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Covid-19 HSE Clinical Guidance and Evidence

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Primary Care - Self-management advice for patients with pre-existing lymphoedema during the COVID-19 pandemic

Self-management advice for patients with pre-existing lymphoedema during the COVID-19 pandemic (CD19-157 / 30.04.20)


  • If you are currently being treated for lymphoedema, you may have difficulty accessing your therapist during the COVID-19 pandemic. This is in order to keep both patients and therapists safe from exposure. In addition, many therapists are being redeployed to other areas of the health services to assist in the effort to fight the virus.
  • For accurate and up to date information on coronavirus and COVID-19 please visit the HSE website https://www2.hse.ie/coronavirus/
  • Please be assured that in nearly all cases, living with lymphoedema does not make you more susceptible to the coronavirus. Please see our leaflet Lymphoedema, Lipoedema and COVID-19 for more information. This leaflet is intended to help you to manage your self-care during this time.
     
To help you to stay as healthy as possible during this time, we suggest that you follow the following advice

Compression Garments

It is probable that your therapist will not be able to see you to re-measure for your garments in a timely manner during this period. Therefore, we suggest that you take extra care of your garments to ensure they last as long as possible.

  • As always, we recommend that you wash your garments according to the manufacturer’s instructions.
  • If you have older garments, please hold onto these to see you over this period.
  • It may be possible to request a repeat of the last prescription from your GP without seeing your lymphoedema team/therapist.
  • Please remember that this advice may only be appropriate if you feel your limb(s) has not changed considerably in size/shape, and you have not developed any other health issues in that time.

Skin Care

Keeping your skin and tissues in good condition helps to prevent skin breakdown and reduces the risk of infections such as cellulitis. Follow the advice your therapist has given you, and remember that tips for keeping your skin healthy include:

  • Wash your skin daily with an emollient wash, don’t use soap or shower gels.
  • Pat dry gently using a clean towel, paying particular attention to any skin folds.
  • Continue to use the cream you usually use or a plain, non-scented emollient.
  • Monitor your skin carefully daily for signs of breaks, including between the toes.
  • Athlete’s foot or fungal infections can lead to skin breaks which can be an entry point for infection.
  • Wear well-fitting footwear.
  • Don’t walk around the house or garden in bare feet.
  • Take care to cover the affected limb if gardening, exercising etc., to prevent accidental skin damage from cuts, scratches or stings.
  • As for everyone, always wear sun protection if spending time outdoors, even under your garment.

What should I do if I get a scratch, cut or sting to my skin?

  • Clean the area carefully with an antiseptic and cover with a dressing.
  • Monitor the affected area for 24 hours.
  • If the skin becomes hot, red or swollen, you must contact your GP immediately, as you could develop cellulitis.

What is cellulitis?

  • People with lymphoedema are particularly susceptible to cellulitis.
  • Cellutlitis is an infection of the skin, which can lead to serious illness if left untreated
  • Learn how to recognise cellulitis infection:
    • Look out for redness, swelling and heat, with associated pain and tenderness.
    • Cellulitis may be accompanied by fever, nausea/vomiting and a feeling of generally being unwell.

What should I do if I develop Cellulitis?

  • Cellulitis should be considered a medical emergency - contact your GP immediately as you will likely need antibiotic treatment. If you become seriously ill, you may require admission to hospital for intravenous antibiotics.
  • If you have previously had cellulitis you may have been advised to keep oral antibiotics at home. If you suspect you have developed cellulitis please start taking the antibiotics but remember you MUST also seek medical advice.
  • If you have been diagnosed with cellulitis the following advice may be useful:
    • Compression garments may need to be removed for the first few days because of pain and/ or discomfort in the acute phase. They should be reintroduced as soon as you are able to tolerate them again, to prevent worsening of the swelling.
    • You may find that using a lower strength compression garment is easier to manage at first.           
    • Discontinue Simple Lymphatic Drainage (self-massage) and exercise until the infection has resolved.
    • Rest your leg/arm in a comfortable position.
    • Keep hydrated.
    • Take pain relief as advised by your doctor or community pharmacist.

Movement / Exercise

Movement / exercise is really important to keep your lymphoedema well controlled. Please keep up with your regular exercise routine. If your compression garments are worn out, putting some extra focus on exercise can be even more beneficial. Even if you are self-isolating or social distancing you can exercise indoors or take a walk as able/indicated. A well-balanced diet and proper hydration will also help you to maintain a healthy weight, which is really important for managing your lymphoedema.

  • Remember! - If possible, please seek advice from your therapist or GP before starting any new exercises
  • If you would like more ideas about what exercises may help your lymphoedema please visit the British Lymphology Society’s EveryBodyCan website at https://www.thebls.com/pages/everybodycan
  • NHS healthcare professionals and patients have worked with the Pocket Medic team to make a series of health information films for Lymphoedema, including skin care, SLD and exercises. You can access these films here http://www.medic.video/b-lymph

Manual Lymphatic Drainage/ Simple Lymphatic Drainage (self-massage)

  • If you have been taught how to perform simple lymphatic drainage (SLD) by your therapist, please continue to carry it out. The Pocket Medic website above also has videos to show you how to perform SLD and can be accessed at the link above.

Elevation

  • Some patients find that elevation helps with increased swelling, but the effect of this can be variable. If your swelling does increase, try resting on the bed in the afternoon if possible, to help drain the legs, or elevating the arm on a pillow when resting.
     
Online Resources

There are a number of reputable organisations where you can access further information. Please be careful to access information only from trusted organisations!

This information leaflet has been endorsed by the following organisations

  • The Health Service Executive (HSE)                                                                                          
  • The National Lymphoedema Framework Ireland (NLFI)                                  
  • Chartered Physiotherapists in Oncology and Palliative Care (CPOPC)
  • Irish Society of Chartered Physiotherapists (ISCP)
  • MLD Ireland
  • Lymphoedema Ireland

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