Fitting In

Gwen Calvert, OTR, CLT-LANA

Fitting In

Compression Garments for Lymphedema

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Sizing Up the Options

Compression garments can become a necessary item in a person’s wardrobe for a number of reasons ranging from burns, post surgery, and even prenatal/postpartum. However, the most likely cause for permanently adding a compression garment to your “look” is lymphedema. Lymphedema is an accumulation of lymph fluid in the skin due to a change to the lymph system, often from cancer. At WTRC, we have seen patients with a variety of causes for their lymphedema including breast cancer, skin cancer, lymphoma, cervical cancer, and even primary lymphedema that is hereditary in nature. In order to prevent further accumulation of fluid as best as possible, compression garments are worn permanently to act as a pressure barrier on the skin that is able to “contain” the size of the affected body part at a static level which is easier to manage long term.
The increased lymph volume of a limb, neck, or trunk does require a slew of treatment approaches to manage the condition and prevent complications. One piece of the solution is compression garments which come in a myriad of forms. “Off the shelf” and “custom” are terms commonly used to differentiate types of garments and those terms can apply to garments worn for night time or daytime use, are flat knit or circular knit in their make, can have a purpose to reduce or to maintain the size of the body part they cover, and can have a variety of ways to apply the garment including velcro and zipper closure options to reduce the struggle of getting the garments on.

In a perfect world:

If money were not a factor in deciding what type of car to get, you’d go for the one that is the most “you”. You’d consider the maker and body style then go with the features you WANT for comfort, ease of use, and enjoyment. Garments can be the same way. For the purpose of this blog, we are going to pretend your insurance carrier will cover what you NEED and allow for a few choices of what you want to increase the compliance of wearing your garment every day.
In the world of compression, there is a “golden standard” that requires layers of foam, cotton and short stretch bandages to be worn 23 hours a day, allowing for 1 hour to bathe and lotion the skin, massage and rewrap. This can be burdensome for most, if not all patients who are trying their best to follow the protocol for lymphedema treatment. Garments have been developed to help in a number of ways including ease of application, consistency in pressure gradient, and hygiene.
Taking a look at garments worn during the daytime, there are two main groups. Over-the-counter and Custom. For the purpose of really “Fitting In”, custom garments allow for the best fit and most options including padding, lining, zippers, open or closed digits and even silicone bands to prevent the garment from slipping down. There are below knee, thigh high, pantyhose, chaps, arm sleeve, glove, gauntlet and trunk garments.  These garments can be made to accommodate amputated digits, scars, areas of frequent wounds, poor range of motion in a joint, and the amount of compression can be custom prescribed by the MD.
There is no direct access to custom garment options and all need to be ordered through someone well versed in measurement and fitting of these products. Often a Certified Lymphedema Therapist has enough knowledge to do this service, direct you to a boutique or a rep for the various companies they partner with to get the best fit for a patient.

What choice is the right choice?

With this knowledge of the best garment options for you to “fit in”, there are a number of other factors to consider including assistance at home with putting the garment on, financial resources, replacing them every 6-12 months, getting new garments to accommodate changes in weight or lymph volume, and even changes in weather impact the garment choices people make. Two pieces of advice I can make as a therapist are:

- You get what you pay for

Typically, the less expensive garments need to be replaced sooner due to poor quality and longevity. And typically YOU PAY because we have yet to see the Lymphedema Care Act pass through our legislation

- Garments are a PREVENTION and MAINTENANCE form of treatment

There is no way to truly understand just what you are “saving” by getting the right garment for your needs when you don’t limit your options based on cost.  Preventing cellulitis, loss of function, and further health complications really has no monetary value and instead it is a quality of life preference.

For more information regarding night time garments, reduction kits, over the counter garments, and donning devices to help get garments on, find a CLT that can provide the right resources to get you the information you need.