Published on: October 15, 2020

A Good Problem to Have

As a compression garment fitter, the first thing we learn is to ALWAYS measure the patient when they are FREE from edema.  For all of you lymphedema therapists out there you know the time of this can be very difficult.

For those of that are new to lymphedema and/or compression garments you might be asking “Why does someone need to be FREE of edema prior to being measured?”  The answer is relatively simple; because if we fit the patient when they are still swollen with edema the garment will reduce the patient’s edema to the point where the garment will be too big.  Now you might be asking isn’t more reduction good?  Yes, it is very good, however now we need to start over again and get the patient a new garment and in most cases, if the patient has lymphedema the garment is custom made.

Luckily for everyone involved most manufacturers have fantastic “fit guarantees” that allow the fitter to measure the patient again and have new garments maid without being charged again.  There are time restrictions so make sure to check with the company you are working with.  For example, Absolute Medical has a very flexible two-week policy which means the patient or therapist needs to let us know of any fit issues within two weeks of when they first received the garment.

This leads me to today’s patient who has left upper extremity lymphedema secondary to breast cancer.  She presented to me outside of therapy and was very swollen when I measured her.  I have been fitting this particular patient for two years in therapy and her swelling always looked and measured the same.  Her therapist just couldn’t get her swelling anymore reduced than what she was.  I suggested that she return to therapy and try again but she refused.

 

This time I wanted to try something new because my tried and true wasn’t working.  I got her a different flat knit for daytime but this time I had a gel pad sewn into the dorsal hand, and for nighttime, I got her a firm quilted nighttime garment but this time I had it made in two pieces instead of one to make it easier for her and her partner to don.

Below are the circumference measurements I took at the initial measuring.

 

Palm: 23cm

Wrist: 21.5cm

Distal forearm: 25cm

Widest forearm: 26.6cm

Elbow: 29cm

Lower Bicep: 33.5cm

Mid Bicep: 37cm

Upper Bicep: 38cm

Axilla: 39.5cm

 

Compared to her unaffected arm she was very swollen but compared to her past measurements these measurements were correct.

I set her up and within one week the patient called and told me that the garments no longer fit and were falling off of her.

I assumed she was exaggerating since I had no such luck in the past with her with my “go-to” garments.  I traveled to see her and took new measurements.

 

Palm: 20cm                          3cm reduction

Wrist: 18.5cm                      3.5cm reduction

Distal forearm: 23cm,        2cm reduction

Widest forearm: 26cm        .6cm reduction

Elbow: 27cm                        2cm reduction

Lower Bicep: 31cm              2.5cm reduction

Mid Bicep: 35cm                  2cm reduction

Upper Bicep: 36cm              2cm reduction

Axilla: 38                              1.5cm reduction

 

This patient achieved a 7% reduction just from being compliant and wearing a daytime and nighttime garment.  I immediately sent the new measurements in and recently fit the patient with better fitting garments to maintain her new limb size.  Special Note: No cost to the patient, to the insurance, or to our company because we were well within the manufacturer’s “fit guarantee”.

For your therapists and patients out there please realize that this reduction, new measuring, and new fitting happens a lot.  It is best practice to get your patient reduced as much as you can prior to measuring for custom flat knit or custom quilted garments.  If you are left with no other option but to measure and the patient is not interested in continuing therapy or doesn’t want to include non-elastic Velcro garments it is best to talk to the patient and let them know that this may be a TWO FITTING process until we get the best fit.

As fitters when presented with a patient that is still showing a lot of edema it is ALWAYS best to recommend that they continue or start lymphedema therapy so the patient can be decongested.

Everyone involved wants a perfect fit and the best way and really the only way to achieve the BEST fit is for the patient to work with a lymphedema therapist until the patient’s swelling is fully decongested.  Once this occurs the fitter will measure and fit the patient with custom daytime and nighttime compression garments to maintain those results.  This is how together, therapists, patients, and fitter can achieve the best possible results so the patient can independently self-manage their swelling for the rest of their lives.