Questions about Compression

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ellentk
ellentk Member Posts: 41
edited June 2014 in Lymphedema
Maybe because I saw an LE PT and carefully followed her guidelines as well as those I read here (thank you, everyone!) and maybe because I was also lucky, I haven't developed arm LE after removal of two nodes and radiation.  But I think I have a mild case of truncal LE, under my arm and on the top outside segment of one breast, and I have some questions about compression.

I've noticed that custom compression garments are classed, Class 1, 2, etc. However, many people here report good results wearing bras and shirts that are called "compression" but aren't classed. For instance, are the Bellisse and WearEase garments classed? And other people here are happy wearing ordinary sports bras and tight sports T-shirts.

Then there are swell spots, which might change the level of compression, depending on what they are under.  And some product claims (for classed and non-classed products) talk about a design that moves and directs lymph in the right direction.  Are the compression garments moving the lymph to the working side, or preventing it from building up in the compromised side?

I've been trying various sports bras, most of which felt too tight and chafed under my arms. The most comfortable garment I've found is ContourMD's "Breast Augmentation Bandeau," which I wear over a pretty tight surgical bra:
http://www.contourmd.com/SearchResults.asp?Search=bandeau
But the bra and the bandeau aren't classed and I'm not sure how much compression these give, how much I need, or how long and how often I should wear compression.

Is it too early to tell? I began doing a number of things in the past week, which also complicates knowing what's working. I'm glad to say some or all of these things seem to be working, as there is much less swelling and the hardness on the side of my breast is gone, but I am still a bit puffy. (I'm doing self-LE-massage, saw my LE PT for a session, began doing stretching exercises, went swimming, began wearing a few different tight sports bras as well as the bandeau in order to see what's comfortable and effective.)   How long does it take to see results? Should I expect the swelling to go down or go away completely?

I also have questions about bras.  How tight do they have to be? How long do you have to wear them? Is the compression on the other breast bad for it? Would a  tight sports shirt or camisole be better?

When comparing a sports bra to something like Bellisse's compression bra, the Bellissee bra compresses so much more of the body.  Is it necessary to compress that wide an area or am I okay with the bandeau? Or are the bigger bras designed to treat the entire upper lymph system and should the entire upper system be treated?

Any advice about any of these questions will be most appreciated.

Ellen


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  • Binney4
    Binney4 Member Posts: 8,609
    edited August 2012

    Ellen, hello!

    There are lots of us here with truncal lymphedema. Here's some information about it in case you haven't already seen it:
    http://www.stepup-speakout.org/breast_chest_trunckal_lymphedema.htm

    At the bottom of that page are links to lots of garment solutions. Your questions about that are good ones!Smile Truncal lymphedema is a bit tricky, partly just because we're all so different, some with both breasts, some with one or none, and some with breasts that don't "match." But even trickier is the fact that as we breathe the measurements of that part of our body changes, which makes giving it a compression number pretty approximate. Also, some of us have swelling front and back, some only near the axilla, or near the cleavage, high or low--all sorts of variations. So a one-style-suits-all solution just isn't possible. Truncal LE just plain takes a lot of experimentation to figure out.

    What you're looking for is something that you can wear with relative comfort all day long, and that also controls and contains whatever area of swelling YOU are dealing with. For me, with bilateral swelling that affects chest, side and back, a Wearease cami works well. But sometimes I have extra trouble with swelling just in front of the axilla on one side, so a Kimbe SwellSpot or a length of "chocolate bar" foam helps reduce that swelling and ease the discomfort or pain. Everybody's different.

    Look over some of the options on that page and see if any of them strike you as meeting the needs you personally have. Try a couple and see if they work for you. It is possible to order a custom vest-like garment from any of the sleeve manufacturers which are very form fitting, but I don't think I know a single woman who actually likes them. So sports bras, camis, sometimes a Bellisse and often an UnderArmour-type sports shirt are all options to consider.

    Basic design features you need to think about include wide straps that won't dig into your shoulders, no underwires or bands so tight as to restrict lymph flow, underarm cut that doesn't dig into a problem area, flat seams that won't irritate your skin--and comfort!

    As for how tight--that too is very individual. Some camis, for instance, offer quite a lot of compression (Wearease is one). Others, like Control It, are less compressive. You might have to try a variety to see which one YOU need. If the bandeau is working to control your swelling (and if you can stand wearing it), then that's a great solution.

    With the help of a good LE therapist and good self-care, most women can expect the swelling to go down more or less completely, though for some that doesn't happen. But flares happen, from travel or weather or activity or diet, and then it takes a bit of extra work to get things back in control.Tongue out Garments alone won't reduce swelling--that takes MLD and some directed exercises.

    Night garments are another option. JoviPac and Solaris Tribute are brands many women use. They're relatively comfortable (though hot in summer) and unlike day garments they do often actually help reduce swelling while you sleep.

     Hmmmm, that wasn't much help, was it?Frown There just aren't easy answers for truncal LE (well, for any LE, actually), but we're here to cheer you on as you work your way through it. Tell us how we can help!

    Be well!
    Binney

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  • ellentk
    ellentk Member Posts: 41
    edited August 2012

    Thanks so much, Binney.  Your post and encouragement is very helpful. 

    For some reason, the swelling seems to go down when I'm sleeping.  I wonder if gravity is a trigger or some activity I'm doing during the day. 

    The bandeau is actually quite comfortable.  It's very soft and smooth and I can adjust how tight it is.  I'll try the lighter camis and sports shirts you suggested too. 

    One thing I'm wondering is how to evaluate effectiveness? How long does it take to reduce the swelling? (Probably no answer as it varies from person to person, but is it hours or days or weeks?) One reason I'm asking is I'm wondering how long to try a garment before I return it. 

    Although I've read and you said that garments alone won't reduce effectiveness, it seems as if just wearing the bandeau or a tight bra does reduce it, because the swelling seems less when I take them off.  So I'm not sure what's going on there.

    Another thing I noticed is that some compression of my breast causes pain and possibly swelling in the side of the axilla closer to my arm and a bit of the top of my arm, which goes away after removing the garment.  But am I using too much compression or the wrong style?

    Thank you again for sharing your take on truncal LE.  It's very good to have the emotional support and to hear that for most people the swelling goes away as dealing with this is very upsetting. 

    Ellen

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  • Binney4
    Binney4 Member Posts: 8,609
    edited August 2012

    Ellen, I love your under-stated "very upsetting"!Laughing Very calmly stated--some of us have been known to rant on that subject.Embarassed

    Truncal lymphedema is treated with both Manual Lymph Drainage (LE massage) and compression. It's the MLD that fixes the problem of removing the fluid from the area for starters. The compression can maintain the reduction and to some extent (as you've noticed) it can reduce it a bit. That reduction is a result of the compression plus movement, because your muscles provide a major part of the lymphatic's pumping action. But, sad to say, a single visit to the PT and self-MLD is not the standard of care. A couple of weeks of MLD done by the PT (4 or 5 days a week) is definitely called for to initiate the reduction of the whole area and establish improved drainage. THEN your self-MLD and compression should be able to maintain it, day and night both.

    It's common for swelling to reduce in the night (unless you're sleeping on your stomach), and gravity is generally the reason they give for that.

    With the problem you described about pain/swelling in the axilla and upper arm, I'd say the style of compression is wrong--you need something that will compress that entire area fairly evenly, say a short-sleeved sports shirt (inside out so the seams don't aggravate), or a cami and a sleeve that is well-fitted at the top.

    The kind of activity you do during the day can cause swelling--repetitive or strenuous arm movements, especially. Long drives. Leaning on your arm, or leaning your head on your arm as you read or side at the desk. Certain yoga positions. Lots of things. Try to keep track and see if there's something in particular that aggravates it.

    Compression alone may reduce the area a bit, but it will not eventually reduce it completely, because it is not redirecting the lymph flow. If the PT you saw is not into truncal LE and willing to treat it, find another one. Here's how to find the ones near you:
    http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm

    I sure hope some of that helps. This is not easy, and it gets brushed aside by our healthcare professionals. Lots of gals here to help and offer encouragement, so please stick with us!

    Hugs,
    Binney

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