Carefully inspect your skin every day for changes, such as swelling, scrapes, blisters, fibrotic tissue, and "pitting". Your therapist has been discussing how to identify "pitting edema". When your finger pressure is applied to the affected limb for 10 seconds and released, normal skin will bounce back into place. When a dimple is seen upon release it is called "pitting edema". If the dimple remains for longer than 30 seconds, the edema is relatively serious. Check for pitting at the same places your therapist has been checking you, as these are the places where we expect to see pitting if it is there. Measure your affected limb weekly and keep a record of your results so you can tell if you are swelling. Measure at a few sites, similar to the sites used by the physical therapist, but always measure at the exact same sites each week. (For example, always measure across the knuckles, 5 inches from the bottom of the wrist bone, 5 inches above that area, and 5 inches above the previous area). Use your daily assessments and weekly measurements to determine if you need additional bandaging over your support garment or if you need to be seen at the clinic for increased swelling.
Keep the affected limb elevated as much as possible. Elevating above the level of the heart is most therapeutic. An arm can be rested on the back of a couch or chair, or supported by pillows. Elevate feet and legs by using a recliner or by improvising with footstools, chairs, and pillows. In bed elevate an arm or legs with pillows. On long car trips avoid holding affected limbs in a dependent (downward) position as gravity will pull fluid into the limb. Arms can be elevated with pillows or over the back of the seat. Legs can be elevated by sitting in the back seat with legs propped up on the seat with pillows. Extra bandaging should be used on long car trips to help prevent increased swelling. Make frequent rest stops to move around and do therapeutic exercises in the car.
Home Exercise Program
You were given a list of therapeutic exercise to do at the clinic and at home. For optimal results, do these exercises at least twice a day, every day. Always do your exercise with bandages (or support stockings) on. Remember that the increased tissue pressure from the bandaging works with the skeletal muscles to pump additional fluid through collateral pathways created by MLD, and eventually out of your body. You may get fatigued while doing your exercise program but you should stop before reaching a point of pain or extreme fatigue.