JoAnn Rovig's Blog

I received an email from someone who knows me very well saying, “Do you wear your compression sleeve when you are exercising on your treadmill?”  They knew the answer was “no” and I think it is important that I explain my answer. Before I really understood my limitations, and before I knew what I could get away with, you bet, I wore garments — around the clock.  A combination of daily self-massage , loosing 30 lbs, and having a benign lipoma surgically removed from my affected forearm,  have brought me to the point where I need not worry about my lymphedema.  I don’t even wear my sleeve when I’m flying.  (Not to say I don’t keep it in my purse just in case!)  So . . .to answer the question. . . .No, I don’t wear a compression garment when I’m exercising on the treadmill, but my arms are either at waist level, or alternately up in the air doing stretch exercises.  If I had lower extremity lymphedema, however, I’m sure I would be wearing a compression stocking.

It’s all about what you can get away with and your measurements are your indicator. If your wrist is 16 centimeters before you exercise and 18 centimeters after you exercise, it is time to reconsider how you exercise and what you wear when you do.   My Australian instructors, the Drs. Casley-Smith, said that with daily manual-lymph drainage (self-massage) it takes approximately a year for the body to remodel, or adapt to the new pathways.  From my own experience as a therapist and as a lymphedema patient myself, I believe this is true.  Many, including my doctor,  thought I was crazy to have elective surgery on my affected arm, but I had done my homework and was confident it would not be a problem.  If I did have some post-surgical swelling, I knew how to fix it, which is my hope for everyone struggling with lymphedema. The removal of the lipoma has made it easier for me to manage my lymphedema and I no longer have to be self-consious about the large lump in my arm!  (We video taped the surgery and for anyone who is interested, we can add it to our self-care streaming videos.) I also wanted to prove there is light at the end of the tunnel, and if we understand lymphedema well enough and master the self-massage techniques we can get away with a lot!

In my last blog I talked about my concerns regarding the rebounder article.  I would be remiss if I didn’t mention that whatever exercise program you choose, if you have lymphedema, you must wear a compression garment during exercise.  Let me explain, but first, remember that one of the main components of resorption of fluids back into the circulatory and the lymphatic systems is TISSUE PRESSURE.   Have you noticed how as we age we lose skin tone  and are more likely to develop varicosities in our legs, particularly if we are overweight or spend a lot of time on our feet?  As we lose  elasticity in our skin, we lose tissue pressure and it becomes increasingly difficult to maintain the integrity of the valves in our lymph vessels and our veins.  Support stockings, or compression garments, are an effective way to restore this deminishing  pressure.  Once a valve fails, it increases the load on the valve beneath it.  If that one fails, there is an even greater load on the valve beneath it.  . . and so on down the line.

As you exercise, you are increasing filtration or the amount of blood rushing down the arteries and being filtered into the tissue.  Since a portion of that filtrate adds to the lymphatic load, and if your lymphatic transport system has already been comprised for any reason, you can surely understand why a supportive garment is an essential part of successful lymphedema management.

Consider another benefit of wearing compression garments during exercise.  As your muscles contract, they push against the garment (or bandage). As long as the garment has a gradient compression, you will be helping the body in its effort to push tissue fluids upstream and back into the circulatory system and  into the  lymphatic transport system.

For those of you I confused regarding the LeBed Method exercise program:  For years it was called the LeBed Method and their DVD was called Focus on Healing.  Sherry LeBed Davis recently changed the name of her program to Healthy Steps.   I am such a strong believer in the benefits of participating in her program, I want to make sure you can  get to her website: www.lebedmethod.com or www.gohealthysteps.net.  If you go to the Northwest Lymphedema Center website:  www.nwlymphedemacenter.org and click on the self-care streaming videos, you can see two of Sherry’s class presentations.

Stay tuned, as I received a great comment regarding acid reflux and we MUST talk about that at some length.  I know this may sound crazy, but poor digestion can have a profound effect on your ability to effectively manage your lymphedema!

Whenever I see an article on the Lymph System, I am compelled to read it.  Perhaps it is a conditioned reflex and it always  takes me back to the days when I was the historian for the North American Vodder Association of Lymphatic Therapy (NAVALT).  It was 1992 and information on lymphedema was nearly non-existant.  If any of our members found any information on this condition, it was sent to me for our archives.  Copies were made and distributed throughout our membership with the hope that we, as lymphedema therapists, could help our patients, their caregivers, doctors and insurance providers better understand the condition and substantiate the need for treatment.

I was excited to see the article, “Boosting the Lymph System” in the current issue of the Well Being Journal.  It is a good article, particularly the section titled, “Importance of the Lymph System.”  However . . . I have one major concern which I would like to share with you.  The focus of the article is on the importance of exercise, specifically a therapeutic rebounder.  There is no question movement of any kind is essential to moving lymph fluid and exercise is an integral part of lymphatic decongestive therapy. When I was training with the Casley-Smiths, Judith said, “You have to think of the lymph system as thousands of tiny pumps.  When you are sleeping, nothing happens until you roll over!”  Spending two three-week sessions at Optimum Health Institute was my alternative to chemotherapy and there were rebounders all over their campus.  For a normal body, whose limbs are not over-burdened by lymphedema, a rebounder makes a lot of sense; however, if you look at the diagrams of the valves in the deep lymphatic collectors, you will better understand my concern about adding any additional pressure on these valves, particularly on lower extremity patients.  If you have upper extremity lymphedema, just hold you arms up over your head so the G force is working with the valves not against them.  Quite frankly, I would rather see lower extremity patients doing the Pilates mat work.  They will be on their back with their legs in the air with gravity pulling fluid through the valves, not against them.

Many of you have commented on the necessity of exercise for successful lymphedema management, and I know, it can be challenging, as well as boring.  Let me make two suggestions:  If you are using a treadmill, tread lightly, but do it to music.  My choice is Manhatten Transfer, which can be a lot of fun as there are so many different upbeat rhythms.  I would also recommend any of you who don’t know about the Lebed Method Healthy Steps program, check out their website, even order their exercise CD.  They too, use Manhatten Transfer music and it certainly isn’t boring.  You can even incorporate some of their arm movements into your treadmill routine . . . . just one arm at a time, however.  I tried both arms and it didn’t work out well at all.   My treadmill is in my (unheated) garage and I flew off the back end and ended up on top of the garbage can!  Oh, the things we do in our efforts to stay healthy!