If you have been diagnosed with lymphoedema or a chronic oedema (swelling) condition you will be aware that in order to maintain & control the oedema there is a degree of self-management involved.

Being aware of what is “normal” for you is the key to spotting any potential problems early and knowing when it is appropriate to seek medical advice. The overall aim of raising your self-awareness and self-care is to reduce the risk of complications such as cellulitis, which may result in a hospital admission if left untreated.

This is especially important at the present time during the Corona virus pandemic. There is no evidence to suggest that you are more susceptible to the coronavirus if you have chronic oedema or lymphoedema unless you have other underlying health issues such as an impaired immunity from cancer treatments. However, as many healthcare services have restrictions in place and are only able to offer reduced non face-to-face services, your normal first line of help may not be available.

It is therefore important for you to be able to recognise the signs and symptoms of any changes to your “normal” limb condition by implementing daily checks and active simple management activities to prevent any problems developing.

Look after your skin

Skin care is a key element to self-management for upper and lower limb conditions.

An unscented moisturiser should be used at least once a day, ideally every night before bed, to prevent the dry skin conditions associated with leg oedema deteriorating, risking infection.

If you have an upper limb condition, with the current increased hand washing regimes, it is vitallyimportant to keep your hands well moisturised. Frequent hand washing can easily make the skin dry and cracked which may lead to cellulitis.

Check your skin daily for any changes such as breaks, cracks and swelling.

Small dry skin splits, often on very dry hands, usually respond well to using the type of plasters marketed for the treatment of blisters, which should be left in situ for 2-3 days.

Any other small skin breaks, especially on legs, should be covered with a plaster/dressing and observed.

Stay Active

• Move your legs and feet regularly and try to use your calf muscles - move your feet around in circles, then up and down – you can do this sitting down – it’s great for circulation and reducing swelling.
• Exercise can also help to strengthen muscles as well as support you in achieving a healthy weight.
• Try to walk for about 30 minutes a day, and generally increase your activity - use a fitness “watch” for encouragement
• Avoid standing for a long time

Use your compression

Your therapist will have discussed the most appropriate compression for your condition. It is important for you to use this as directed, to maintain your oedema. If there are problems with how your compression is fitting, contact your therapist for advice.

Elevation

When you are resting it will help to reduce the oedema if you elevate your limb as instructed by your therapist. It is also important that you sleep in a bed overnight, as this will make a big difference to how well your oedema is controlled.

Keep a Healthy diet

Aim to eat a well-balanced and healthy diet. Carrying extra weight increases the risk of developing problems in your legs and feet. For more hints and tips on how you can do this visit the NHS eat well website

Stop smoking

Smoking narrows your blood vessels, decreasing the blood flow and reducing the amount of oxygen reaching the legs and feet, making healing more difficult.If you do smoke, try to cut down or quit. For more advice on how to quit smoking visit the NHS quit smoking

“Red flags” and when to ask for help

As health care professionals we rely on “Red flags” as a kind of early warning system to help us recognise and identify the potential underlying cause of any changes to the “normal” and start an appropriate treatment or referral pathway.

What to look out for

• New redness and swelling of your affected limb which may be accompanied with a high temperature (fever) and/or a feeling of being unwell, or loss of appetite – can signify an infection or cellulitis requiring antibiotics.
• Any other persistent new discoloration of your legs or toes - REMOVE any compression if your toes go a dusky or very pale colour, or go cold and do not warm up again quickly.
• Any increased or new pain or discomfort in your affected limb that does not resolve with your normal pain killers.
• Increased numbness, altered sensation (feeling) or pins and needles that does not ease with movements.
• Increased swelling to your limb that is unusual for you, especially if this is quite sudden or acute.
• A new wound or an existing one, that has not improved or is not healing within 2 weeks, has increase in size, become inflamed or painful.
• Increased leaking from an existing wound that cannot be contained in your current dressing or compression garment

If you notice any of these red flags it is important to contact your healthcare professional immediately or NHS 111 if you are worried.

About the author

With a background in vascular surgery & District nursing, chronic oedema & lymphology have been the focus of Sue’s nursing career for the past 30 years. Since 1997 Sue has developed and managed the Lymphoedema service for Mid & North Bucks based at Florence Nightingale Hospice, Aylesbury. The service is nurse led & treats Primary & Secondary Lymphoedema along with an increasing caseload of chronic oedemas.