Really frustrated, and kind of at a loss

Aunt Paula...  I can sympathize with you and offer some general advice.  I too live away from "official" services (rural northern WI) and have had to be my own resource (with a lot of help from these boards...). My OT is also not certified, she doesn't deal with a lot of LE garments aside from general recommendations, but she does a great job with the MLD and lymphatic system knowledge.  Once I am dismissed- due to insurance limitations I have "active" therapy and then get released to "self-care"..  I am kind of on my own. (By the way, I get around that by occasionally asking my onc. to refer me for a evaluation visit, which I use as a check in time with my LE therapist.)

I went to a fitter she recommended for my initial evaluation which was about 2 hours away.  It was an investment in time, but worth it for the knowledge.  Once I had established a "baseline" and found garments that worked, I am much more comfortable with my local fitter or getting stuff online.  Finding LE garments that work well for each individual is so tricky, for now it might be worth the time and cost to travel to get advice, be able to select from a range of garments, and have a fitter who knows what they are doing.  

I would call the therapist from the larger city and see if they have a recommendation for a fitter and  schedule an appointment to see what products and recommendations they may have.  While this is all new to you, having someone with experience in garments ( and insurance coverage) may be helpful.

Another option might be to ask your therapist (or the big city one) if they know anyone who might be willing to be a "mentor" for you.  Privacy regulations mean THEY can't share info, but they might know someone who has been down that road and may be willing to offer advice on garments and services if you're willing to give out your contact info for them to pass along.

Hang in there!!   Hopefully you can find something that works for you.  In the meantime, venting here is a safe place, because we all have been there and understand the frustration of dealing with this on a daily basis.

Yes you do need a glove or gauntlet with sleeve.  The hand needs compression support too  to keep swelling down there also.  Not wearing a glove can encourage hand swelling.  I have only 1 gauntlet and the rest are all gloves.  I only wear the gauntelt for short periods of time when I'm seriously working the horses as it gives me a better feel but fingers will get a bit puffy if I leave it on too long.  With the gloves, I have no issues of fingers getting puffy.  My night garment (Solaris Tribute), also custom, has a gauntlet type hand in it, so I have to use an opera length isotoner glove with it for that little bit of suppprt.

My day garments are Juzo and yes - Juzo will definately custom make garments.  'Off The Shelf' sizes do not fit me at all.  My hands are somewhat 'webbed' so standard gloves cut into the webbing making sores and hurting bad.  So have to have custom.  Also, my arm is quite long for the circumference so they have to be custom also for a correct fit.  The degreee of compression is also something that can cause issues if you get the wrong level.  For me, I have to have light compression, which works great.  Jeavy compression make the swelling much worse.  The first set of garments I got were heavy compression.  I picked them up, put them on and headed back to town to go to rads and in that approx. 45 min. my hand had more than doubled in size.  Called my LE guy and took them back the next day and he ordered light compression which has been working great in the years since.

You might try calling some local Medical Supply stores to ask about rather or not they deal with LE garments.  BC survivors are not the only ones who deal with LE.

I don't know the difference in price between OTS and custom.  My care is through VA, so what I need is ordered and I pick it up.  It is my VA LE guy (he's also an OT), who measures/orders/handles what I need so I've never had to deal with someone who just works at a store.