Prevention of Cellulitis in Lymphoedema
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Prevention of Cellulitis
Now you have been diagnosed with lymphoedema. It doesn't matter whether it is primary or secondary, your next big battle is going to be dealing with infections (more commonly called cellulitis or lymphangitis).
It is true that no matter what you do, sometimes, these infections come out of no where. One day you are fine and the next day you are in the hospital.
Learn to listen to your body. If you start getting that "flu-like" achiness, running a low grade fever or have any unusual redness in the lymphoedema limb, pay attention. Getting on antibiotics early can spare you from that hospital visit.
Also, one very important rule of thumb is to always keep a supply of antibiotics on hand. When cellulitis attacks, you do not need to waste time waiting for the doctor to call in the prescription or waiting for the pharmacy to fill it. Prompt treatment is urgent.
But there are certain things that we can do that will lessen our chances of getting these nasty infections.
Here are a few tips I have picked up along the way. They may seem redundant, but every little thing we can do is going to help us.
Preventative Antibiotic Therapy
If you are particularly susceptible to infections, you may wish to discuss with your doctor about undertaking preventative antibiotic therapy.
There are a couple ways of doing this.
Either an oral antibiotic (I take 2 875mg augmentins every day.)
Or if you are not allergic to penicillin, you may well consider taking long acting penicillin injections. This worked wonderfully for me during the 1970's. Until my family allergy to penicillin raised its ugly head, this was perhaps the most successful therapy I have had in preventing cellulitis.
Remember one important point regarding cellulitis. With fibrosis
the bacteria is able to "hide" in pockets and may escape the antibiotic or the fibrosis will make it much more difficult for the
antibiotic to be effective. Doing all you can to prevent infections
Another important step in preventing cellulitis is in understand the concept of what is called Septic Foci. This is the concept that certain body areas are focal points of infection. These are locations within us that bacteria easily grow, and eventually spread throughout our system.
The principle area of such focus is the bowel, followed by teeth, gums, sinuses, throat, ulcers and any other areas wherein pockets of toxins and bacteria multiply.
Another major area would be dermal inflammations. Examples of this would be carbuncles, boils, and acne. Other areas that could become a host site (entry foci) would be wounds, cracks, scratches and fungal infections of the skin. That is why it is so absolutely important that we do all we can in preventing and/or treating these conditions with the appropriate medical care.
I would especially like to express my thanks and appreciation to
Prof. S. Jamal, Retired Professor of Plastic Surgery, and member of the Lymphology Society of India for suggesting a note on this topic.
Simple self-care techniques
Handwashing: Hand washing is the most important thing you can do to prevent infection. You should wash your hands several times every day. Soap and water cannot kill germs but they loosen the normal skin oil where germs live. Always wash your hands after you have been to the bathroom. You should also wash your hands every time you cough, sneeze, or blow your nose. Wash your hands before and after giving patient care to a family member. Always wash your hands before you prepare or eat food.
Bathing: Shower often. Make sure to wash between folds of your skin. You should bathe/shower every day to keep your body clean and to keep from getting an infection. If you work in a public place, outside, or with food or animals, you should bathe often. If you live in a warm humid climate - I would even recommend two showers a day.
Also, my rule of thumb is never use a towel, wash cloth twice. The little extra laundry is well worth the effort. Bacteria can build up quickly in a damp cloth.
Wash your hair regularly.
It is also very important to wash thoroughly the feet, between the toes, the groin area. These are prime bacteria breeding grounds.
Trim your finger and toenails once a week. Doing this after a bath or shower is often easier because the nail is softer. Tell your caregiver if you cannot see or reach your nails to trim them.
I also advise against going to "nail" salons. The has been an epidemic of nail infections from unsanitary tools.
Dental Care: Each family member should use his own toothbrush and drinking glass.
Infections in your mouth can be caused by food left on or between your teeth. Brush your teeth at least 2 times each day. It is best to do this in the morning and before bed. Gargle with mouthwash if you cannot brush after a meal.
Floss your teeth each time you brush. This helps to remove food from between your teeth.
Change the water in your denture cup every day if you have dentures.
It is very important to see your dentist at least once a year. Dental caregivers can give your teeth a deeper cleaning than you can. This prevents cavities and infections in your mouth.
If you have dental problems, take care of them as quickly as possible. Mouth infections can spread rapidly - even to the point of causing septicemia.
Housecleaning: Dust and vacuum your house every week. I know how difficult this can be with the pain and fatigue we experience with lymphoedema (some with lymphoedema and cancer).
Mop the kitchen and bathroom floor each week and when something is spilled. This includes all the nooks and crannies.
Wash trash containers with soap and water. Then spray the container with a disinfectant. Always use plastic garbage bags to help keep these clean.
Keep the inside of the refrigerator clean. Use soap and water to clean it about every month. Keep foods that can spoil in the refrigerator. Throw away food that is spoiled.
When using a cutting board, wash it with soap or put it in the dishwasher often. Always wash the cutting board carefully after you have put raw meats on it.
Use a cleaning product to clean the kitchen counter. Many germs can live on a kitchen counter if it is not kept clean. You would be amazed at the number of and types of germs that live on what appears to be a clean counter top.
If you use a sponge in the kitchen replace it every few days. Also, every time that dishwasher is run, throw the sponge in it. Sponges are another favorite breeding ground for bacteria.
Bathrooms absolutely must be kept clean. In the old days there was nothing like Comet, Ajax or Bon Ami cleaner. Now there are many excellent spray products that help make this job much easier.
When you clean, also clean shower heads and faucets too. You may also want to use latex (or alternative if you are allergic to latex) gloves while cleaning your bathroom and/or kitchen.
Clothing: A rule of thumb I use is never wear a piece of clothing twice without washing. It may still look lean, but again all clothing picks up bacteria. Also, clean sheets are a must! You may wish to change them every few days.
Shoes I use regularly an anti-fungal powder in my shoes. Not only does it help keep them smelling fresh but provides an extra added bit of protection from potentially catastrophic fungal infections.
Gardening and outdoor work: Always, always wear gloves when you are working outside. I love gardening and seeing my yard explode with flowers in the Spring and Summer. When I plant those little seedlings, I trade my regular gloves for latex gloves. Its easier to handle the little plants in those. Never ever dig around in the soil with your bare hands. (I have learned the hard way about this.)
Traveling: I always carry my bottle of disinfectant when traveling. I will not use a bathroom in a motel until I have disinfected it. You may also wish to carry your own set of sheets.
Skincare: It is absolutely imperative that you maintain excellent skin care. Any scratch, wound or rash must be dealt with immediately. Those of us with extensive stage 2 or 3 lymphedema have a double duty as our skin will get so dry and try to crack.
Use skin moistening creams and lotions to help with this.
Those wounds we all get that leak lymphorrea? Take care of them
immediately. Not only does the lymphorrea severely damage surrounding skin tissue, but the wound provides a welcome mat to bacterial infections.
Outdoors: Always when outdoors, use an insect repellant. A simple mosquito bite or flea bite can quickly send us to the hospital
Lakes, swimming pools, hot tubs: A very good rule of thumb is to stay away from these. Especially ones that are used by a number of people. The chlorine used in these does NOT always kill bacteria.
Nail Care: As mentioned earlier, the best time to trim your nails is after a bath when they are softer. Never allow yourself to get a hang nail. And for women, I strongly urge not using the stick on nails. These also provide a safe haven for bacteria.
Remember, we don't have to live in a cocoon. Nor do we have to live every minute in fear of a germ. But there are some very simple guidelines that will help keep us healthier and keep us out of the hospital.
Alcohol: Consumption of alcohol should be limited with people having lymphoedema. Your body can not metabolize alcohol and converts it into sugar. The sugar level then increases in your body system. It is this sugar that provides "food" for bacteria.
Prevention of Cellulitis
It is very important to keep your skin clean by practicing good personal hygiene.
If you notice pain or discomfort from an area of the skin, check to see what it looks like. If it appears inflamed and progresses from one day to the next, you will most likely need treatment.
Avoid situations that may injure your skin, especially if you have swelling from circulatory problems.
Wear sturdy, well-fitting shoes or slippers with loose-fitting cotton socks. Avoid walking barefoot in areas where you do not have a good idea about what you are walking on, for example, in garages, on a littered beach, or in the woods.
If you do injure your skin wash the area with soap and water and check to make sure that the injury is getting better over the next several days.
Certain injuries may be at greater risk for infection than others. You may need to take antibiotics to prevent infection or have other preventive care. Be sure to contact your doctor if you have injuries such as these:
Animal or human bites
Puncture injuries deeper than a half-inch, such as stepping on a nail
Crushed tissue that bleeds, burns that blister, frostbite, or deep injuries with dirt in them
Injuries in contact with sea water, especially if you have liver disease
Find out if you have diabetes or other significant medical conditions, such as liver or kidney disease. These conditions may be present without symptoms. Follow your doctor's instructions for improving these conditions.
Talk to your doctor if you have swelling in your limbs that does not go away.