the Tribute off, but within a minute my hand has swollen up again. By the time I finish MLD, my hand is more swollen than when I first take off the Tribute. Has anyone had a similar experience?

My LE therapist has worked incredibly hard to find garments that work for me. No success yet on day garments, but IMHO, the Tribute she fitted works reasonably well. However, she doesn't like the finger compression, so she made me a mitten out of Tribute materia that has stiching rather than spacers between the fingers. (Talk about custom! Talk about amazing therapist!)

So here's my question -- given that my hand swells when it isn't compressed and MLD isn't keeping it down, should I punt on the MLD? Or maybe wear her mitten when I do MLD and punt on hand MLD for a while?

KS1

kira66715

KS1--does she know how rapidly it's refilling? I have talked to my LE therapist about that situation, and she says it often happens when there's a blockage to the lymph flow higher up.

I'd say, clear the neck and axilla--if it doesn't hurt you--and only do the arm minimally.

There are schools of thought that MLD is the least effective of the tools in our arsenal.

What an amazing therapist! Can you ask her?

Kira

KS1

Hi Kira - Sorry for the delay in responding.   Round the clock Tribute wearing on dominant hand has me rationing my typing.  

Unfortunately, despite my efforts, my hand flare has gotten worse.  After I finished MLD last night, fingers were too swollen to get new Tribute on.  I was able to get my older, looser Tribute on.  

You may be right about the problem being upstream.  I have been having more axillary puffiness since I started PT for herniated discs, and a couple of days before this hand flare, my axilla seemed especially puffy.  I did mention the fast refill issue when I saw my LE therapist a week ago.  She didn't comment, but she did spend most of the session on myofascial release of axilla.  I just reapplied kinesiotape for hand, arm & axillary drainage.  Maybe the fresh kinesiotape will get things under control. Times like this I really wish I knew how to wrap. KS1

kira66715

KS1, I was thinking about this, and when my hand was in rough shape, after the cast, my LE therapist put a finger wrap on it while doing MLD, so it wouldn't refill.

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OneBadBoob

Couple YouTube videos on hand wrapping that could be useful.



http://www.youtube.com/watch?v=Z8jNlZXMJ-c&feature=youtube_gdata_player



http://www.youtube.com/watch?v=3ibOkDM9-08&feature=youtube_gdata_player



http://www.youtube.com/watch?v=FzPJ1ulI3UU&feature=youtube_gdata_player



(sorry the links are not active)



It seems like each therapist has their favorite way of wrapping, and I know my therapist always tell me to leave my palm open but I several of these examples have covered the palm.



The best way to learn this is to watch your therapist wrap your hand and then for you to wrap your hand with your therapist watching so he/she can correct you if you are not doing it properly.

KS1

Bad news - taping doesn't seem to be helping.  Good news, I don't think I am any more swollen today than yesterday, which is something.   

Kira, I took your suggestion.  I've been wearing my full length Tribute for all but arm MLD.  When I get to the arm, I switch to my custon Tribute-material mitten for all of the non-hand MLD.  Last night I put some coban on my fingers after taking of the mitt and starting on the hand.  Didn't seem to make any real difference.  

 OneBadBoob, thank you so much for the links to videos of wrapping.  I had 3 or 4 lessons this summer, but then it got crowded out by other more urgent medical crap.  top on my list was to hunt down some videos.  

In the meantime, my LE therapist got back to me.  She is suprised MLD isn't working, and said to talk to my doc about getting an U/S to rule out a DVT.  Now I am waiting for a call back from the doc.

 my husband agreed to help me wrap today,  should be interesting.  KS1 

KS1

Bad news:  1)  hand looked worse this AM than last night;  2) have lost enough function in arms/hands that I can't wrap myself; 3) my Monday LE therapist appointment was rescheduled for end of January

Good news -  After much study of the AV material Kira and OneBadBoob sent, and a couple of practice wraps last night, my husband wrapped me this AM and I am still wrapped

I haven't taken the bandages off, so I don't know whether he did an "effective" wrap, but I am going to put it in the "win" column because a) we are still on speaking terms, and b) even bandaged, I had more use of fingers than when wearing Tribute oven mitt.   (I was seriously going nuts after wearing Tribute mitt round the clock for 10 days.)

I've got a question -- I am definitely more swollen after MLD than before I do it.  When I take off the bandages tonight to shower, should I just skip the arm and hand MLD and reapply the bandages?    KS1

Binney4

KS, do what works; don't do what makes it worse. That took a long time for me to grasp. I was thinking the process was the issue, the "rules" and procedures. But it's the result that matters. And we're all different.

If your self-MLD is making things worse, could be you're not being gentle or slow enough -- and it's way too easy to do that when we're cranked and/or just determined. Check out your technique with your therapist before doing it again.

Congrats on saving your marriage despite wrapping, without even resorting to counselling, and HUGS!
Binney