Compression

2017 before SAPLWearing compression garments is simply not a question- it’s an essential part of my LE management. They are one of the most important tools that any of us can have to help contain swelling. I wear my compression garments 24/7, except for when showering or if I go swimming in the pool. The type of compression I wear during the day is very different to the things I wear at night, but generally speaking there isn’t a day that goes by where I am out of compression for longer than 30 minutes.

Compression garments for Lymphedema are not your average “compression” stockings that you might find on a pharmacy shelf. They are carefully engineered pieces of technology that work to support broken down lymphatic and venous systems, by imitating the body’s natural mechanics that normally support blood and lymphatic flow.

Their main role is not to significantly reduce the swelling in your limbs (this is what bandaging is for). Their job is to reduce excess leakage of fluid from the capillaries and increase absorption of tissue fluid by the capillaries and lymphatic vessels (Jobst, 2017).

My day-time compression wear

Compression garments are produced using two main knitting methods- flat knit and circular knit. The majority of experts will advise lymphedema patients to wear flat-knit garments because their design is ‘stiffer’ and contains oedema better than the circular ones (these are usually recommended for patients with venous disease).

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I wear flat-knit compression garments in class 3 gradient compression. My preferred brand is Jobst (BSN Medical) and the model I order is the Jobst Elvarex.

Since my SAPL surgery, I have been wearing multiple layers of compression on my leg during the daytime. This is because I need some extra support in my calf and ankle (the areas I see most of the swelling). The white stocking you see in the image above is not really a compression garment, it’s a TED stocking (that I received in a hospital once for a non-lymphedema related surgery)! It has a very little gradient of compression and is just enough to help keep my calf from swelling throughout the day. It is not recommended anywhere for lymphedema management but it’s something that I have experimented with and cannot live without right now! It goes up to my knee and then my Jobst Elvarex continues to thigh height.

How I put my day time garments on:

Toe cap -> thin knee-high stocking -> Jobst Flat knit (full-length stocking).

My night-time compression routine

During the night, I wear either my Jobst relax garment // or// wrap with short-stretch bandages. I never sleep without compression (see my reasons why below).

Both night compression options are applied with a lot less pressure than my day-time garments. This is because when we are laying down, the force on our tissues is different and gravity is no longer a factor. Therefore, the amount of pressure we need is a lot smaller. I find that anything too tight on my leg at night is a disaster and actually makes it swell more! It’s definitely a fine line between applying too much pressure and not enough during the night. It takes time and patience to get your night routine working well, so don’t give up too quickly.

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Jobst Relax custom-made garment.

The Jobst relax garment is really, really comfortable in terms of night time compression. You can read my full review of it here. It quickly became an essential item in my toolbox for lymphedema after the first time I slept with it on! It’s extremely soft and doesn’t cut into my skin (bonus). It also uses gradient compression but at a lower pressure for night use. Another thing I love about this garment is that it has very small grooves in the foam/ fabric that help to direct lymph flow up and out of the leg.

The second tool for night compression is wrapping my leg in short-stretch bandages. Let me just start by saying that it’s the least sexy thing on earth BUT totally worth the after-effects when you take them off. Bandaging involves wrapping your limb in multiple layers of materials to gently move fluid from the area and improve tissue elasticity. I choose to do it at night because it’s more convenient and suits my lifestyle better.

bandaging

Is wearing compression 24/7 really necessary?!

I would have shuddered in my early days at the thought of having to wear compression 24 hours 7 days a week.

Really, isn’t that a bit extreme?!

Surely my leg can be free during the night and have a break from all the pressure?!

The answer is… no! Let me explain why:

The chronic swelling of lymphedema does not simply stop when you lay down and put your feet up or go to sleep. Sure, in the early stages of lymphedema you don’t notice this so much and sleeping without compression seems okay because your leg looks normal again in the morning. But once the condition starts progressing and more fluid and protein fill your leg, it starts to damage the lymphatic vessels inside and everything continues to slow down and drain less efficiently. Once the capillaries and lymphatic vessels are damaged, it is irreversible. The pressures inside the tissues change permanently and can no longer be regulated by our bodies natural processes. It’s around stage two of lymphedema that most people start to notice that their legs don’t reduce overnight and in some cases, keep filling while they sleep. It’s because the mechanical process of oedema continues, whether we like it or not!

Therefore, compression must be sustained over a continuous period to help prevent the fluid build up and to maintain a ‘normal’ pressure within the interstitial tissue spaces. If compression is discontinued, oedema will continue to occur. This is why I wear compression at night- because I notice the huge difference it makes in the reduction of my leg. Night time is my “take advantage” time! Take advantage to reduce swelling my continuing my compression routine while I sleep.

There are definitely lots of moments during the week when I take my compression off and let my leg be in the air, in the sun (yes, I put it in the morning sun because it needs to have these beautiful rays of vitamin D zapped into it too! I certainly don’t sunbake or put my leg in direct, intense sunlight for long periods of time either). The things to note here is that I only do it for a very short period of time (maximum 30 minutes) because our skin needs oxygen, light and air on it.

Recent photo Jan 2018 Australia