HOLIDAYS AND TRAVEL FOR PEOPLE WITH LYMPHOEDEMA
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HOLIDAYS AND TRAVEL
FOR PEOPLE WITH
LYMPHOEDEMA
This information has been produced and verified by accepted experts in
their field. It reflects current best practice and evidence based research
where appropriate. It has been designed to assist you in managing your
condition and is not intended to replace advice you may receive from
your healthcare practitioner. If you or your healthcare practitioner
would like to ask any questions or require details of the research used
to develop this information, please contact the Lymphoedema Support
Network on 020 7351 4480.
Some people who suffer from lymphoedema are very worried about going away
on holiday, but with a little thought and preparation before travelling, there is no
reason why you should not have a wonderful, carefree and relaxing time. Careful
planning is the key and the following guide has been put together to help you.
Vaccinations and holiday medications
Check to see if you require vaccinations before your holiday (your practice nurse
will be able to tell you) and allow plenty of time to have them before your
departure. Do not have them in your affected limb and if several are needed, try to
space them out over a period of time.
Before leaving for your holiday, especially if you are going abroad, check that you
have enough medication and prescription drugs for any other medical conditions (if
you need them) and always carry the prescription sheet with you as foreign officers
may want to check.
THE LYMPHOEDEMA SUPPORT NETWORK Page 1Holidays and travel for people with lymphoedema fact sheet
You may also want to pack a small travel kit especially for your swollen limb. Think
about the following:
n Antibiotics: All patients suffering from lymphoedema have a significantly
increased risk of infection in the affected area, and certainly for those people
who have suffered from infection (cellulitis) before, it would be best if you had
a course of antibiotics with you ‘just in case’ you require them. Some GPs are
very happy to provide them; others will be more reluctant. However, if you
explain the situation and give him/her the LSN fact sheets (see below), then
they may be willing to help. This precaution is especially important if you are
travelling to areas that have increased risk of disease e.g. tropical regions. When
on holiday, treat any injury/trauma (cut, scratch, or bite) on the affected limb
with antiseptic. If you develop an infection seek medical assistance immediately
(or start to take the antibiotics, if you have them with you, as soon as possible).
Signs of infection are ’flu’-like symptoms, high temperature, headache, redness/
heat of the affected limb, increased swelling, localised tenderness and even pain.
You may experience any or all of these.
Always check the expiry date of antibiotics on a regular basis, especially if you
have had some in the house for some time before travelling.
For more information, see the LSN fact sheets, ‘What is Cellulitis’ and
‘Management of Cellulitis in Lymphoedema’.
n Good quality sun block (as high as possible e.g. SPF 50-60).
n Insect repellent spray or cream. Many of these products contain toxic chemicals
– speak with your pharmacist to find the best product for you. A repellent
containing at least 50% DEET is required.
n Products to counteract skin irritation from bites – or an old fashioned remedy
such as calamine. Anti-histamine tablets may also prove useful to counteract the
effects of bites/stings etc.
n Anti-fungal powder in case you develop Athlete’s Foot or other fungal infections.
Alternatively, tea tree oil is recommended, diluted and used as a prevention.
n Antiseptic lotion or ointments (Savlon or TCP) to treat any cuts, scratches or
bites.
• Good quality adhesive dressings with antiseptic fabric incorporated into the
product. Cheaper brands and those bought abroad do not always contain this.
Ensure that you are not allergic to Elastoplast!
Always carry your medicinal travel kit in your hand luggage – you never
know when suitcases may be lost!
Flying
There is a lot of conflicting advice about flying for people who suffer from
lymphoedema (and those who are at risk of developing it) – particularly in relation
to the fluctuation of cabin pressure. However, as yet, there is no real evidence to
support what is right or wrong and until we have that, then our best judgement
and a common sense approach should prevail.
THE LYMPHOEDEMA SUPPORT NETWORK Page 2Holidays and travel for people with lymphoedema fact sheet
Long flights with extended periods of inactivity can have an adverse effect on
anyone with lymphoedema. The lymph fluid has a tendency to collect in areas
affected by gravity (hands/lower limbs) and from a lack of movement.
Airlines can be very helpful, but do not expect them to perform miracles for your
comfort at the last minute, so prepare your journey well. The following information
may prove helpful:
n If you are able to obtain Manual Lymphatic Drainage (MLD) therapy, then a
session just before you travel or on arrival at your destination and upon your
return can be beneficial.
n Try to reserve seats on the outward and return journey well in advance and,
if possible, request a seat with plenty of room. Ideally this could be an aisle or
bulkhead seat.
n A doctor’s certificate is useful to have with you to request a particular seat (you
may have to pay privately for this) and don’t forget your medical insurance
papers or NHS European Health Insurance Card for Europe.
n Never take chances. Even if your limb is under good control, always wear your
usual compression garment a few hours before take-off, during the flight and for
some hours afterwards, to ensure your limb can normalise any tissue pressures
that may have been affected by the flight. Don’t forget the gloves, finger mittens
or toe caps if you wear them. If your lymphoedema is severe, wear a second
compression garment or bandage on top as an extra support on a long flight.
Do not wear a sleeve that only goes to the wrist as the hand is likely to swell.
Consult your lymphoedema practitioner for advice.
n• Wear loose underwear and clothing. Do not wear tight belts. Remember,
watches, bracelets and rings should never leave indentations or red marks on
the skin.
n If you have lower limb lymphoedema, wear well-fitting shoes which provide
good support. Do not remove them during the flight as swelling could increase.
n Make sure your seat-belt is loosened when seated, but stretch and move around
as frequently as possible. Massage appropriate lymph gland areas as instructed
for Simple Lymphatic Drainage (SLD).
n Try to do some simple exercises and include breathing exercises. Get up and
walk around when permitted. Most long-haul flights provide a series of in-flight
exercises for you to perform. These are helpful to prevent joint/muscle stiffness
and will also help to stimulate lymphatic/venous drainage, preventing the
pooling of fluid that can occur. Alternatively, ask your lymphoedema practitioner
for a set of simple exercises you can perform whilst in the air. Don’t forget to
wear your compression garment whilst performing the exercise!
n Drink lots of water! Remember that alcohol is dehydrating and even more so at
30,000 feet, so limit intake or better still avoid altogether!
THE LYMPHOEDEMA SUPPORT NETWORK Page 3Holidays and travel for people with lymphoedema fact sheet
n Use cooling and refreshing body/facial sprays to prevent you becoming hot and
sticky.
n Try and keep your hand luggage as light as possible. Don’t carry heavy cases or
remove your case from the luggage carousel at the airport with your affected arm.
Try and use luggage that has wheels, so that it does not have to be carried/lifted.
n Do try and break the journey with a stopover if the flight is very long.
n As soon as possible on arrival, do some breathing and limb exercises. If MLD is
available, treat yourself to a session. Alternatively, perform SLD to encourage
lymphatic drainage.
n Have a short rest and then enjoy yourself!
Car and bus travel
Once again, it is vital to wear your compression garment for any mode of transport
that will mean you are inactive for long periods of time. Try to plan regular stops so
that you can take a walk and exercise your limbs – however irritating this may be for
the driver! Whenever possible, try and get a seat with plenty of leg room and space
to extend the limbs as much as possible. Remember that sitting for long periods in
a cramped position is very bad for someone with lymphoedema. However, even
when in a confined space, it’s still possible to move fingers or feet, helping general
circulation and lymph flow.
Remember, that if you have lymphoedema, you must keep on the move.
While on holiday
n Avoid sunburn. Use a good quality sun block (as high as possible e.g. SPF
50–60)) and keep the affected limb(s) covered when on the beach. Don’t forget
you can still burn through compression garments, particularly synthetic ones.
Your lymphoedema practitioner can advise you on which garments will offer the
most sun protection.
n Protect against insect bites by using a repellent spray or cream when going
out, particularly at dusk or at night (see section above). If bitten, don’t scratch
the bite as this might open up the skin. Use a commercial product to stop the
irritation or take an anti-histamine tablet.
n If you have lower limb lymphoedema, remember to use an anti-fungal treatment
between the toes even as a precautionary measure. Tea tree oil (in the bath or
20% strength directly onto the skin) can also be used as prevention.
n With lymphoedema of the leg, wear sandals to protect the feet from injury (soft
‘jelly’ shoes are perfect). Avoid walking barefoot whenever possible.
n Be extra diligent with skin hygiene. Follow the skin regimen recommended
by your lymphoedema practitioner, applying moisturising cream/lotion at
least once a day (night time is preferable) and particularly between the toes.
Increase if the skin becomes drier in the warmer weather. When putting on
your stocking/sleeve, it can be useful to use some powder first to help put the
garment on more easily (or use an applicator).
THE LYMPHOEDEMA SUPPORT NETWORK Page 4Holidays and travel for people with lymphoedema fact sheet
n Check your compression garments carefully before you go on holiday. In
hot weather, it is important to have a garment that is providing the right
compression. If you are feeling too hot in your garment, dampen it with water,
but do not leave it off. Keep a spare garment in the fridge (protected by a
plastic bag) – this will keep it cool and may offer comfort to your limb when the
temperatures outside become too high.
n Cool down your arm or leg by taking a cool shower. Alternatively, cover with
loose, white or light coloured clothing or a cotton towel whilst travelling or sitting
out in the sun. Also see the section on clothing tips.
n Take care when swimming or paddling in the sea, or walking on the sand;
protect swollen feet with swim shoes to avoid trauma.
n Observe the skin regularly for signs of infection and treat any cuts, scratches and
bites promptly with an antiseptic such as Savlon or TCP.
n Wash the skin after you have been swimming in the sea/pool. This will take away
chemicals from the pool and salt from the sea. Ensure the skin is dried carefully.
Apply more sunscreen after swimming.
n When exfoliating for your holiday, never be tempted to have the limb waxed or
use a wet shaver. Always use an electric shaver to remove unwanted hair.
Exercise continues to play an important role during your holidays – though it may
seem more difficult to do when the weather is especially warm. Try and exercise
in the coolest part of the day – either early morning or late evening and always
wear your compression garment in whatever exercise you do. However, it is not as
necessary to wear garments when swimming, as the water provides the same sort of
support as garments. Water also provides resistance to movement which makes the
muscles work harder – so swimming/exercise in water is especially good for people
with lymphoedema. Swimming, or exercises in water are excellent activities in the
hot weather and the water will generally keep you cooler. Even if you are unable to
swim, think about gentle water aerobics as an alternative. Avoid strenuous exercise
that involves a constant motion or vigorous repetitive movements, unless you are
well-accustomed to it. Scuba diving, walking, T’ai Chi and Yoga are all good exercise,
but do not over-tire the limb(s). If your affected limb starts to ache, lie down and
elevate it. If you are walking, keep the affected arm supported with your hand in
your pocket.
Clothing
Compression garments can be extremely hot to wear at the best of times, not least
in the summer. Even the flat knit variety (which are slightly more comfortable) trap
normal body fluids/sweat between the skin and the garment, causing build up of
heat.
Clothing should be light, loose and non-constricting, especially around the waist,
under the breasts, and at the wrists/ankles/axillae. Loose cotton material is best, as
this will allow movement of air between the garment and the clothes, the cotton
will absorb any sweat that is allowed to pass through.
THE LYMPHOEDEMA SUPPORT NETWORK Page 5Holidays and travel for people with lymphoedema fact sheet White or light coloured clothing is also recommended, as this reflects the sun’s rays and keeps you cooler; black or dark coloured clothes retain the heat and make you feel hotter. If sweating under your compression garments is a tremendous problem, the use of technically advanced outdoor wear can be recommended – these contain a type of absorbent wick in the lightweight fabric, absorbing excess moisture and keeping you cooler. Such items of clothing may be purchased from specialist outdoor wear manufacturers like ‘Lowe alpine’ and ‘Patagonia’, amongst others. Finally, anyone going on holiday abroad is recommended to take out travel insurance – people suffering from lymphoedema are no exception. Many options are available and it is best to shop around to get the best possible package for you. Holidays and travel may prove daunting for lymphoedema patients – particularly if you are newly diagnosed. However, by following the above advice, you can relax and enjoy your time away from home, confident that you have prepared for every eventuality. Happy holidays! Contributors Denise Hardy, Clinical Nurse Specialist – Lymphoedema, Kendal Lymphology Centre, Cumbria LSN Nurse Advisor. 1, 2 Professor Peter S. Mortimer, Consultant Dermatologist at the Royal Marsden and St. George’s Hospitals, London. 1, 2 Dr. Judith Casley-Smith, Chairman, Lymphoedema Association of Australia. 1 LSN Trustees. 1, 2 1. Member of original contributors’ panel 2. Member of 04/2012 contributors’ review panel This information was revised in 04/2012. It will next be reviewed in 04/2014 or before, should the LSN become aware of significant changes in practice. THE LYMPHOEDEMA SUPPORT NETWORK Page 6
Holidays and travel for people with lymphoedema fact sheet LYMPHOEDEMA IS THE SWELLING OF THE LIMBS AND BODY DUE TO THE ACCUMULATION OF LYMPH. Lymphoedema affects at least 100,000 men, women and children in the UK causing swelling of the limbs or body and an increased risk of infection (cellulitis). However, it remains an underestimated health problem and is little known or understood by many medical practitioners. The Lymphatic System Lymph is a colourless fluid which forms in the body. It normally drains back into the blood circulation through a network of vessels and nodes. Lymph nodes act as filter stations and they play an important part in the body’s defence against infection, by removing excess protein, cells (which may include cancer cells) and micro- organisms. Why does lymphoedema occur? If the drainage routes through the lymphatic system become blocked or damaged, lymph accumulates in the tissues and swelling (oedema) occurs. Unlike other oedemas, lymphoedema leads to changes in the tissues such as fibrosis (hardness) and an increased risk of infection. The swelling can then become even more difficult to control. Primary and Secondary Lymphoedema Primary Lymphoedema develops as a result of a fault within the lymphatic system itself - usually as a result of genetic underdevelopment or weakness of the lymph conducting pathways. It can affect children and men or women at any age. Secondary Lymphoedema is the result of damage to lymphatic pathways. This maybe the result of treatment for cancer following surgery or radiotherapy. It can also occur as a result of infection, severe injury, burns, or any other trauma that can damage the lymphatic nodes/vessels. It can also arise as a result of the venous system not working efficiently (i.e. those who have had a deep vein thrombosis (DVT), varicose veins or varicose ulcers). Those patients suffering from lack of muscle movement (i.e. those suffering from a stroke or Multiple Sclerosis) may also be at risk. EARLY DIAGNOSIS AND EARLY TREATMENT ARE VITAL TO CONTROL LYMPHOEDEMA. Become a member of the LSN – see next page. THE LYMPHOEDEMA SUPPORT NETWORK Page 7
Holidays and travel for people with lymphoedema fact sheet
The LSN is a registered charity founded in 1991. It provides vital information and
support for people with lymphoedema, while working towards the availability of
better national resources for lymphoedema treatment.
What the LSN offers to members:
n Telephone information and support line
n Quarterly newsletters containing current information on lymphoedema, research
and treatment
n A wide range of ‘gold standard’ fact sheets
n A frequently updated website
n Self-help DVDs
n School packs
The LSN relies solely on membership subscriptions and donations. Please help us to
continue our vital work by becoming a member and/or making a donation.
APPLICATION FOR MEMBERSHIP
Mr, Mrs, Miss, Ms. surname_________________________________________________
First names______________________________________________________________
Address_________________________________________________________________
_______________________________________________________________________
________________________________________ Post Code______________________
Telephone (Home)_ ______________________________________________________
(Work)_ ______________________________________________________
I have Lymphoedema
I am a Health Care Professional
Other (please specify)_ ______________________________________________
I would like to join the LSN and enclose a
cheque made payable to the LSN for __________________
Annual UK subscription £15.00
Annual overseas subscription £30.00
Donation to support the work of the LSN of __________
Total __________
Please send to:
The Lymphoedema Support Network
St Luke’s Crypt, Sydney Street, London SW3 6NH
THE LYMPHOEDEMA SUPPORT NETWORK Page 8Holidays and travel for people with lymphoedema fact sheet
Fact sheets available:
Breast and truncal oedema
Coping with lymphoedema following a mastectomy or lumpectomy
The management of cellulitis in lymphoedema
Recreational exercise with lymphoedema
Manual Lymphatic Drainage for people with lymphoedema
Skin care for people with lymphoedema
The use of compression garments in lymphoedema management
Prevention of lower limb lymphoedema
Reducing the risk of upper limb lymphoedema
For information and help, please contact
The Lymphoedema Support Network
St Luke’s Crypt, Sydney Street, London SW3 6NH
Telephone: 020 7351 4480 (Information and Support)
020 7351 0990 (Administration)
Facsimile: 020 7349 9809
e-mail: adminlsn@lymphoedema.freeserve.co.uk
Website: www.lymphoedema.org
Registered Charity No. 1018749
Patron Zoë Wanamaker CBE
THE LYMPHOEDEMA
SUPPORT NETWORK
LSN 04/2012
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