LSN THE LYMPHOEDEMA SUPPORT NETWORK HOLIDAYS & TRAVEL

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1 LSN THE LYMPHOEDEMA SUPPORT NETWORK HOLIDAYS & TRAVEL People with lymphoedema, or at risk from lymphoedema, should remember some essential Dos and Don ts when planning holidays and travel. Many people at risk from developing lymphoedema have said they did not have lymphoedema until they embarked on a long haul flight or picked up an infection through sunburn, an insect bite, a scratch or some other trauma. It is wise to be careful. Lymphoedema is a chronic and very real condition. It is something we would all like to take a holiday from, but we just cannot afford to forget it. A little thought and preparation before travelling can save a lot of trouble later on. Vaccinations and Holiday Medications Check to see if you require vaccinations before your holiday and allow plenty of time to have them before your departure. Do not have them in your affected limb and if several are needed, try to have them at intervals. Before leaving for your holiday, especially if you are going abroad, check that you have enough prescription drugs (if you need them) and always carry the prescription with you as foreign officers may want to check. You may also want to pack a small travel kit especially for your swollen limb. Think about the following: Antibiotics. Your GP may prescribe these in case an infection occurs whilst travelling, especially if you have had an infection (cellulitis) before. Treat any injury or infection of the affected limb with antiseptic and seek medical assistance immediately. Signs of infection are flu -like symptoms, high temperature, headache, redness and heat of the affected limb, increased swelling, localised tenderness and even pain. You may experience any or all of these. (See the LSN Cellulitis fact sheet). Always check the End by Date of antibiotics on a regular basis, especially if you have had some in the house for some time before travelling. Good quality sun block (SPF 15 or higher). THE LYMPHOEDEMA SUPPORT NETWORK Page 1

2 Insect repellent spray or cream. Commercial products to counteract skin irritation from bites or an old fashioned remedy such as lemon juice/vinegar. Anti-fungal powder in case you develop Athletes Foot or other fungal infections. Alternatively, Tea Tree Oil is recommended. Antiseptic lotion or ointments (Savlon or TCP) to address any cuts, scratches or bites. Good quality band-aids with antiseptic fabric incorporated into the product. Cheaper brands and those bought abroad do not always contain this. Ensure that you are not allergic to Elastoplast! Always carry your medicinal travel kit in your hand luggage you never know when suitcases may be lost! Flying Long flights with extended periods of inactivity, low cabin air pressure and poor air supply will have a major adverse effect on anyone with lymphoedema. The lymph fluid will pool and swelling will worsen due to gravity and non-movement. Airlines can be very helpful, but do not expect them to perform miracles for your comfort at the last minute, so prepare your journey well. If you are able to obtain Manual Lymphatic Drainage (MLD) therapy, then a session just before you travel and upon your return will be beneficial. Try to reserve the outward and return journey well in advance and if possible, request a seat with plenty of room. This could be an aisle or bulkhead seat. A doctor s certificate is useful to have with you to request a particular seat (you may have to pay privately for this) and don t forget your medical insurance papers or NHS forms for the EC. Wear loose underwear and clothing. Do not wear tight belts. Remember, watches, bracelets and rings should never leave indentations or red marks on the skin. If you have lower limb lymphoedema, wear well-fitting shoes which provide good support. Do not remove them during the flight as swelling could increase. Make sure your seat-belt is loosened when seated but stretch and move around as frequently as possible. Massage appropriate lymph gland areas as instructed for Simple Lymphatic Drainage (SLD). Try to do some simple exercises, particularly breathing exercises. Get up and walk around when permitted. THE LYMPHOEDEMA SUPPORT NETWORK Page 2

3 Never take chances. Even if your limb is under good control, always wear your usual compression garment, and don t forget the gloves, finger mittens or toe caps if you have them. Wear a second compression garment or bandage on top as an extra support on a long flight. Do not wear a sleeve that only goes to the wrist, as the hand is likely to swell. Drink lots of water! Remember that alcohol is dehydrating and even more so at 30,000 feet. Use cooling and refreshing body/facial sprays to prevent you becoming hot and sticky. Try and keep your hand luggage as light as possible. Don t carry heavy cases or remove your case from the luggage carousel at the airport with the affected, or at risk, arm. Do try and break the journey with a stop over if the flight is very long. As soon as possible on arrival, do some breathing and limb exercises. Have a short rest and then enjoy yourself! Holidays and travel fact sheet Car and bus travel Try to plan regular stops so that you can take a walk and exercise your limbs - however irritating this may be for the driver! Remember that sitting for long periods in a cramped position, is very bad for someone with lymphoedema. However, even when in a confined space, it s still possible to move fingers or feet, helping general circulation and lymph flow. Remember that if you have lymphoedema, you must keep on the move. While on holiday Avoid sunburn. Use a good quality sun block (SPF 15 or higher) and keep the limb(s) at risk from sunburn covered when on the beach. Don t forget you can still burn through compression garments, particularly synthetic ones. Protect against insect bites by using a repellent spray or cream when going out, particularly at dusk or at night. If bitten, don t scratch the bite as this might open up the skin. Use a commercial product to stop the irritation or apply an oldfashioned remedy like lemon juice or vinegar. Remember to use an anti-fungal treatment between the toes when you are barefooted in any public place or hotel room, even as a precautionary measure. Tea Tree Oil (in the bath, or 20% strength directly onto the skin) can also be used. With lymphoedema of the leg, wear plastic sandals to protect the feet when paddling in the sea. THE LYMPHOEDEMA SUPPORT NETWORK Page 3

4 Be extra diligent with skin hygiene. Follow the skin regimen recommended by your practitioner, applying moisturising cream/lotion at least once a day (night time is preferable) and particularly between the toes. Increase if the skin becomes drier in the warmer weather. When putting on your stocking/sleeve, it can be useful to use some powder first to slip the garment on more easily. Check your compression garments carefully before you go on holiday. In hot weather, it is important to have a garment that is providing the right compression. If you are feeling too hot in your garment, dampen it with water, but do not leave it off. Cool down your arm or leg by taking a cool shower. Alternatively, cover with a white or light coloured cotton towel whilst travelling or sitting out in the sun. Also see the section on clothing tips. Take care when swimming or paddling in the sea, or walking on the sand protect swollen feet with swim shoes to avoid trauma. Never go barefoot. Observe the skin regularly for signs of infection and treat any cuts, scratches and bites promptly with an antiseptic such as Savlon or TCP. Wash the skin after you have been swimming in the sea/pool. This will take away chemicals from the pool and salt from the sea. Ensure the skin is dried carefully. When exfoliating for your holiday, never be tempted to have the limb waxed or use a wet shaver. Always use an electric shaver to remove unwanted hair. Exercise continues to play an important role during your holidays though it may seem more difficult to do when the weather is especially warm. Try and exercise in the coolest part of the day either early morning or late evening and always wear your compression garment in whatever exercise you do. Swimming, or exercises in water are excellent activities in the hot weather and the water will generally keep you cooler. Even if you are unable to swim, think about gentle water aerobics as an alternative the water will support your limb and promote the drainage of fluid. Avoid strenuous exercise that involves a constant motion or vigorous repetitive movements, such as tennis or riding a bicycle, unless you are well-accustomed to it. Scuba diving, walking, T ai Chi and Yoga are all good exercise, but do not over-tire the limb(s). If a leg starts to ache, lie down and elevate it. If you are walking, keep the affected arm supported with your hand in your pocket. Clothing Compression garments are extremely hot to wear at the best of times, not least in the summer. Even the flat knit variety (which are slightly more comfortable) trap normal body fluids/sweat between the skin and the garment, causing build up of heat. Clothing should be light, loose and non-constricting, especially around the waist, under the breasts, and at the wrists/ankles/axillae. Loose cotton material is best, as this will allow movement of air between the garment and the clothes, the cotton of course absorbing any sweat that is allowed to pass through. THE LYMPHOEDEMA SUPPORT NETWORK Page 4

5 White or light coloured clothing is also recommended, as this reflects the sun s rays and keeps you cooler; black or dark coloured clothes retain the heat and make you feel hotter. If sweating under your compression garments is a tremendous problem, the use of technically advanced outdoor wear can be recommended these contain a type of absorbent wick in the light wear fabric thus absorbing excess moisture and keeping you cooler. Such items of clothing may be purchased from specialist outdoor wear manufacturers like Lowe Alpine and Patagonia, amongst others. Contributors Professor Peter S. Mortimer, Consultant Dermatologist at the Royal Marsden and St. George s Hospitals, London. Dr. Judith Casley-Smith, Chairman, Lymphoedema Association of Australia. Revised by Dr. Judith Casley-Smith, Chairman, Lymphoedema Association of Australia. Denise Hardy, LSN Nurse Advisor. THE LYMPHOEDEMA SUPPORT NETWORK Page 5

6 LYMPHOEDEMA IS THE SWELLING OF THE LIMBS AND BODY DUE TO THE ACCUMULATION OF LYMPH. Lymphoedema is not well-documented and is far more common than the medical profession generally realises. The Lymphatic System Lymph is a colourless fluid which forms in the body. It normally drains back into the blood circulation through a network of vessels and nodes. Lymph nodes act as filter stations. They play an important part in the body s defence against infection by removing excess protein, dead or abnormal cells and bacteria. Why does lymphoedema occur? If the drainage routes through the lymphatic system become blocked or damaged, lymph accumulates in the tissues and swelling (oedema) occurs. Unlike other oedemas, lymphoedema can lead to changes in the tissues such as fibrosis (hardness) and an increased risk of infection. The swelling becomes even more difficult to control. Primary Lymphoedema is usually determined from birth and may be due to underdevelopment of the lymphatic system. It can affect infants or children and men or women at any age. Secondary Lymphoedema can occur in the treatment of cancer following surgery or radiotherapy. It can also occur as a result of infection, severe injury, burns or any other trauma. EARLY DIAGNOSIS AND EARLY TREATMENT ARE VITAL TO CONTROL LYMPHOEDEMA. Become a member of the LSN see next page. THE LYMPHOEDEMA SUPPORT NETWORK Page 6

7 The LSN is a registered charity founded in It provides vital information and support for people with lymphoedema, while working towards the availability of better national resources for lymphoedema treatment. The LSN provides its members with: A telephone Information and Support line. Quarterly newsletters. Current information on lymphoedema, research and treatment. Fact sheets. Website. Self-help videos/dvds. The LSN relies solely on membership subscriptions and donations. Please help us to continue our vital work by becoming a member and/or making a donation. APPLICATION FOR MEMBERSHIP Mr, Mrs, Miss, Ms. SURNAME First names Address Post Code Telephone (Home) (Work) I have Lymphoedema I am a Health Care Professional Other (please specify) I would like to join the LSN and enclose a cheque made payable to the LSN for Annual UK subscription Annual overseas subscription Donation to support the work of the LSN of Total Please send to: The Lymphoedema Support Network St Luke s Crypt, Sydney Street, London SW3 6NH THE LYMPHOEDEMA SUPPORT NETWORK Page 7

8 Fact sheets available: Coping following a mastectomy/lumpectomy Breast oedema The management of cellulitis in lymphoedema Prevention of upper limb lymphoedema Recreational exercise with lymphoedema Manual Lymphatic Drainage Therapy Skin care for people with lymphoedema The use of compression garments in lymphoedema management Prevention of lower limb lymphoedema For information and help, please contact The Lymphoedema Support Network St Luke s Crypt, Sydney Street, London SW3 6NH Telephone: (Information and Support) (Administration) Facsimile: adminlsn@lymphoedema.freeserve.co.uk Website: Registered Charity No Patron Zoë Wanamaker CBE THE LYMPHOEDEMA SUPPORT NETWORK LSN 08/2007 THE LYMPHOEDEMA SUPPORT NETWORK Page 8