Prevention is better than cure. Whereas the following points apply to all patients with lymphoedema, this can often be prevented or avoided for many years after an operation or radiotherapy (e.g. after a mastectomy or lumpectomy, after pelvic operations for cancer and in general after any form of surgery or radiotherapy to a group of lymph nodes). The patient should be carefully educated at the time of the operation and made to realize that they have a limb or limbs 'at risk', which must be carefully looked after. Unfortunately, this is often not done, and results in a very angry patient who would have wished to be fully informed of the possible consequences of the operation and/or radiotherapy. In particular they would have wished to be informed of any preventative measures that could have been taken to avoid lack of full arm movement and, even more importantly, the onset of lymphoedema.

Use of pumps , massage therapy, heat etc. are to be done under medical supervision or on specific advise of Doctors. We are providing you additional points to keep yourself healthy and free of complications which make lymphoedema a dreaded disease.

Memorize all of the following points. Observing them will help to prevent the limb from becoming lymphoedematous or worse; ignoring them is foolish. Patients who comply to these points have been treated very successfully, so that they no longer have to wear a compression sleeve, must remember that their limb is still "at risk" (with an impaired lymphatic system). These points are still vital if they are to stay 'normal'. If you have a limb "at risk", or Lymphoedema. The most evident signs of incomplete cleanliness in Tropical countries and humid areas (esp the monsoon) is a white candidal patch in between the toes. If you can avoid these and minor cuts - attacks of infection leading on to Lymphangitis will not occur.

a. Keep your lymphodematous limb spotlessly clean. A Daily bath is recommended; do use soap but be sure to wash off all soapy residue. WIPE DRY. When drying, be gentle but thorough (a hairdryer may help for difficult areas). Make sure your underclothes and compression garments are regularly washed (in accordance with the manufacturer's instructions). Dust an anti fungal powder between the webs, skin folds and other areas where sweat may accumulate.

b. Avoid any trauma (knocks, cuts, sunburn, insect bites). Be careful cutting nails; do not cut the cuticle or push back too hard (this can injure it and allow bacteria to enter, thus leading to infection); ease back gently with a cotton wool covered orange stick. If you are sewing, wear a thimble; if gardening, wear a glove and long sleeves; if bush walking etc. wear boots and protective clothing. Never cut calluses (e.g. heel or sole). Use 10 % urea or Salicylic acid cream may help. Attend to minor burns, cuts, stings, bruises, etc. immediately

c. Keep the limb as cool as possible in hot weather. Be careful of the water temperature in showers and spas. (These can be useful in therapy and self massage). If traveling for a long time in a car, drape a white shirt over a limb in the sun. Move it if possible when you have to sit for a long time, flex and stretch fingers or feet.

d. (For Arms) Do Not pick up heavy loads with an arm 'at risk', e.g. a case or heavy shopping. Do not carry a heavy bag or handbag on this arm.

e. (For Legs) Do Not use heeled shoes. Do not walk barefoot.

f. Any redness or other signs of infection like pain brawny hardness should be treated AT ONCE (keep antibiotics in your purse). All infections need antibiotics. Some patients may need these permanently (e.g. Monthly Penicillin injections). However, if warm red patches have often occurred but disappear in 3 days, antibiotics may not be needed unless their frequency or duration increase greatly. Watch out for tinea! (often only a slight redness and a peeling of the skin.) You will need to puff an anti fungal powder into shoes or gloves as well as on the inflamed area (replace rubber gloves often). Redness and/or peeling under a breast or in the groin can also be fungal. Some conditions need oral anti fungicides for many months. Generally weekly ketoconazole (Syscan 150) is best.

g. Oral and topical benzo-pyrones, where available, help prevent and treat lymphoedema and infections by removing stagnant protein.

h. It is very important to keep the skin supple and moist in winters. Best not to use creams in summer.

i. You MUST NOT allow ANYONE to measure blood pressure, to take blood, nor to give an injection in a lymphodematous limb or one at risk. Another limb can be used, even a leg.

j. To remove hair, a properly maintained electric razor (new heads, as needed) is better than either safety razors, depilatories, or abrasive mitts. Do not use these.

k. If traveling by air it is a good precaution to wear a compression garment (and glove, for arms) or an inflatable splint may be used. If lymphoedema is present, additional pressure bandages may be needed on a long flight. Bandages may be used on fingers, hand or toes if necessary.

l. There should be no redness or indentation when you remove clothing, otherwise it is stopping some of the lymphatic drainage that you do have left! Arms: Brassieres should not be too tight around the ribs or over the shoulders. A good supporting one (not too tight!) helps prevent oedema forming in your other breast. A wider shoulder strap is recommended and, if needed, some foam padding under this and the chest band. Tight jewelry also will constrict, and should not be worn. Legs: Clothes (including underpants/panties) should be loose around both waist and thighs. Do not wear a tight belt - use braces to keep your trousers up.

m. Try not to lie on an arm at risk when sleeping or resting.

n. A normal balanced diet is best (with plenty of vitamins!). Lymphoedema is a high protein oedema, but eating too little protein will not help. Rather it weakens the connective tissue, thus making an edema worse. Dieting will not reduce lymphoedema, but is advisable if a patient is overweight. It is not necessary for patients to have a "low salt" diet or diuretics (unless needed for another disease). Lymphoedema may be temporarily reduced, but not permanently. Patients have enough troubles and do not need pointless diets in addition. Again, some patients are advised not to smoke or drink alcohol, "because these will worsen the lymphoedema". This is completely wrong! Nicotine in fact makes the lymphatic pump better (so does coffee). While too much alcohol causes obesity and it mildly increases the lymphatic load, there is no evidence that it worsens lymphoedema (unless drunk to excess so that the limb is neglected). There may be other reasons to avoid these, but worsening lymphoedema is not one of them.

o. If you are under severe psychological stress, concentrate on relaxing the shoulders, back and neck. Extend your spine and 'stand straight'. Constant tension in these areas will worsen lymphoedema or may precipitate it if you are at risk. Tension in the upper body may cause a "balance" tension in the lower limbs, so a leg 'at risk' may also develop lymphoma. If lymphoedema is already present, the above points must be observed, plus:

p. Your way of life may need to be modified; but you should not become a 'victim' to the disease. You just need to be aware of the facts about your condition and to be sensible. Do not give up sports or hobbies that you love. Low impact sports should be encouraged, as long as the limb is monitored. After surgery and/or radiotherapy it is perhaps unwise to take up a new sport when you muscles and coordination will be tested and perhaps strained (and therefore add to the lymphatic load) until some expertise is gained. Cycling, aerobics, weight lifting etc. may strain the limbs; swimming, SCUBA diving etc. are helpful.

q. It is very well known that patients who are intelligent about their lymphatic deficiencies can keep their limbs reduced and live normal, or almost normal, lives; those who forget details and are careless almost invariably have problems.

r. Wear the compression garment at all times including at night. Bandages are often more comfortable at night but only if a patient (or a caretaker) can bandage properly and without causing damage. If a limb reduces at night by itself, you may be able to leave the compression off at night (but not until 6 months after a course of treatment).

s. If you are going out for a special occasion, you may be able to leave the compression garment off - just for this time. Try at home, several days in advance, and measure before and after about the same period. If the circumference increases, or if the limb aches, then do not risk it. However do NOT do this until some months have passed after your last Course of treatment, the tissues will not have strengthened very much before then. They can readily open up again! If a garment does not cover your fingers and hand, and they swell, see a therapist at once. Coumarin powder can be safely used under the compression garment to assist with the reduction of lymphoma, and helps you to put the garment on. Do not use the ointment under a garment; use it under bandages, especially over fibrotic areas.

t. Measure (or get someone to measure) your limb once a month at least. If there is any real change (up or down) see a therapist. You may need help or a new compression garment.

u. Change the compression garment according to the recommendations of your therapist, or if it feels at all loose, or too easy to put on. (Looseness means that either the limb is smaller or the garment is old - either way it will not do its job!). The compression garment must not leave a band at the wrist, elbow or under a limb. It should not chafe at any point; if is does, get help from the Therapist. Wash it regularly according to the manufacturer's instructions.

v. DO exercise; but NOT too much (don't make the limb ache with tiredness). If you have a 'limb at risk' and do not need to wear a garment, consider doing so if you know that you are going to use it a lot that day. Wear a compression garment, or bandages, while you exercise. Exercises may be modified or added to according to your own requirements by your therapist.

w. It is not easy to remember how to exercise correctly.

x. Self massage is important. It consists of regular gentle pressure with rotary motion on the key drainage areas which are - Both groins, both axilla and just above the collar bone in the neck (especially the involved side).