PROPER
FITTING OF AND CARE FOR SLEEVES AND GLOVES/GAUNTLETS
Brand new to compression
garments? How hard can this be? After all, we've spent
our lives trying on all sorts of garments, even
unfamiliar ones. It's always an occasion. The first
flowery dress-up hat and little white gloves. That
longed-for (or dreaded) training bra. A wobbly maiden
voyage to the theater in a new pair of high heels.
Braving the mysteries of Victoria's Secret for a
silky black negligee. You may never have owned anything
like it before, but you know it fits because it feels
right, and it looks right too.
But immediately you know
this time is different. All those other milestones were
predictable, rites of passage that you knew were coming.
Everybody else did too. Lymphedema is different. You
didn't expect it, and the chances are nobody you know
did either. But here you are, needing compression
garments, wondering what this new experience will hold.
A few words of warning and encouragement are in order.
HOW SHOULD THEY FIT?
A good garment fitter is
a real gift. S/he can ease your transition to
compression garments with careful measurements, a wise
selection of brand and style, simple instructions for
donning and laundering, and lots of encouraging words
along the way. If your garment fitter is like that, make
the most of it. Bake her a batch of brownies as a
thank-you, or drop her employer a letter of
commendation. Either will be appreciated.
But what if you're not
that lucky? In that case, it pays to be smart instead.
Maybe your fitter is first and foremost a shrewd
businessperson, only secondarily concerned about doing
what's best for you. She has a bunch of garments on
hand, and one or more of them are close to what you
need. Close, but not quite. The sleeve you need is long,
but she's only got it in regular. The gauntlet doesn't
quite cover your knuckles. Your upper arm is a bit more
swollen than the size chart indicates, but the rest of
the sleeve fits fine. The sleeve you need is a
20-30mm/Hg compression level and all they've got in your
size is a 30-40. There's a gap at the wrist where the
sleeve and glove don't quite meet – just about, but not
quite.
Close enough, right? WRONG! You're not there to close out the fitter's
stock, but to get the garments that are exactly
right for YOU. Have no pity!
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Insist
on a Sleeve that:
-
reaches comfortably
from wrist to axilla
-
does not bind
anywhere along it's length
-
does not cause
bulging at the wrist or top of arm
-
does not leave
long-lasting indentations at wrist or top of arm
when removed
-
is not so loose at
any point that it gaps or overlaps itself
-
does not slip down
the arm when active (this can be achieved with
either a non-slip top band or an application of a
liquid adhesive such as It-Stays)
-
does not cause pain
-
see examples of
properly fitting sleeves
below
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Hold out for a gauntlet
or glove that:
-
comfortably covers
your knuckles
-
overlaps the sleeve
by at least an inch or two so there is no separation
even with movement and exercise
-
does not turn your
fingers any shade of purple, blue, bright red, or
white
-
does not cause your
fingers to tingle or turn cold
-
does not cause your
fingertips to swell like mini-sausages
-
is not loose at any
point around wrist, palm, or (for gloves) fingers or
thumb
-
does not cause pain
-
see example of
properly fitting sleeves
below
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Here are some
examples
of properly fitting sleeves, gauntlets and gloves:
With the arm extended,
sleeves are smooth along their entire length, axilla to wrist,
with no wrinkles and no excess fabric.
Gloves and gauntlets are long enough to cover
the intended areas comfortably, with no gaps between glove and
sleeve.
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Below are some
examples of poorly fitting sleeves, gauntlets and
gloves:
This sleeve is
too short, leaving the upper part of the arm unprotected.
The bulging skin at the
top of this sleeve indicates that the sleeve is too tight at the
top.
Wrinkling, such as this in the wrist
area or elbow area, can block the flow of lymph instead of promoting
it.
Bunching of the
sleeve will restrict lymph flow.
A gap between
sleeve and glove will allow the exposed area to swell; the two
garments should overlap at the wrist.
Gauntlets
should cover the knuckles of the hand. Falling short like this
can push fluid into the fingers and top of the hand.
IS JUST A SLEEVE ENOUGH, OR DO YOU NEED HAND PROTECTION AS
WELL?
The answer to that question
will depend on several factors. If you are wearing garments
to reduce your risk of developing lymphedema, you'll
definitely want a gauntlet or glove to prevent any swelling
from becoming trapped in your hand. If you already have
lymphedema in your arm, and your hand is not yet involved,
the decision to use hand protection or not is one you and
your therapist should discuss. If you choose to wear the
sleeve alone, be alert for signs of new swelling, tightness
or heaviness in your hand, and move quickly to using hand
compression (either garments or hand wrapping). This article
by
Dr. Andrea Cheville from the LympheDivas website
explains your options in more detail.
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WHAT
IS EVERYBODY TALKING ABOUT?
The world of lymphedema garments has a language all its own. Here's
a partial list of terms to help you speak it like a native!
"Off-the-shelf"
and "custom made"
Sleeves, gloves and
gauntlets come in pre-made sizes, referred to as
"off-the-shelf" (or "ready-made") that fit an average hand or arm in
a range of sizes. There are small, medium and large sizes as well as
categories for short and long hands and arms and for extra fullness
in the upper arm. Off-the-shelf garments are frequently used for
those who are at risk for developing lymphedema and wear their
garments only for travel, exercise and strenuous activities. If the
fit is good they're an efficient and relatively inexpensive choice.
Several brands of off-the-shelf garments in a variety of colors and
patterns can be ordered on-line without a prescription. Be sure to
see a skilled garment fitter or lymphedema therapist for
measurements before you order on-line.
Of
course many people can't get a good fit with off-the-shelf garments.
And there are also many therapists who prefer sleeves and gloves
fitted exactly and precisely for each individual lymphedema patient.
These specially fitted garments are called "custom made." Naturally
they're more expensive than buying off-the-shelf, but they can be
adjusted with every order to meet your on-going compression needs.
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"Circular knit" and "flat
knit"
Most
off-the-shelf garments are "circular knit," which means they're
knitted continuously in a circular pattern that results in a roughly
cylindrical shape with no seams. Custom made garments, on the other
hand, are most often "flat knit," or cut to the proper size from a
flat piece of knitted fabric and seamed into shape. Circular knit
garments are generally lighter in weight, and many people prefer the
seamless look. Flat knit garments can be cut from a wide range of
breathable fabrics and may include such features as zippers or
extension panels to ease joint flexibility.
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"Millimeters
of mercury" and "compression class"
Unfortunately, size is not the only consideration in fitting a
lymphedema garment. The amount of compression your garment applies
will vary according to your specific needs and the stage of your
lymphedema. This compression level is measured in units called
"millimeters of mercury." It's written in scientific shorthand like
this: mm/Hg. (The "mm" stands for millimeters, and the "Hg" is the
chemical symbol for mercury.) Compression garments are ordered by
"compression class," or the range of compression you need, stated in
millimeters of mercury.
Here's a run-down of compression classes recognized in the United
States, along with their usual uses (which may vary with individual
circumstances):
-
Class 0: 15-20 mm/Hg – used for
those at risk for lymphedema
-
Class I: 20-30 mm/Hg – used for
those at risk, or for early or mild lymphedema
-
Class II: 30-40 mm/Hg – used for
moderate or severe lymphedema
-
Class III: 40-50 mm/Hg – used
for severe or hard-to-control lymphedema
To
add to the confusion, European compression classes differ slightly
from their US counterparts, like so:
-
Class I: 18-21 mm/Hg
-
Class II: 23-32 mm/Hg
-
Class III: 34-46 mm/Hg
There is a Class IV as well, with higher numbers of millimeters of
mercury, but they are rarely used for arm lymphedema.
The fabric used in your garment may be soft (like Juzo's "Varian
Soft") or sturdy (like Jobst's "Elvarex"), or somewhere in between.
It may feel flexible or stiff, smooth or rough. All these factors
add to your sense of the fit of your garment, and to its
effectiveness for you as well. An experienced fitter takes fabric
choice into consideration in order to provide you with the garment
best suited to your specific needs. A compression sensitive person
may need a softer fabric to prevent her fingertips from turning an
unhealthy shade of purple, while a person who tends to develop
fibrosis easily may do better with a firm and sturdy fabric –even if
they both require the same compression level-
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WHAT ELSE SHOULD A FITTER DO?
A good fitter is crucial, and usually a
reputable lymphedema therapist will have a relationship with a
fitter or be one themselves. Coverage for lymphedema garments
varies by insurance, but almost always requires a prescription.
You should clarify your insurance coverage before placing an
order. In the past, the internet was a source for discounted
garments, but one by one the manufacturers are forcing the
internet distributors to raise their prices. Usually internet
sites will not be "in network," so you should check with
your insurance carrier about what is covered and what providers
of durable medical equipment (the classification for compression
garments) are in network.
Unfortunately, the quality of a fitter's knowledge and training
can vary widely. Also,
many therapists and fitters will have a favorite brand, and tend
not to consider the whole scope of available garments,
or may not even know about them. Additionally, lymphedema
garments are not universally stocked at durable medical
equipment companies, and while they may be in plan for leg
stockings, they may know nothing about how to measure and order
for upper extremity and chest and trunk lymphedema.
So, check with your therapist.
Check your benefits with your insurance carrier. And if
your insurance coverage is minimal or none, compare internet site prices.
If you choose to order your garments
through the internet, do so only after being measured by your
fitter/therapist for the proper size, and be sure to have your
therapist check the fit when you receive your garments.
For insurance coverage, the reason for
the garment needs to be coded correctly: here's a link to coding
from
Lymphedemapeople.
Once your garments are ready to try on, a competent and experienced
fitter will have a routine that includes the following:
Helping you don
(put on) your garments
The first time out, wrangling your way into a skin-tight glove or
sleeve can be a daunting job.
Always "promote" your lymph flow with manual lymph drainage
massage before donning any of your compression garments.
The fitter will show you how to fold
the garment down and work it into place. It will need to be smoothed
into position, wrinkle-free and without twisting, so it won't
irritate your skin. Sleeve seams should run straight and lie in a
comfortable line (preferably not directly over your elbow). Getting
it smooth and perfectly aligned is easiest if you wear a sturdy
rubber donning glove (with grips on the palms/fingers) on your opposite hand.
(Shown on the right.) In fact, the effectiveness of a
rubber glove with grips on the palms/fingers in smoothing and aligning a compression garment is
almost magical. Many fitters supply these as standard donning
equipment; if yours doesn't offer you a rubber glove with grips on
the palms/fingers during the
fitting, be sure to ask for one.
Jobst
has recently put out a wonderful new donning glove in a soft knitted
fabric that has a gripping surface on the palm. We have found this
even easier to use than the rubber donning gloves. Many fitters
also recommend that you place your hand against a wall, palm flat on
the wall, to make it easier to smooth your sleeve evenly, wrinkle
free and without twisting, while using your donning gloves. Once you get the idea, practice
taking your garments off and donning them again, with the fitter
watching and coaching, before you take them home.
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If
donning your sleeve is still difficult, there are devises available
to help you, such as the or the
Juzo Slippie (shown on left)
Arion
for Jobst Ea
sy-Slide
(shown on right). These are sturdy tubes made of a
slick fabric, with fabric loops attached to one end. You put the
tube on your arm with the loops hanging off your hand, slide the
sleeve into place on top of it, then use the loops to haul the tube
out from under the sleeve. Since it works best if you're holding the
top of the sleeve in place with your other hand while removing the
tube, you can either ask someone to pull the loops for you or hook
them over your foot or a handy door knob for pulling. Some women
have succeeded in using plastic grocery bags as donning devices.
Another
option for donning sleeves is the
Ezy-As, a sturdy
plastic framework you can stretch your sleeve over (rubber
gloves or donning gloves make this easier), then apply the
sleeve in one smooth movement up your arm. With a minimum of
practice this device will gently lay the fabric smoothlly
and exactly
where you want it. There is no tugging necessary to remove
the
Ezy-As, which
makes it a good choice for
those with fibromyalgia or other
skin sensitivities, as well as for application over wound
dressings.
We once again
reviewed this product at the 2012 NLN Conference in Dallas
and were indeed impressed not only with ease of application
and smooth, wrinkle free application of the sleeves on the
arm, but were impresssed that it worked just as well on
heavy, custom made and even
Elvarex®
sleeves with or without gauntlets attached.
We
also found it fabulous for donning compressios stocking
(which many of us survivors, with or without lymphedema,
need to wear when flying because of the cancer preventative
drugs we take which could cause blood clots or DVT's.)
The only way to see just how this product actually assists
in doning compressioin garments is to go to their website
and watch the videos of garments actually being donned.
You can see the videos at
http://www.eastcoastinnovativeconcepts.com/ezyas.html
toward the left of the page.
If
the sleeve style you've chosen does not have a silicone band at the
top to keep it in place and prevent slippage, you may need to use a
skin-safe adhesive, such as
"It-Stays,"
to keep your sleeve where it belongs throughout the day.
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Checking the fit
Your fitter will check all the points discussed above. You can help
by bringing up any questions or concerns as soon as you notice them.
Some problems won't become obvious until you've worn the garment for
a while, so have your fitter explain the return policy on your
garments before you sign for them or take them home. Return policies
are generally more generous for custom made garments than
off-the-shelf, but either way you should be clear about the time
frame and conditions for returning your sleeve or glove if problems
develop.
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Instructing you in
garment care
Compression sleeves and gloves will never be your favorite fashion
accessories, but they're likely to be among your most expensive. So
caring for them properly and extending their useful life will save
you time, trouble and expense.
Garments need to be washed frequently to
maintain their effectiveness.
The frequent washing
restores the compression that gets stretched out from wearing, and
it also ensures that they're as sanitary as possible.
Different garment manufacturers have
varying suggestions for laundering their garments, but most allow
for gentle machine washing at warm temperatures on a gentle cycle,
using a mild laundry soap. Do not use bleach or other laundry
additives. Air drying is usually recommended.
Another handy way to wash bandages
without them getting all tangled in the
washer is a standard netting
laundry bag and using hem tape
sew
channels into the bag.
Ingredients in some skin lotions can damage the stretchy fibers of
compression garments, so bring your favorite lotion brand along with
you and ask your fitter to check the ingredients for compatibility.
(Some garment makers sell their own brands of laundry or skin-care
products as well. You may wish to purchase these since they are
specially made for your garments, but they can be expensive;
suitable substitutes are readily available as long as you read
labels carefully and are aware of the ingredients to avoid.)
- The fitter I had told me when the silicone on the top of
the day sleeve seems to be slipping to use rubbing alcohol
on the silicone. This will sort of renew it so it will do
its job again. - Jennifer
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WHAT
SHOULD YOU DO IF IT DOESN'T FIT?
A
compression garment that doesn't fit properly is not only useless
for controlling your lymphedema, it's downright dangerous. Please
insist that the professional who fitted you accept the
responsibility for assuring your garments are safe and effective. If
they refuse to replace a poorly fitting garment, contact the garment
company representative responsible for your area and explain your
concerns. Request that they replace the offending garment and
retrain the fitter so that the problem will not be repeated. It's a
battle none of us wants to fight, but fighting it returns some
much-needed control to our lives, and it sets precedents that others
with lymphedema can build on.
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WHEN SHOULD YOU ORDER
NEW GARMENTS?
Many
garment manufacturers suggest replacing your compression garments
every six months, and most insurance companies will not pay for
replacement garments more often than twice a year. But the actual
useful life of your garments depends on several factors. When you
receive your garments, use a fine-tipped permanent marker to write
the date on the tag. That will help you keep track of when to
re-order. If your insurance will be paying, you may also need their
approval before the order can be processed, so allow extra time when
you re-order.
You'll need
to monitor the fit of your compression garments all along, because
even minor weight gain or loss can affect their usefulness. A
gradual improvement or worsening of swelling in any specific area
can also cause garments to sag or constrict, losing their ability to
control your lymphedema.
Some
fabrics wear better than others. Softer fabrics may need to be
replaced more often, while sturdier sorts may last beyond the
"magic" six-month mark.
Darker-colored garments don't show the grubby ground-in dirt and
food stains that lighter garments do; that may be a consideration in
how often you'll want to order new compression wear. As with any
other kind of clothing, wear and tear varies depending on the types
of activities you do and the degree of care or abandon you do them
with.
It's a good
idea to be re-measured each time you order new garments, even if you
think the old ones still fit. This will alert you to any changes you
may not have noticed over time. But even if there are no changes, be
prepared for a surprise when the new ones arrive. Your old ones have
stretched out a bit, but so gradually you haven't noticed, and the
new ones will likely feel impossibly tight. Stay calm, and use the
fitting guidelines above to assure yourself of the perfect fit all
over again.
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HOW SHOULD GARMENTS FEEL,
AND WHAT CAN YOU DO ABOUT IT?
Comfort
A compression garment is
a thing of amazing precision and brilliant engineering.
It combines all that's best in modern fiber technology,
physics, and medical science. After several weeks of
being
wrapped in yards of
short-stretch bandages, it's even a source of tremendous
relief. But let's face it: it's not real comfortable. If
you don't like the feeling of being squeezed into your
clothes, then a compression garment isn't going to feel
quite right. In fact, it may feel all wrong, especially
if it fits correctly and is not too loose to provide the
compression you need. A compression garment that fits
you well should not gap or bind or cause you pain, but
don't expect it to have that welcoming feel of a worn
flannel shirt on a brisk winter day. Give yourself time
to get used to the feel: wear it only for an hour or so
the first day, gradually increasing the time each day
until you can wear it with relative ease throughout the
day.
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Skin irritation
A well-fitting garment is
practically guaranteed to cause a bit of irritation at
first in the bend of your elbow or (in the case of a
glove) on the web of skin between your thumb and first
finger. It should not rub those areas raw, so if it
begins to bother you, remove the garment and give your
skin a break before trying it again. With your
therapist's permission, you might find that an
application of a bit of cornstarch on those trouble
spots will help sooth the irritation. To apply it
without mess, dump some cornstarch into the toe of a
clean cotton sock. Close the top with a sturdy rubber
band and pat the cornstarch right through the sock onto
the areas that need it. Store your cornstarch-sock in a
pretty bowl or small basket in your bedroom or bathroom.
(A word of caution: keep these trouble areas clean and
the skin well moisturized to avoid any chance of fungal
infection in the irritated skin.)
Allergies
are another possible skin concern. Many (but not all) compression
garments contain latex. If you have a latex allergy you'll want to
inform your fitter about it each time you order. Other skin
reactions may be caused by the dyes used in producing your garments.
Your fitter should work closely with you to find the source of any
allergic reaction and a garment that can address the problem.
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Day or night?
Because of the nature,
fabric, and design of compression garments, they are not
recommended for nighttime wear. Their efficiency in
increasing lymph flow depends on the action of your
muscles as you go about your daily activities. Sleeping
in them reduces their efficiency and runs the risk of
causing constrictions that can cause a worsening of
lymphedema. Instead,
wrap your
hands and arms at night in layered short-stretch
bandages, or order special
night garments designed to help maintain fluid flow
when you are inactive.
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Special
Concerns
A very few people
experience special problems with compression garments,
but these can be managed with a little extra effort.
-
If your lymphedema is
bilateral and you wear sleeves and gloves on both
sides, your entire sensory surface is suddenly
limited to the tips of your fingers and you may
experience something akin to sensory deprivation. It
can be straightforward and simple: you simply can't
get the information you're used to about the texture
or temperature of the world around you. Walking
through the sewing department at your local crafts
shop, you reach out to touch the bolts of fabrics
and find yourself frustrated and even anxious
because the quality of your tactile experience is
severely limited. Take a moment to remove at least
one glove, tuck it safely into your pocket or purse,
and use your whole hand to ground yourself in the
familiar. Or the sensory loss can be less apparent
but just as frustrating: you begin to feel and act
detached from your surroundings, depressed and short
on motivation. Try removing both gloves and sleeves
for a couple of hours every evening when you're not
doing anything strenuous. Make a point of rubbing
your hands and arms on a variety of surfaces and
being aware of the stimulation that provides.
