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LymphLink Question Corner

July 2011
Debra S. Daugherty

Q:  I am a 48 year old bachelor who weighs over 400 lbs. I have lymphedema in my right leg from cancer treatment, and I just found out I have diabetes. I have been getting regular bouts of athlete's foot since high school. I didn't think much about it, but now my doctor insists that I take better care of my feet. I have started to wash my socks more, but truth is I don't know how I can physically do what he asks. I can barely see my feet in the shower, much less reach down to clean them. What can I do? Buddy from Texas

A:  Your doctor is right. Chronic foot infections cause terrible problems for people with diabetes and lymphedema -- problems up to and including amputation. It is imperative that you set up a routine for maximal foot hygiene.

Grab bars and bath mats Safety first! You need to make sure that your new shower calisthenics do not lead to a broken hip. Grab bars are available at large hardware stores. They need to be installed into the studs so if you do not know carpentry, please hire an experienced handyman to put them in. Be sure that you have a secure, non-skid bath mat to stand on while bathing. Clean and disinfect your stall and mat regularly to get rid of any bacteria or fungi that might try to grow in that warm damp atmosphere.

Shower Chair You can get a very good extra-sized shower chair for less than $90.00. Be sure to check the weight limit on the chair before you buy it. A "bariatric" shower chair is designed to hold heavier people, and weight specifications should be listed in the product specs. It is easier to clean your feet well from a seated position.

Reaching your feet If you still cannot reach your feet, try a "long handled shower sponge". Basically, it is a sponge on a stick. You can usually find one at a pharmacy or a bed and bath store. They even come with special sponges to clean between the toes. Be sure to clean and rinse the sponge after each use.

Drying your feet It is hard to dry between your toes if you cannot reach your feet, but it is vital to prevent infections. Try using the belt from a terry cloth robe to "floss" between their toes, or use a blow dryer set on low. Afterwards you can sprinkle some corn starch powder over them to keep them dry.

Long handled lotion applicator Once your toes are dry, be sure to get some lotion on your feet to keep the skin intact. Spread a generous layer over all parts of your feet except between the toes. You can usually find a lotion applicator at bed and bath stores.

Bottom line: from this day forward, you must keep your feet and toes immaculately clean. Not being able to reach your feet is no excuse, there are adaptive aides available. Listed below are some websites to help you find the items mentioned:
www.walmart.com
www.homedepot.com
www.target.com
www.sammonspreston.com
www.livingXL.com
www.bedbathandbeyond.com

Q:  My husband has lymphedema in both legs and he keeps getting infections, the last two times he had to go into the hospital for IV antibiotics. He has had five bad infections in the last three years. Each time a leg starts to swell even though he wears his stockings, then fluid starts to come out of his skin, then the redness comes. We have retired to the country and cannot visit our therapist, the doctors here do not know much about lymphedema. What can we do?

A:  Here are several suggestions:

• As soon as increased redness occurs, he should be seen by a physician to determine if prompt initiation of antibiotics is warranted.
• When swelling increases but there is no new redness: If your therapist taught you how to bandage, then you need to start bandaging the minute you see the extra swelling. If neither of you can bandage, then check the referral list in this newsletter to find a therapist close to where you live. Prompt treatment will usually prevent the problem from getting worse.
• You should go see your MD and a therapist the minute the weeping of fluid starts; and, of course, keep the skin meticulously clean. The best way to stop the weeping is with good bandaging and a clean sterile absorbent pad over the wet areas. An experienced therapist should be able to contain the weeping in 4-7 days with intense bandaging and skin care.
• Your husband may have to replace his compression garments more frequently, and may need stronger garments on his legs. There are many good options on the market now. You might check into custom stockings made with a "waffle-weave" material or adjustable leg garments with Velcro closures.
• Educate your new doctor. Take some information in. A good place to start is to take him/her copies of the NLN position papers and one of your NLN newsletters. It would insure that he/she has access to accurate information and reliable resources.

I hope this information helps you. I know it is hard to consider spending even more money on your legs, but these severe infections probably cost more. You need to do everything you can to prevent them.

Q:  My mother is a large woman with lymphedema in her left arm. She refuses to wear her sleeves or go back to treatment. She got some redness in her elbow and her Dr. said it was a yeast infection. Is this possible? Is it bad for the lymphedema?

A:  Yes it is very possible and can make the lymphedema much worse. We are all prone to developing infections in skin fold areas if we do not keep them clean and dry. When skin folds in on itself - such as large breasts, tummy folds, groin, buttocks or lymphedema pouches - it gets warm and sweaty. That is the perfect environment for bacteria, fungus, viruses or infections to develop. This is a bad situation for anyone, but can create serious problems for someone with lymphedema. If the infection gets beneath the skin, it can spread rapidly throughout the limb. All of my patients who have suffered these infections have told me it was a miserable experience. It would be good if you could convince your mother of the importance of preventing these skinfold infections.

• She needs to wash the areas daily with a pH balanced soap. Her doctor probably has a list of soaps that he would like her to use.
• Then she needs to dry the area completely with a towel and/or a blow-dryer set on low. I advise my patient to lay on the bed, pull the skinfold apart gently and let a fan waft a cool breeze on the area.
• She can dust some corn starch (not talc) into the fold to help keep it dry or place several layers of clean cotton into the fold to prevent the skin from rubbing itself all day long. Old cotton t-shirts or old bed sheets work well.
• There are even people who sell washable cotton liners in various sizes to fit under large tummy folds or breasts (pambras.com).
• Several companies specializing in lymphedema products make washable chip foam inserts designed to lift and separate a large skinfold. Some of my patients wrap clean cotton cloths around these inserts and wear them daily to keep the area dry. (Jovipak.com, Solaris.com).
• For severe skinfold infections physicians may prescribe topical or oral antifungals, or antifungal absorbent dressing (e.g. InterDry Ag)

Debra S. Daugherty

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Please address questions to: Editor c/o NLN, 116 New Montgomery Street, Suite 235, San Francisco, CA 94105 or e-mail: nln@lymphnet.org. Deadlines for submissions (for the following issue) are: Feb 1, May 1, Aug 1, Nov 1.

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