May 2010

HEALTH NOTE - SWELLING & Summer in the South

Author: Dr. Madeline Chatlain

By the time you read this article, you will be enjoying one of the most beautiful seasons of the year (sans pollen). Cool nights and warm days may have you turning on your air conditioning at some point, but that long, cold (soggy!) winter we had this year, will be a thing of the past. Well, summer is coming, along with the inevitable humidity we all dread, and so is swelling of our various body parts. I have been dealing with my patients’ lymphedemas and edemas for over two decades in the Lowcountry, and I am happy to have this opportunity to share with you some practical tips for reducing those symptoms and enjoying your summer.

In brief, the lymphatic systems (LS: think lymph nodes or filtration system) and cardiovascular (CVS: circulatory system, think heart) both work together to maintain and regulate your body’s fluid balance. When they are dysfunctional, they produce swelling, seen by the patient as a swollen foot, ankle, leg or arm, that won’t go away and usually only improves (temporarily) if they elevate the limb. Walking, driving, exercising all become more difficult (and sometimes painful) as the swelling worsens. Over time, these patients become more disheartened as they cannot participate in many of their favorite activities, and when they do, their only reward is to see their swelling worsen. Treatments for both lymphedema and edema overlap, and for the purposes of this article, we will focus on the similarities and common practices for treating both types of edemas.

Regardless of you diagnosis, we all know that we swell up more in summer due to the heat and humidity. But there are many things you can do to protect your swollen limb. First, let’s deal with the elephant in the room: diet and exercise. Americans are getting fatter every year (sorry, that isn’t edema! It’s fat!), consuming far more calories than they burn off and exercising far less with each passing year. Let’s look at six basic strategies to help control your swelling this summer.

DIET:
1) Cut down on salt. Did you know that the average American eats 20 times as much sodium as the body needs? In fact, your body needs only one quarter of a teaspoon of salt every day. In the April 2010 issue of Nutrition Action Health Letter, the cover story focused on salt, “Shaving Salt, Saving Lives.”* If we are looking for a way to lower our staggering health care costs (by $10 to $24 billion), reduce deaths, strokes and heart disease, take a look at Table 1 that gives you the highlights from this article. I have provided a link to a Web page which lists many common foods and their sodium content which you can download and print out for your perusal. So, what to eat? UCSF medical center has some great ideas on foods with low sodium alternatives (Table 2). But in general, use the guideline of “moderation.” Also, stay away from anything in a package; fresher is better. It really is that simple. (Hint: Take time to read the ingredients on those salad dressings!)


TABLES 1 AND 2 PICTURED ABOVE

2) Drink plenty of water. Water makes up 60 percent of an adult’s body weight; and as we age, we are more susceptible to dehydration, regardless of the weather. It is important to keep in mind that our brain controls our thirst mechanism, and older adults are less efficient in this stopgap measure. This makes them more susceptible to urinary tract infections, pressure ulcers, confusion and disorientation. Many patients who suffer from edemas think that if they drink more water it will worsen their symptoms. This is simply untrue, and the opposite effect actually occurs. The majority (70 percent) of the delicate pathways that transport fluid from your skin are located in the top or superficial tissues, and dehydration causes them to become constricted, closing off those pathways and worsening the swelling.

EXERCISE:
Many people with edemas find that their affected limb(s) swell more in the summer because of the heat. It is important to stay cool. Try some of these strategies this summer:

3) Location, location, location. Just like the real estate industry tells us, location is key to success, and in this instance, in decreasing the chance of your limb swelling. Try to exercise in a well air-conditioned place while indoors, and when outdoors, try and stay out of the sun as much as possible. The location of your edema also will determine how long you can exercise, how much and where you add compression to your limb, and the intensity of your workout. (Hint: Lowering those window shades while working out can not only keep you cooler but keep you from overheating when you get your electric bill this summer!)

4) Timing is everything. Limit the time you spend outside during the hotter parts of the day, between 11 a.m. and 3 p.m. Compression garments may be needed in the afternoon when the heat is more intense and may be removed in the evening. Remember, we live in a very humid climate, and it is easy to trick our body into thinking it is hydrated, when, in fact, it requires more fluids when it is “liquid air” outside. Just because your hair is frizzing and your car windows are foggy doesn’t mean you can skimp on water, keep that water bottle handy the minute you start your day. And what is in that water bottle?

Caffeinated beverages (teas, coffees) are very dehydrating and can worsen your symptoms (headache, mid-morning anyone?) making you reach for more of the same; and if you add a soda to the mix (soda aka “sodium” pop, hint! hint!) even if you don’t have a headache or edema, your abdomen will be bloated by mid-afternoon. Stick to simple water in that water bottle. (Hint: We are in the “rock belt” of the south (kidney stone belt), instead of fancy water from Fiji, keep distilled water in your bottle: You’ll save money and prevent a painful condition!)

5) Clothing. Wear light, loose, non-constricting clothing. Cottons are great. Upside: Not only will it be cooler, it is also better for the free flow of your lymphatic and vascular pathways. Downside: I apologize for those of us who hate to iron. (Hint: There are plenty of high tech fabrics out there…check out the Activewear departments at Ross, TJ Maxx or Marshall’s, and I guarantee you will find a comfortable fabric that you don’t have to iron. Also, get that workout shirt a size or so larger than normal. Remember, you are working out, not getting ready to guest star on Housewives of New York!)

COMPRESSION:
Compression garments are the key not only to surviving, but enjoying your summer if you have edema. They are readily available, but patients don’t know what compression, material or style to purchase. Obtaining a prescription from your doctor is mandatory to success in this regard. Not everyone can or should be wearing compression, and it is up to your health care provider to advise you accordingly. That said, a good compression garment (leg, arm) will allow you to exercise outside safely and more efficiently, controlling your symptoms and actually strengthening both your cardiovascular and lymphatic systems.

6) Garment Care. Be especially conscientious about washing your garments, because sweat, body oils and various lotions can cause fabric to deteriorate more rapidly. (Hint: Avoid putting insect repellent on your skin and then wearing a compression garment over it. It may cause skin reactions and can also damage the fabric of your garment. Also, the ingredient DEET may actually cause your garment to melt!)

This is the take-home message: the precautions recommended when you have lymphedema and/or edema or are at risk for it are not meant to keep you from living your life by hemming you in with “don’ts” and “can’ts.” Instead, these precautions and resources are intended to give you a better chance at keeping your swelling under control so that you are free to get on with your life and enjoy your summer in the Lowcountry.

Dr. Madeline Chatlain, CDT-LANA, OTR/L, is the owner, operator of Hilton Head Occupational Therapy, Myofascial Rehabilitation and Lymphedema Services, the only nationally board certified lymphedema clinic in the Lowcountry. For more information or questions regarding this article, visit lymphedematreatment.com or e-mail madchatlain@cs.com.

HELPFUL WEBSITES:

- Salt article: cspinet.org/nah/index.htm (Table 1)

- General Foods with High Sodium content: ucsfhealth.org/adult/edu/lowSodiumDiet.html (Table 2)

- Cool Tips for Lymphedema patients: lymphnet.org/lymphedemaFAQs/Risk Reduction/summerTips.htm

- Specific foods Sodium Content: http://oto2.wustl.edu/men/sodium.htm

  1. Very good article, Dr. Chatlain – with important and good tips. I would also add that during these hot humid months, we must also protect ourselves from insect bites which can trigger cellulitis infections. be sure to use some type of repellant when outdoors. If you garden, always use gloves. Soil (dirt) is full of potentially harmful bacteria, so we need to be vigilant when we garden. Finally, always use sun screen. You absolutely must avoid sunburns at all costs. Using simple guidelines can assure you a fun filled and wonderful Summer! be well – be safe. Pat – Lymphedema People – http://www.lymphedemapeople.com


    — Pat O'Connor    May 14, 08:05 am   

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