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Basic Guidelines for Air Travel for People with a Compromised Lymphatic System

by Jeannette Zucker, DPT, CLT-LANA

Patients with lymphedema continue to be told that they have to be careful when they fly.  But what does this really mean? This advice is often given without much detail, and as a result patients decide not to travel at all. By clarifying this misconception I hope to encourage you to travel and enjoy life to the fullest.

Flying itself is not what increases the risk for the onset or exacerbation of lymphedema.  Rather, it is the combination of decreased cabin pressure along with other factors such as stress, dehydration, and prolonged immobility that makes the lymphatic system work harder than normal.

In my professional opinion, if patients follow some basic guidelines and use a lot of common sense, air travel can be a viable means of transportation.   

  1. Consider where you are going and what the physical demands will be. If your trip will involve physical activity that you are not accustomed to then it is important to build endurance and strength. You can achieve this by going to the gym more regularly or you can also "sneak" exercise into your daily routine by doing things like walking up stairs instead of taking the elevator. Most importantly, gradually build up your level of fitness, working within your level of comfort; doing so prior to the trip. Also make sure to speak with your doctor or therapist regarding any particular restrictions you may have to exercise.    
  2. Bring only the bare essentials. Heavy luggage can strain your muscles. Think about the essentials (clothing, shoes, etc.) and only bring what you will use. In general, try to pack lightly and tightly. Try packing things in as few bags as possible so that you are not fumbling with multiple pieces of luggage. Even consider having everything shipped to your destination. Be sure to ask for help from family and friends or even from drivers and airport personnel.
  3. Use rollers and backpacks. Although luggages without rollers are somewhat obsolete these days, I still see people using them. Make sure that only rollers are used and that any over-the-shoulder bags are lightweight and wide-strapped so that they don't cut deep into the shoulder area and interrupt lymphatic flow.
  4. Avoid tourniquets. Oftentimes, great care is taken to avoid blood pressure cuffs, tight jewelry, and other things that constrict and cut off circulation. However, there are times when this occurs in ways that are not so obvious. For people who have their arms involved or at risk, it is important not to hold heavy plastic or thin-handled bags that create tourniquets in the hand.  For people who have their legs involved or at risk, do not cross you legs while sitting. Change your socks every day and make sure your nails are short for good hygiene. Choosing proper footwear is important. Avoid sandals, tight, strappy, and poor-fitting shoes. Make sure to bring shoes that you know are comfortable and not only will you be sure to enjoy your trip but your feet will be so grateful.
  5. Pack well in advance. If you finish packing at least 2 days before flying, you can stick to your usual routine and avoid being sleep-deprived, stressed, or cranky. You'll minimize stress, be less likely to skip meals, and more likely to maintain hydration.
  6.  Eat healthy meals and bring your own snacks. Skipping meals because you're so busy packing for the trip or too busy throughout the trip causes you to eat whatever is available such as airport and airplane food, which is high in salt. Salt increases fluid retention in your body and mild swelling may result even if your lymphatic system is not compromised.  So by eating meals at regular times and bringing your own snacks, you'll be able to eat things that you enjoy and avoid hunger attacks.
  7. Drink plenty of water. The opposite (drinking less water) may seem true, but drinking more water is important because lymph fluid has high protein content.In order for protein to be removed from your tissues, it needs water to move it. Having more water available means "protein traffic" moves better which also means decreased risk for lymphedema.
  8. Choose a seat with a lot of leg room. Try getting to the airport earlier than expected so that you can request bulkhead seats, which are the first seats in coach. These seats have enough space for you to elevate your legs, perform exercises, and get up to walk the aisle without worrying about inconveniencing your neighbors. If bulkhead seats are not available, aisle seats are the next best option.
  9. Exercise throughout the flight. Simply put, good blood circulation also means good lymphatic flow.  Perform simple stretches or range of motion exercises throughout the flight while in your seat. But also make it a point to walk up and down the aisle as much as feasible.  The longer your flight, the more often you should do this. Exercise will have the added benefit of decreasing your risk for a blood clot, which is a well-known concern for all air travelers.
  10. Wear your garments. If you have been diagnosed with lymphedema, compression garments and alternative garments are essential on a flight. You can wear daytime garments or durable bandaging alternatives, which ever provides the support you need. If you have a new garment wear it a couple of days prior to the trip and make sure it fits correctly. For upper extremities, a handpiece (either a glove or gauntlet) should be worn with the compression sleeve. Leg wear should not be too tight and constricting or make it difficult to go to the restroom. For people who do not have lymphedema, but are at risk of lymphedema, talk to a lymphedema provider about whether you should wear a compression garment. There is no evidence that wearing a garment when you do not have lymphedema will cause lymphedema. This is an individual decision based on your specific situation. A note from your doctor regarding lymphedema may help answer security questions related to bandages and garments when you are screened.
  11. Bring your Medications.If you have a history of infections make sure to carry antibiotics or a prescription for antibiotics, especially when traveling outside the US.Wear a LYMPHEDEMA ALERT bracelet (upper extremity) and/or necklace (for lower extremity) during your trip in case of emergencies.

Although there are no guarantees, if you follow the above guidelines flying can be an option to get where you want to go without necessarily increasing your lymphedema risk. There are so many variables that have yet to be considered and hopefully research will one day provide more concrete guidelines.But until then, bon voyage and safe travels!

zuckerj [at] mskcc [dot] org (zuckerj@mskcc.org)