The complexity of garment fitting: Does your garment fit well?

Therapist Perspective

The complexity of garment fitting:

Does your garment fit well?

By Katrin Schumann and Marie-Eve Letellier

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ou may have been diagnosed with lymphedema yesterday, post-cancer treatment or perhaps you’ve been living with it since you were born. No matter how long you’ve been living with your diagnosis, most patients will require a life-long commitment to compression garments.

Finding the right garment is like finding shoes that fit you perfectly: you may need to try on several before finding “the one.”

Your experience fitting a garment may be similar, although the fitter’s job is more challenging because to get the right fit, he or she must address lymphedema, a condition in which fluids can move around.

Whether you are new to lymphedema management or quite experienced, this article will educate you about your prescription, your fitter and your garment.

Your prescription Reimbursement for compression varies greatly from province to province and therefore the process for obtaining garments is also different. Please check with your doctor or therapist as to what is required for the compression prescription in your particular situation. As a reference, the following example of a prescription applies most directly to patients in Quebec.

Prescription components • Your complete name • Your diagnosis (e.g. primary lymphedema of the left leg, right arm lymphedema post breast cancer) • Type of compression fabric: custom-made or standard • Type of garment (e.g. sleeve and glove, stockings, pantyhose) • Compression class (e.g. 20-30 mmHg, 30-40 mmHg) • Accessories (e.g. rubber gloves, rubber pad, butler, on and off aid) • Physician signature with license Your fitter Expect to be asked a variety of questions before your fitter even takes your limb measurements. Here are some examples: •W hat is your general health situation?

•D o you have any help at home?

•W hat type of work do you do?

•W hat are your daily activities?

• What sports or exercises are you doing?

•W ere you satisfied with your last garment?

The fitter asks these questions to gather information about your general condition and any possible mobility restrictions. Your

Katrin Schumann, CDT is a registered massage therapist (specialized in complex decongestive therapy) and garment fitter. She is also a certified physiotherapist and CDT therapist in Germany. She received her certification as teacher of manual lymphatic drainage/complex decongestive therapy in 2007.

Marie-Eve Letellier, PhD has a degree in kinesiology and a PhD from McGill University in rehabilitation services. As a lymphedema therapist also trained in Aqua Lymphatic Therapy, she is combining clinical work and research at the Breast Clinic, Royal Victoria Hospital, Montreal.

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answers will also help in the choice of the best donning aid for you (e.g. rubber glove, butler, easy slide). In order to select the best compression garment fabric for you, the fitter will also inspect your skin (e.g. natural color of the skin, tourniquet marks from bandaging or the old garment).

To confirm your doctor’s prescription, the fitter should do a skin fold test, as the dimension of the swelling is not always visible, but may be discerned through touch.

In the eventuality that other symptoms and/ or your skin condition prove to be inappropriate for the actual prescription, your fitter will discuss suggested modifications with your lymphedema team: YOU, and your doctor and/or lymphedema therapist.

Your compression garment Next, the fitter will ask you to select your fabric color. Depending on the complexity of the order, the production of your garment will take some time as custom-made garments are manufactured either in Germany or the United States. While awaiting its arrival, it is important that you keep up your skin care routine, continue to bandage or wear your old garment, maintain your self-management routine (e.g. exercises, self-massage), or continue to receive partial therapy with your lymphedema therapist. Otherwise, the new garment may not fit, due to an increase in your limb volume since the initial measurement.

Any type of lymphedema can be fitted for compression garments, even difficult cases such as male or female genital lymphedema or facial lymphedema.

If you have arm lymphedema, you might also experience swelling at the top of your arm or at your shoulder girdle. A regular Summer 2018

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sleeve does not cover this area as it stops below your armpit. A solution could be a custom-made bolero. The bolero is made of a long sleeve and separate glove (if necessary) on the affected side and a short sleeve on the non-affected side. You must have good range of motion in your shoulder in order to put on this type of garment.

If you are experiencing breast and/or chest wall lymphedema, with or without arm lymphedema, this might be a challenge for both your lymphedema therapist and your garment fitter, as adequately compressing those areas can be difficult. If only breast lymphedema is present, a compression bra might be enough. For chest wall and/or breast lymphedema another solution might be a custom-made compression vest that will cover both the breast and the chest wall.

The length of the vest can be adapted and fitted to the area of the swelling and the size of the breast.

For leg lymphedema, your garment needs to cover the length of the swelling, which could

be from the toes up to your belly button.

Your fitter can inform you about different types of garments (e.g. pantyhose, capri-style stockings, thigh high garment with shorts, etc.).

If you are experiencing abdominal swelling, a good garment solution might be the use of suspenders to prevent your pantyhose, capri pants or shorts from slipping down.

When your garment is ready, your fitter should help you to put the new garment on and will explain the proper fit: i.e., the position of the seam (if custom-made) and of the darts (special marks for elbow, knee and heel). However, it is suggested you remove it and put it back on yourself in front of your fitter. This will ensure that you can apply it correctly on your own.

It is your responsibility to give feedback to the fitter in regards to how the compression feels and whether there is any discomfort. The

new garment will feel tight, but it should not cause constriction, such as numbness in your fingers/hand or toes/foot. Common situations where the garment must be returned and the affected part re-measured are: 1) the garment is too tight, and you are experiencing numbness in your limb, 2) your garment is too loose, and it keeps sliding down, 3) the length is too long or short. Each custom-made garment comes with a manufacturer’s warranty.

It is important to ask your fitter about the return policy every time that you pick up a new garment, in case you require adjustments.

Measuring is an art and it is important for you to find the right “artist”. You need to be comfortable and confident with your garment fitter. Make sure that your garment fits properly as you must wear it every day. Don’t forget that your body will change over time, so your garment should too! LP

cutting-edge science The future of medical graduated compression is here.

With LympheDIVAs you can experience custom-fit in an off-the-shelf garment. Using advanced science LympheDIVAs utilizes a patient's measurements to provide approximate medical graduated compression at each measuring point in any of our three sizes and two levels of compression.

ultimate comfort & fit If patients aren’t wearing their compression garments, then they aren’t benefiting from their therapeutic properties. With this in mind, LympheDIVAs has created garments that are more comfortable to wear. All LympheDIVAs products are 100% seamless, breathable, moisture wicking, lightweight, have 4-way stretch and a soft & silky feel.

unique & exclusive art LympheDIVAs offers a vast and unique collection of designs.

Each Spring and Fall LympheDIVAs introduces new and fresh art, conceptualized and created specifically with the customer in mind.

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