Lymphedema caused by flying?

Belle, Kathryn Schmitz, the expert answering that question, is one of my personal heroes, because her work on strength training with LE opened my eyes and got me the confidence to embark on a strength training program that has paid me many, many dividends. I've met her and she has a sincere concern for our best interests.  Having said that, she's an exercise physiologist and expert, and yes, she follows the LE literature to support her exercise literature, but I just don't think her opinion is expert in this particular matter.  I hope that Sandi Hayes --another exercise champion!--has followed up with a good study on compression during flight, and I'll do a search for that.  Next week the NLN has its biannual research conference, and several of our forum members will be there.  I'll ask them to see if they can find a way to ask the air-flight compression question to find out if there have been any updates, or if any studies are in process.

Here's a link to a Boeing website page explaining cabin pressurization. It says that by law, the cabin needs to be pressurized to no less than the equivalent of 8,000 feet: http://www.boeing.com/boeing/commercial/cabinair/

The World Health Organization explains the pressure effects on the body when flying in an airplane's cabin: http://www.who.int/ith/mode_of_travel/cab/en/ . There's no mention of swelling or LE there, but it's a good explanation of how the reduced air pressure changes oxygen and other gas levels in the body, and what happens as pressure changes during take off and landing.

Here, a vascular surgeon opines that swollen ankles after flying are caused by reduced cabin pressure, and he recommends both walking around during flight and compression stockings: http://www.angiologist.com/uniquely-vascular-medi...

But Mayo Clinic's discussion of swollen feet during flight chalks it up entirely to inactivity: http://www.mayoclinic.org/diseases-conditions/ede...  and they suggest compression stockings only if there's some added risk of blood clots. There's no mention of lymphedema here.

Anecdotally, you'll find lots of women with LE who have rough time when traveling by land in high altitude, such as driving through the mountains. The typical cabin pressure range of 6,000-8,000 feet cited by WHO would mimic that experience, I imagine. Same problem during storms that bring big barometric pressure fluctuations: ouch and puff! So I don't think there's any question that air pressure reductions have an impact on the body, and in a body with LE, cause added swelling, throbbing, aches. But do we know if an at-risk body (nodes removed, but no sign of LE) needs help from a compression garment to prevent the pressure loss from actually triggering LE onset?  Nope.  We just do not know.  

I just have a hard time seeing how it's considered smart to wear a compression stocking to prevent DVT and swelling for the general population, but somehow that strategy could cause LE in an at-risk-for-LE arm.  Kathryn Schmitz's description of the Hayes experiment tells us that arms not in sleeves did not change in size during flight, but there's no mention of whether the same was true for arms wearing sleeves. If the sleeve is suspected to cause LE for at-risk arms, would the effect be immediate during flight, and therefore measurable on landing?  And for those who were found not to swell in flight without a sleeve, do we know whether the effect of the pressure changes is cumulative, and some of those women would develop visible LE after flying a few times within a short period, or after taking just one or two very long flights?  Nope--we just don't know.

Belle, here's a thought--'split the difference,' so to speak by wearing a long-sleeved compression shirt during flight. It's not medical compression because it's both light compression and continuous, instead of gradient. Gradient compression in our sleeves means that there's more compression at the wrist than at the top, so that the gradual reduction of compression encourages the lymph to move upward. But--as in all things LE, there's an asterisk to this suggestion--which is to watch your hand very carefully, to make sure that the shirt isn't allowing lymph to pool there. If so, sprint to the bathroom and remove the shirt.  

I am mighty curious about this topic because I fly quite often for work, so I found chasing down these links pretty interesting. But my search for insights is by no means comprehensive, so if anyone else has more or better information that helps to answer Belle's very good question, I hope they will post it here.

Carol

Carol, thank you so much for the help.  I will get on that site to see what I can find as soon as I finish here. I called my breast surgeon's office this morning after reading your posts last night and they agreed I need to see someone for PT and a sleeve fitting.  They sent the fax order to the same PT place but I am going to see if there is another therapist I can schedule with. When I saw this one the last session, I asked her if she thought women should wear a gauntlet with a sleeve or just a sleeve and she said she never puts anything on the hand, just a sleeve, because the hand is in water and other things so much. That was another red flag that stuck in my mind when I compared that to what I was reading here.  I see I have some work to do, but I feel more positive than I did yesterday at this time. Thanks so much.

Not only that, but I have made several trips up to Lake Tahoe this summer (I'm in Reno, only 30 mins away), which took me up to about 8,000 ft. If that Boeing info is correct, that's the same pressure I would experience flying. This is an interesting tangent!

http://www.stepup-speakout.org/riskreduction_for_lymphedema.htm

Here's a link to the part about reducing your risks.

My LE is also very mild. My therapist measured me again today and I'm the same as I was back when I first saw her in April. But this last week, my arm has been very achy and heavy and I think I overdid it with some grocery bags. I wear a breast binder with a "breast" swell spot and that seems to keep the trunal under control  And I do wear a sleeve since my upper arm is mildly affected and my therapist thinks that wearing it when I'm doing anything stressful, gardening, etc is a good idea.  Since my job is 8 straight hours on the computer, she considers that stressful also, and I wear it when I work too.

oh my gosh,, I replied earlier before I saw this whole page of posts.  How interesting about living at higher altitudes!  Belle, maybe you are used to the lower pressure and plane trips will not bother you. 

I wonder if people who are already prone to leg swelling when flying, would also be more prone to developing LE.  I've had swollen ankles from flying and I do wear compression knee high socks now when I fly more than 2 hours.

I just have a hard time seeing how it's considered smart to wear a compression stocking to prevent DVT and swelling for the general population, but somehow that strategy could cause LE in an at-risk-for-LE arm.   AGREE WITH THIS. It just doesn't make sense to me.

Carol, you are a wealth of knowledge and I thank you so much for sharing with us.

coffeelatte:  I don't regularly wear a gauntlet; I'm only wearing it when I fly right now. ONLY because my LE is mostly truncal with minimal upper arm involvement. I monitor my hands and believe me, if I need to start wearing a gauntlet all the time, I will. Rubber gloves over it will help with dish washing etc, where hands get wet. So that advice you got, seems,,, wrong to me.

Binney, I think the take-away point is that we simply don't know what causes it and we have to take precautions that are right for us.  I do seem to have issues with changes in altitude. In addition to ankles swelling on long flights, I just remembered something else when you mentioned flying from sea level to 8000 ft.  I flew non-stop from Miami (sea level) to Quito Ecuador (9000 ft)   I got altitude sickness after landing there as my body did not know how to handle the change. Need oxygen and everything. It was not pleasant!! Apparently I can't handle these big adjustments.  And I was much younger then!! I can't imagine doing it now. 

I am reading all of this as I am flying soon. One thing I did learn is some experts aren't sure if the air pressure causes the LE or does it happen in conjunction with lifting, wheeling and pulling luggage. My oncologist said he thought wearing a sleeve when you don't have LE could make your Lymph system "lazy" but I just considered the source, he is wonderful at what he knows, chemo. he is not an LE expert.

The LE therapist said wear sleeves and gauntlets on the side where 9 nodes were taken, as well as the other side where none were taken. I have had that "heavy" feeling for years, and have had to have my rings sized up 3 times now. no one is taking this seriously but *I* am taking it seriously and getting good advice right here.

As an aside, people wear leg compression all the time for flying to prevent blood clots and you never hear of that compression causing LE, so I doubt compression could cause LE. Thoughts?

I am glad we have each other for support and info!

I'm following this thread with interest, too, because I will be flying across the country soon and am worried about getting LE on my first flight since BC.

crystalphm, I think the difference in the people who wear compression hose on their legs is that they haven't had their lymph nodes cut and their normal flow disrupted.  I kind of understand what your doctor means because I'm worried that wearing compression garments will make my lymph system dependent on it every time I fly or do hard or repetitive physical work. But that probably doesn't make much sense either. 

I'm hoping I can gradually increase the efficiency of my lymph system with exercise and then do binney's compromise and maybe wear an Under Armour long-sleeve t-shirt under my clothes.  Is that what they're called?

I did have cording under my arm about 6 months after radiation (3 years ago) and the doctor said, "whatever you do, don't exercise and it will go away."  Well, it did but I do feel like I have to do exercises specifically for LE to help avoid another problem.  I have not had any problems since then and have not been diagnosed with LE so maybe just the shirt would be enough...

oh and you only had 3 nodes removed, PoohBear,, your risk is really low.  **heavy sarcasm**   I had 6 removed and I was told that. 

Read everything you can.  Decide for yourself.

Thank you ladies for all your information. I have stage 0 LE and am always interested in learning more about what to do and not do! There are so many of us who greatly appreciate your knowledge and your willingness to share it.