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Joachim Zuther, Lymphedema Specialist. Read more
Solaris
MediUSA

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Lymphedema and Vacation

 

With the holidays around the corner some of you affected by lymphedema might be planning an extended road - or airplane trip. Getting to your destination may require hours of sitting, which causes a considerable slow down in the venous and lymphatic circulation, and fluid to pool in the extremities.

Air travel can be especially challenging for individuals with lymphedema and those at risk for developing lymphedema. In pressurized airplanes, the cabin pressure during flights is generally lower than the atmospheric pressure on the ground, which causes a change in pressure in the connective tissues. These pressure changes, combined with the pooling of fluid in the tissues may even cause swelling in normal tissues. It just makes sense that these travel-related issues may have even more serious consequences in individuals with a compromised lymphatic system.

To avoid the onset of swelling and to prevent the worsening of pre-existing lymphedema, it is recommended to wear a compression garment during air travel. In some cases it may even be necessary to apply additional bandage(s) on top of a copression garment.  Compression increases tissue pressure and considerably aids in the prevention of fluid accumulation in the tissues.

While traveling with lymphedema does have some drawbacks and requires more planning, it should not stop you from taking a long awaited trip.

The following recommendations are intended to help your planning and make your trip more enjoyable:

Plan Ahead

  • Seek the advise of your physician and your lymphedema therapist if there are any questions, specifically in regard to added compression during flights
  • If you are an individual at risk for developing lymphedema, you should discuss with your physician and/or lymphedema therapist if it may be beneficial to wear a well-fitted compression garment, or short-stretch bandage(s) during the flight
  • Check the quality of your compression garment. If you have more than one garment, take the extra one with you as a back up. If your destination is located at high altitudes, you need to take the same precautions as for your flight
  • Ensure that you can manage your luggage. If you travel with another person or a group, ask someone else to carry the luggage for you. Should you travel on your own, use a suitcase with wheels and don’t lift your luggage from the baggage carousel with your swollen arm
  • Carry your prescription medication with you; if necessary get your prescriptions filled before you leave to make sure they last you through your vacation. If your destination is located in hot or mosquito-infested areas, take precaution (sun screen, insect repellants, and antibiotics). Should you travel to a tropical country in which filariasis is endemic (especially during the wet season), talk to your doctor about special medication to take with you. Take some antifungal powder with you – the bathrooms and showers in hotel rooms may be a source for infection.

    Endemic countries for filariasis

     

  • Bring skin lotion – the air in pressurized cabins is very dry
  • If possible, request an exit seat, which gives you more legroom. Definitely request an aisle seat so you can get up periodically without disturbing the person sitting next to you
  • Wear loose, comfortable clothing and comfortable shoes that have been worn previously. If you have lymphedema of the leg avoid taking off your shoes during the flight
  • Allow ample time to check in and reach your departure gate

During the Flight

  • Wear your compression garments. It is also a good idea to wear an additional short stretch bandage on top of your garment to counter the effects of low cabin pressure – discuss with your therapist before you leave
  • Drink plenty of water or fruit juices and eat lightly – the cabin air is very dry
  • Ask somebody else to place your carry-on luggage in the overhead compartment
  • Stand up and walk around the cabin as often as possible
  • Do not place anything under the seat in front of you, so you can stretch and exercise your legs
  • Elevate your arms as often as possible if you have lymphedema of the arm and bring a “squeeze” ball for muscle pump exercises
  • If you have an open toe stocking, it is advisable to apply bandages on your toes and any other part of your foot that may be exposed
  • It may be necessary to wear a glove (or finger/hand bandage) in addition to your arm sleeve. If you have a gauntlet without finger stubs, you may want to bandage your fingers
  • Make sure to do some easy to remember muscle pump exercises (roll you feet, lift the heels and toes alternating, etc.). Ask your therapist what kind of exercises (s)he recommends during the flight

Arrival

  • Do not remove your garment and any additional bandage materials before you reach your final destination
  • Upon arrival at your destination, a shower and a nap should be your top priority. Make sure you moisturize your skin thoroughly after the shower. A few more exercises with your garments in place would be beneficial
  • Should you spend a lot of time on the beach, make sure you wear sunscreen and cover your affected limb as often as possible. Wear rubber sandals in the water if you have lymphedema affecting your leg(s)

Additional Resources:
National Lymphedema Networks position paper on air travel with lymphedema
The Role of Compression Garments
Lymphedema People

Join Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more

 

32 comments to Lymphedema and Vacation

  • Sue

    I have lymphedema in one leg, and I always wear compression bandages when I fly, even short flights. It really helps. Wearing leg bandages will almost invariably result in the TSA staff pulling you aside for a pat down, so be sure to allow a little extra time for getting through security. The advice about staying hydrated is important too, in my experience. Thanks for the post, Joe!

  • Sharon Gaston, LLCC, CMT

    Thank you for this article. There are a couple pieces of information I hadn’t thought of in sharing self-care information with clients. Most helpful.
    Regards,
    Sharon

    PS – I’m writing a book and creating a DVD as well, would you consider referencing your information, as in copywrite aproval?

  • This is wonderful advice! Thanks for all the tips. Be well, Jan

  • D. Schwarz, Ph.D.

    This is a great article, but could use some additional suggestions. I have traveled around the world with Arm Lymphedema, and have run into many dificulties with airlines security. Often I have been asked to remove my bandages, or take off my compressions sleeves and gloves. They also do not recognize Lymphedema supplies as medical equipment to take on board as an extra carry-on. My supply bag has actually been removed from me on one flight. They do however allow CPAP machines for, sleep apnea patients, as an extra carry on with no questions asked. Also what recommendations do you have for travelling with a Lymphedema pump? Could the NLN and the Medical Community work with TSA and the FAA to devise a “Medical Necessity Guidline and Official Authorization I.D. card” for patients travelling with Lymphedema supply bags and wearing compression garments?Even though Guidelines for the Americans with Disability Act,should apply here, airline personnel often indicate they have different instructions and have not been trained in dealing with passengers with Lymphedema. D.Schwarz, Ph.D.

    • Joachim Zuther

      Dear Dr. Schwarz: I think these are great suggestions. We hear from many patients that bandages and compression garments have to be removed during the check-in process with TSA; however, this is the first time I hear that the compression supplies were not allowed to be taken on the airplane. I will contact the NLN and other organizations to discuss your suggestion for a medical necessity guideline for lymphedema patients.

  • Andrea Bowes

    This is extremely good advice. I have to travel a lot for my job and this information is invaluable to me. Thanks a lot Joe. I usually find your topics extremely intresting.

  • t.k.thanthoni

    I am a lymph edema patient of the entire right lower limb, for the past 7 years after a cancer surgery some 25 years ago. An international traveller from India , I find the above tips are very useful and most of them I am already following and this edema does not bother me at all. The compression stockinet is highly useful, without which I could not have moved about

  • Thank you for this information. It’s helpful to get practical suggestions for travel.

  • C Rabbit

    I have a few insights, since I am an airline gate agent responsible for monitoring excessive carry on baggage on domestic and international flights, I have had lymphedema for 30 years, and I travel internationally 3-4 time a year.
    If you travel with medical equipment of any kind, it is against regulations for airline employees to make you check this equipment. There is a federal act which prohibits separating a passenger from medical necessities.
    Basically all you should have to do is say that you have medical equipment in your bag and you are untouchable. No one wants a lawsuit for discriminating against people with disabilities.
    When you travel, limit salt intake, which is essentially all the food provided by the airline, including tomato juice for your bloody mary, and the pretzels/peanuts. That excessive salt just adds insult to injury when you have compression issues.
    Never say you have a medical need when you ask for an exit row (the ones with all the legroom) as people with physical disabilities cannot sit in exit rows. You be the judge whether or not you can help in an emergency, and ask for it without disclosing medical need. Just say it would be helpful to you.
    When I fly internationally, I have a special pair of pants which have excessive fabric and will accommodate my compression garments. I dress normally for the flight, then get up when the fasten seat belt light goes out, and change into my Tribute night garment with the full pants over it. It’s a little odd, but not that noticeable, and makes all the difference in how I tolerate a long flight. It’s great to be squished into something nice and tight.
    Avoid traveling to destinations in their hot season. So many things can go wrong. Take antibiotic cream and ask your doctor if they prescribe antibiotics in case things go south for you.
    Keep flying. The experience of other cultures is well worth the few things of which you must be mindful when you fly with lymphedema.

  • Nicole Marsh, OTR/L, LMT, CLT

    I have had patient’s sent to me for CDT that are currently receiving treatment for a new onset or recurrence of cancer. The course manual indicates that malignancies are a relative contraindication and can be performed for pain management or palliative care. What is currently recommended or done to help manage lymphedema?

    • Joachim Zuther

      Dear Nicole: As you correctly stated, MLD and CDT can be performed in active malignancies for palliative care as long as there is a prescription from the referring MD. Treatment protocol is identical with the ones for primary/secondary lymphedema.

  • Nicole Marsh, OTR/L, LMT, CLT

    Thank you! On that same topic, how do you get physician’s to understand that this treatment is a contraindication if not treating palliative? Do you know of any articles I can refer the physicians to?

  • Nicole Marsh, OTR/L, LMT, CLT

    Thank you very much!

  • David

    Thanks for taking the time to write a helpful article.

  • Susan Trickel

    Before going on vacation, if you are seriously overweight and have leg wounds see your doctor. My husband’s wound doctor has found that lymphedema can mask thyroid and diabetic symptoms. Doctors look right at you and know your symptoms but the tests always come out negative so no help is given. My husband had a week of intravenous insulin and antibiotics with 10 mg. per day of thyroid. His wounds are finally healing and he is losing weight without effort. This doctor thought outside the medical box and it worked.

  • Joachim…Thanks for taking time to write these great tips. Keep them coming.

  • M. Kunkle

    I had a lumpectomy and radiation 18 months ago. I am at low risk for lymphedema, and am doing what I can to prevent it. I do special exercises given me when I had post-op P.T. I have a prescribed Juzo arm compression sleeve for when I travel by air or if arm is bothersome. I also have a hand gauntlet. My confusion is this: one physical therapist said I MUST wear the gauntlet when wearing the sleeve, although I can wear the gauntlet alone. This therapist said wearing the sleeve alone could cause fluid pooling in wrist/hand area and defeat purpose of the sleeve. Another therapist said she doesn’t think this is necessary. She has other low risk clients who wear the sleeve alone and have not had any problems. What is the correct method? Thank you.

    • Joachim Zuther

      Dear M: If you hand tends to develop swelling, it is certainly advisable to wear the gauntlet in combination with the compression sleeve. Wearing the sleeve without the gauntlet could result in swelling in the hand area. However, you may also try to wear the sleeve without the gauntlet once in a while, and should you realize heaviness or swelling in your hand, wear the gauntlet as well. During airtravel you should definitely wear both.

  • M. Kunkle

    Dear Mr. Zuther,
    Sorry for delay in replying. Just want to thank you for your informative response. Thank you, also, for this site where folks can get quick and helpful responses to their questions.

  • Carole

    Any advice for traveling 6 days by train? thanks

  • Natasha Lambert

    Thank you for providing me with this information.I’m regretfully in a position where I have to acquire a Bio Compression device. It was suggested that:
    Bio Compression Systems was one of my top options but I would like a second opinion. Thanks.

    • Joachim Zuther

      Dear Natasha: Advanced and newer compression pumps consist of multi-chambered inflatable sleeves that include trunk garments containing inflatable chambers designed to prepare drainage areas on the trunk prior to moving fluid from the extremities.

      Pneumatic compression used to treat extremity lymphedema without treatment of adjacent body quadrants and drainage areas using complete decongestive therapy bears a significant risk of moving lymphedemateous fluid from distal to proximal, where it accumulates. This may cause protein molecules to accumulate in this area, forming a fibrosclerotic ring, truncal quadrants previously not swollen to fill with fluid, or external genitalia to swell.

      Recent studies suggest that multi-chambered sequential compression devices that include trunk and extremity garments and deliver the pressurized air in individual patient-oriented patterns may be beneficial as an adjunct treatment to effectively control lymphedema in the self-administered maintenance phase (Phase II of CDT), especially in those cases when physical limitations of the patient may result in challenges controlling the lymphedema independently with self-MLD.

  • Leah Pugh

    I was told by my lymphodema nurse that it wasn’t safe to fly over 4 hours if you have lymphodema! Is this true?

  • Nancy Dagan

    Many thanks for your articles. Always find them informative and interesting in a world where there is little consistent information. When travelling from one Province to another in Canada, the airlines did not allow me to carry my sequential device. They said they would mark it fragile. Going to my destination that worked. Coming home my suitcase was in taters and it was on the carasol with the regular luggage. The device was not damaged and the airlines did replace the suitcase. Of note: I had a Drs. letter with me and had this clarified by the airlines prior to the trip. Very frustrating.

  • N Weisdorff

    I’ve been told to keep my compression garments on for 2 hours after landing from a flight. Is that really necessary? I find by the time I arrive I can’t wait to get them off me!

  • maria

    Hi. U woukd be grateful if you give me some tips on driving. I am wearing stockings, doing the brush body every day but have changed jobs and am driving 30-40 minutes twice a day which has made my leg lymphodema worse. My ankle every day is 4cm in diameter bigger than the other leg and 2-3cm everywhere else. Ihave slight swelling in other leg. I had bilateral lymph gland removal. Is there a goid way to drive? Also my stockings at night leave red ridge marks by the knee, which wake me up as it is painful. Is this bad fir my lymphodema. Thank you.

    • Joachim Zuther

      Maria – you would certainly benefit from products offered by companies like Solaris or CircAid, which offer compression devices that are adjustable by use of velcro straps. These devices can be applied and worn on top of compression garments while you drive in order to increase compression during that time and prevent increased swelling.

  • maria

    Thank you very much for your help… i will definately get these as i am worried about my condition deteriorating. It ‘popped up’ a year after surgery on a holiday abroad.. the 8 hour flight was the trigger to a nightmare 2 week introduction to lymphodrma whilst on holiday 3 years ago.. it would have been nice to have been warned. :( but it has worsened to the point that hot weather is not the only trigger… it is always there… I would love support stockings that are a nice colour. Ie. More natural looking .. than the american tan and yellowy choice :s. Thank you once again.

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