New Sleeve Wearer: Have Questions
Today I wore my first-ever sleeve and gauntlet, prescribed by my LE therapist for air travel and for exercise, especially strength training. I wore the garments this morning during my first post-surgery upper-body strength workout since my bmx/recon, with a trainer who is schooled in the PAL protocol. Our mantra is to be ultra-cautious, so the upper-body work was just that.
I have very mild LE that manifests mostly as tingling in the flappy part of the underside of my SNB arm, and as minor truncal swelling just under that armpit. So far, it has been a problem only when I fly and when I do vigorous exercise. The therapist put me in Jobst 20/30mmHg garments. Following the (wonderful) ‘what should the fit look like' demo on the Step Up, Speak Out website (http://www.stepup-speakout.org/proper_fitting_of_lymphedema_garments.htm), I think the fit is good, but only if I can keep the top of the sleeve nearly all the way up to my shoulder. If it rides down (which it did a few times as I worked out), a bit of poochy bulge appears, which seems to be a no-no.
I do not understand how the sleeve can help control my truncal area, so I wore an Under Armour short-sleeve shirt with the sleeve. Therapist gave green light to this plan. The shirt sleeve did not overlap the top of the LE sleeve, as the shirt sleeve is more of a cap sleeve. There was a small gap between the two sleeves, but except for the few times when I needed to tug the LE sleeve back in place, there was no arm bulge between them.
All seems to be well this afternoon-no tingle, no swelling-but I have a slightly irritated feeling under the armpit. I think the cap sleeve of the UA shirt was too short, and it had the effect of pulling too tightly, bunching slightly, and cutting into my armpit. So, here's my question: Would it be intelligent to find an UA with a slightly longer sleeve (maybe a men's version?) and find a way to make that sleeve grip the LE sleeve? My feeling was that if I could eliminate the gap between the shirt sleeve and the LE sleeve, I would have continuous pressure under that arm, curving down and against the interior arm pit. The UA sleeve has less compression than the LE sleeve (right???), and my understanding of the LE sleeve is that the top of the sleeve is its least-compressive spot. So, why not sew some Velcro tabs on the UA sleeve to reach tabs sewn on the LE sleeve?
I also wore the LE sleeve/gauntlet for my daily cardio routine, which involves lots of arm movement. In the past, despite the UA, I have usually had arm tingles in the hours afterward. Today-no tingles, so I think the sleeve may well have addressed that problem. That's great news, but I don't know what to think about the residual irritation in the pit. It's not tingling and it's not swelling, so truly I think it's just the result of the UA sleeve being too close/too tight there. So-is there merit to my Velcro idea, to eliminate bunching and ensure a consistent ‘hug' of compression up the arm and into the pit area?
One last bit of info is that I am a month past DIEP stage II, and PS wants me to be in trunk compression, so I do need to wear some kind of compression garment in addition to the sleeve. My various shaper camis have armholes cut so low, they don't help my truncal LE. I am reluctant to go a day without trunk compression, let alone exercise without it.
So to all you LE-knowledgeable and creative women...ideas?
Thank you!
Carol
Comments
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Carol--My sleeve goes up to the shoulder. I do have loose skin at the top (back) and have to make sure I get over the last "bulge" for it to stay in place as the top is measured to go over it. I use "it stays" there to keep it from sliding down. I used kineseo tape for truncal and a compression bra. I have ordered a UA shirt as the asset ones from Target did not come high enough. I have a Jobst sleeve that has the softer elbow part front and back. I have to make sure the elbow is in the right place for the correct fit. I have the wider silicon top and if I am not careful it rubs my trunk and gives me a rash. I have to be careful with what I wear. I have a great therapist who measures me for fittings and seems to get it right each time. I know some others will weigh in on what they do. Be careful having velcro around the sleeve material! I don't have tingling either when my sleeve is on. Becky
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Becky, does 'it stays' keep the sleeve in place even if you're doing very aggressive arm movements, i.e. cardio/aerobic workout? --Carol
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It seems to keep mine in place. I do cardio/aerobic daily. The hardest is getting the sleeve past the "it stays" I have put on before my sleeve. It is sticky. I am not sure how aggressive you get with your arm as I am careful with mine but I do the arms on the elliptical, swing them when I walk, do the LeBed exercises which has a lot of stretching, and lift light weights every other day. Becky
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Have you tried the Slimmer by Wearease? It's a compression cami and covers pretty well. I wear mine almost every day for mild truncal symptoms, and find it very comfortable.
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Carol, I'll second Snorfia's recommendation of the WearEase Slimmer cami. Comes up high enough in the axilla and it's long enough to stay in place. Since I didn't do recon, I wear mine inside out so the prosthesis pockets are easier to access. It's covered by insurance as either LE garment or mastectomy bra. My insurance entitles me to two bras a year and four chest compression garments, so I get six WearEase camis a year.
Binney
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I like the Bali "torset" I found at Kohl's. You wear your own bra. It may have the highest amount of spandex available on the non-specialty market at 35% in the body and 53% for the lining.
According to the Wear Ease website, their product is 80/20 (nylon/spandex). I would like to know what percentage the Under Armour shirts use.
Is there a formula to convert fabric content to compression strength?
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Thanks so much for the recommendations!
My trial and error tells me that my arm/armpit/torso are happiest when I can manage a continuous compression, up the underside of the arm, into and through the armpit, and then to cover the area below. I have a potpourri of camis--some acquired to manage the post-recon swelling, others in pursuit of the LE control. I don't have the WearEase, however, so will take a look. I do have that same Bali torset, which I wear with a bra that's really wide on the sides and goes well up toward the armpit. But maybe I have a long torso, because the straps of the torset dig in, even when I put silicone strap thing-ys under them. I do wear these various solutions when I cannot find a way to make a compression shirt work with the wardrobe.
But nothing works as well as the UA or some other compression shirts I have, because I'm compressing that whole U-shaped area. Hence my question about somehow connecting the LE sleeve to the short sleeve of an UA.
vlnrph, what a good question, and I cannot believe I have not actually checked on it before. So I just took a look and I'm very surprised. The UA shirts marketed as 'heat gear' (for dissipating, not just for holding heat in) are 87% poly, 13% elastane. Another UA I have, which is a much lighter feeling fabric--almost looks a bit waffle-y, and I like it for cardio because it just feels lighter- is 82% poly, 18% elastane. So I guess it pays to look at the label. I think one problem with converting shirt content to compression strength compared to a sleeve is that the sleeve compression is graduated, and the shirt sleeve is not. Such a comparison for a cami would be very interesting, though. Binney, are the med garments made for truncal LE done with graduated compression?
I'm so new at this --figured out I had LE just in October or so --I really don't know what I'm feeling half the time. Binney, snorfia, vlnrph--do you think it's possible I'm just feeling surgical issues of some sort --maybe harmless--up under the pit, instead of as a point of swelling from LE? For sure I have some numb spots under there, from the mx and SNB I presume.
I need an inch-by-inch swell-o-meter to figure out what's going on!
Carol
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Namaste!
Carol, Just a note about the UA heat gear. I found that the cap sleeves in women's caused problems so I use the mens UA heat gear short sleeved Tees and then there is total coverage over the top of the arm area and is much better. The compression seems to be just right for me. In my experience I have had to watch the sizes very carefully based on colors. The gray Tees are sized bigger or don't have as much compression or something while the black, green, red, med blue fit tighter. The tags revealed the grays were made in a different country than the other colors. I think Mexico for the grays and the Dominican Republic for the colors (or vice versa).
I have found that if I am having a lot of the tingling sensations going on in the underarm area of both my arm and trunk, that just wearing the UA settles it down.
Good luck on finding what will work for you.
Karla
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Carol, interesting questions! Gradient compression on the arm works by decreasing the compression from distal (think "distant," in this case the hand, which is most distant from the axilla) to proximal (as in "proximity," meaning closest to the axilla). Arms are pretty standard, in that our wrists and lower arms are narrower than our upper arms, which is why there can be standard sizes in gradient compression sleeves and they're still gradient in their compression (though they're not suitable for everyone, depending on the shape of their arm).
With truncal swelling any attempt at something like that would involve first of all determining which direction you wanted the fluid to go. If your surgeries were unilateral, you'd want it to go from the affected axilla to the unaffected one, where presumably there are still functional nodes -- and you can see how gradient pressure going in that direction would be impossible. Those of us who are bilateral want the fluid to go south, to the groin nodes. And those of us with long mastectomy scars also have to consider moving the fluid above our scars upward to the neck area nodes, since the fluid doesn't cross scars well, further complicating the matter.
Besides that, our individual shape would also have to be considered, since some of us have breasts and some don't and all of us have our weight distributed in different ways.
Another factor that makes this complicated is "bridging," which is the term they use when a raised area of our anatomy (the breasts, say) lift the fabric away from an adjacent area of the skin (like between the breasts), so that there's a lot of compression on the breasts (creating a "loaf of bread" effect instead of a cleavage
), and no compression at all in the cleavage.
Night garments are another matter, because they use directional stitching to direct flow. So if you get the stitching going in the right (for you) direction that's quite workable.
Whew!
Did any of that help?!
If the issue with your UA shirt is chafing, a bit of baking powder patted on the area before you get dressed might help. Or a Swell Spot. But if it's truly too tight it would cause real problems with the LE. Swim suits, same thing. You don't want them too tight under the arm or in the shoulder straps.
It's impossible to guess how much of what you're feeling is due to the surgery, but for me there's pain WHEN I also have LE issues, and no pain when I don't. MLD and Lebed exercises reduce the pain, so that helps to distinguish the cause.
I wonder if my insurance would cover a Swell-O-Meter...?
Hugs,
Binney -
Hanta, You have answered a question I had about switching to a men's version. Today I was comparing the UA sizing charts men vs. women. I'm wearing black women's size medium. Size chart for women's medium is bust 36-38, waist 28-30. Small for men is chest 34-36, waist 28-29. Medium for men is chest 38-40, waist 30-32. Obviously I can go to a store to try them on, but in fact that's a 45-minute drive each way, so I often shop online. Any clue if the closest size match womens-men is to go down in size, or use same-size? Assuming black.
Thanks for the great hint!
Carol
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Binney, I see that you have a PhD in compression garment engineering, and another in body fluid hydraulics. Clearly, you are the most qualified individual to develop the Swell-O-Meter. I wish you would, and get rich on it to boot (Ha! take that, you Impedimed people!).
That explanation was crystal clear and it makes me wonder why, if I have an ab recon scar that extends oh, 55% around my abdomen, I am MLD-sweeping over that scar. Also prompts me to ask you if the recon breast --in my case a diep flap model--regenerates the lymph pathways under the skin. Old skin, stuffed with new fat. BS scraped every shred of tissue that was not skin before PS stuffed me like a scarecrow. Just curious: Did the lymph pathways regenerate as the area developed its blood supply?
I think the issue with the UA shirt I wore with the LE sleeve today was just a too-small sleeve that hit me in the wrong spot. I will be pursuing HantaYo's suggestion to try a men's version, to get a sleeve that covers better. Will try on with LE sleeve and do some quiet cardio-type arm punches in the dressing room, to see what budges where. If security ladies are watching via a camera, look for me on the news.
Thank you, Binney. Your input is always valued, and literally priceless.
Carol
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Namaste!
Carol, For me men's Medium works in the short sleeve T UA heat gear in black. I never bought any women's short sleeve because when I tried them on I knew there was that gap with the cap sleeve. However, I do have a couple of the women's long sleeve Ts in the UA heat gear and the large in navy seems to work. I like to wear the long sleeves heat gear when I am at home doing hardly anything and just MUST MUST have some time without my sleeve. Mostly it feels good to have my sleeve on but every now and then I need a mini vacation from it.
So, for me I wear Med in mens and Large in women's. Hope that helps.
Karla
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Karla, Thanks! Helps a lot-- Carol
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Carol - you are so funny! Stuffed like a scarecrow...
I also asked my therapist how lymph would find a way around the abdominal scar. And why, for 4 months after the initial surgery, there was no swelling: wasn't that long enough for alternate drainage paths to be generated? (I realize that LE can develop years later in some people - another reason for Binney to get that Swell O Meter on the market).
One thing I have noticed recently is less "numbness" around the back of the upper arm & shoulder. In addition, a rather large lump that has been present in the axilla for quite a while has diminished! I can use the electric shaver more easily now that hair is growing again post chemo. So, further healing seems to be taking place over time.
Thinking about fabrics, perhaps it is also the weaving process that confers compression strength, not just fiber content. I hope that Solaris follows up on their email promise to contact me when they begin local trials of their new day garments this spring. I will certainly have questions for their product development people.
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I haven't been at this very long- just had UMX no recon in June. My gut feel, and fervent hope, is that things will settle down as the cancer surgery fades into the mists of distant memory physically as well as mentally. Already I have a lot less pain, strange numbness, tingling, shooting, and other bizarre sensations than I did over the summer. And I feel a lot less "fragile" - like I can overdo it a little without gruesome consequences. I also realize that I am writing this on a non-flare day, because all these things really do come and go. I hope my overall trend is that my symptoms are fading. I'll know more in a year or two...
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Carol, I found the men's UA shirts to be more generous in their arm measurements, which has been a positive for me, who has large upper arms. The women's was simply cut too small. Also, are you wearing your shirt inside out? When I wear them with the seams in, I have a lot of swelling and irritation in the armpit area, which I don't have when turned inside out. For the short sleeve shirt, I go men's, but the longsleeve shirts, I go womens.
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kc, After Karla's suggestion, I bought a men's short-sleeve UA a few days ago, and it is a big improvement--felt much better after I wore it with my LE sleeve for exercise. I have never had the impression that seams were causing armpit or other irritation, but of course, maybe that's a problem and I haven't realized it. So--have just turned today's shirt inside-out, and I'll be doing cardio work in it in a little while, and hopefully I'll notice a difference. Thanks for the suggestion!
vlnrph and snorfia, I have not detected any improvement with time, but my bmx/recon were only in July, so I am encouraged by both of your comments about noticing improvements. Patience has never been my strong suit, but this LE business more or less forces it on you.
Carol
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For the first time today, wore sleeve and fingered glove on left arm for a few hours. Fell asleep with it on and woke up with the the hand or fingers feeling numb. Took them off immediately and all was fine.
They were fitted by an LE therapist and today measurements were checked again. Not enough of a difference to change the sizes but to show there was a mild issue beginning to occur in the upper arm. Most of the LE is occurring at the side of the breast next to the trunk, more than the arm.
These are Juzo Class I btw. Can't see how I'm to type much with the glove on and I run a computer helpdesk so this is going to be very interesting (done in an Arte Johnson voice).
thoughts or suggestions?
Sally
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