LYMPHEDEMA PREVENTION OF CELLULITIS

Prevention of Cellulitis

Now you have been diagnosed with lymphedema. 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 lymphedema 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.

Remember, the best treatment is preventative treatment. Every time we get cellulitis, there is scarring of the lymphatics and as a result a worsening of our lymphedema. There are also serious complications that can also arise from the infection itself, these include:

Sepsis (Septicemia) (Septic shock) - Bacteremia - Gangrene - Meningitis

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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 is critical.

For those of us with lymphedema, who are also exceptionally susceptible to cellulitis, I strongly recommend being under the care of an infectious disease doctor.

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SEPTIC FOCI

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, impetigo acne and other superficial abscess. 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.

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Pets

A word of caution also as regards our family pets. We love them and they are an important part of our family, but we can also get infections from them. Many, many cats carry a bacteria called Bartonella henselae which causes cat scratch fever.

What is cat scratch fever?

It is a bacterial disease caused by Bartonella henselae. Most people with CSD have been bitten or scratched by a cat and developed a mild infection at the point of injury. Lymph nodes, especially those around the head, neck, and upper limbs, become swollen. Additionally, a person with CSD may experience fever, headache, fatigue, and a poor appetite. Rare complications of B. henselae infection are bacillary angiomatosis and Parinaud's oculolandular syndrome.

It is contracted from either a scratch or bite, so please, be careful when playing with kitty. It is interesting that one of the oldest archived articles I ran across in PubMed was on secondary lymphedema as a result of cat scratch fever.

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Hot Tubs

Hot tubs also present a problem for those of us with lymphedema. I again urge caution in using hot tubs. Infact, ifyou are especially susceptible to infections as I am, you probably want to consider not ever using one. There is a common form of folliculitis that you can get from them.

This is a superficial skin infection usually caused by Pseudomonas aeruginosa. Pseudomonas survives in hot tubs, especially hot tubs made of wood, unless the water's acid and chlorine levels are strictly controlled.

Symptoms include:

History of using hot tub within previous 3 days
Itchy, bumpy, red rash appearing within 2 days of hot tub exposure
Bumps developing into dark red tender nodules
Bumps developing small pustules (pus-filled blisters)
Multiple members of family or party with same rash and same hot tub exposure

Treatment includes antibiotics, and anti-itch medications. However, since this is a "gram-negative" infections it can be quite difficult to eradicate.

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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.

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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.

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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.
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Housecleaning: Dust and vacuum your house every week. I know how difficult this can be with the pain and fatigue we experience with lymphedema (some with lymphedema 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.

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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.

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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.)

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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.

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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.
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Outdoors: Always when outdoors, use an insect repellant. A simple mosquito bite or flea bite can quickly send us to the hospital

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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.
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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.

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Alcohol: Consumption of alcohol should be limited with people having lymphedema. 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.

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Basic Lifestyle Tips

Wash your hands often, with warm, soapy water. Be sure to wash for 15 to 20 seconds each time you do it (about the time it takes to sing "Happy Birthday"). Ensure that your food handlers also wash their hands.

Watch what you eat and drink in foreign countries. Find out before you travel whether the water in your destination country is safe for tourists to drink. If not, use only bottled or boiled water for drinking, brushing your teeth, preparing infant formula, and rinsing off fresh fruits and vegetables that you want to eat raw. Peel those fruits and vegetables yourself after washing and before eating. Avoid salads and other uncooked vegetables if you don't know the source of the water used to wash the produce. Also, avoid unpasteurized milk and milk products such as cheese. For prepared meals, eat only food that has been cooked thoroughly and is still hot. When flying with local air carriers, drink water on the plane only if it comes bottled. And remember that if the water in a country isn't safe, neither is the ice. The U.S. Department of State (www.state.gov) and the Centers for Disease Control and Prevention (www.cdc.gov) both offer food safety information for Americans traveling abroad.

Practice a healthy lifestyle, including a good diet; regular exercise; adequate sleep; avoidance of tobacco, illegal drugs, and excess alcohol; and avoidance of behaviors that raise the risk of infection, such as multiple sex partners or unprotected sex.

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Prevention of Cellulitis

eMedicine Health

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.

http://www.emedicinehealth.com/articles/19926-7.asp

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How To Clean a Skin Wound

Proper cleaning and treatment of a superficial wound is a critical step in preventing not only cellulitis, but other possible bacterial infections as well.

Date updated: June 30, 2006
Sydney Youngerman-Cole, RN, BSN, RNC
Content provided by Healthwise

Skin wounds need thorough cleaning to reduce the risk of infection and scarring and to promote healing. Try to stop the bleeding before cleaning the wound. Mild to moderate bleeding during the cleaning usually occurs. After cleaning, stop the bleeding by applying direct pressure again and elevating the wound.

A visit to a health professional is needed if you are unable to clean the wound adequately because it:

Covers a large area.
Has injured many layers of tissue, creating a deep wound.
Is too painful to clean.
Has dirt, debris, or a foreign object you cannot remove.

Before cleaning the wound

Wash your hands well with soap and water, if available.
Put on medical gloves before cleaning the wound, if available.
Let the injured person clean his or her own wound, if possible.
Use your bare hands to clean the wound only as a last resort.

Rinse the wound

If you are not going to see your health professional immediately, rinse the wound for at least 5 to 10 minutes:

Use a large amount of water under moderate pressure (faucet at least halfway open). Cool water may feel better than hot water on a wound. Washing the wound will remove as much dirt, debris, and bacteria as possible which will reduce the risk for infection.
If you have a water sprayer in your kitchen sink, try using the sprayer to wash the wound. This usually removes most of the dirt and other objects from the wound. Avoid getting any spray from the wound into your eyes.

Large, deep, or very dirty wounds

Large, deep, or very dirty wounds may need to be evaluated by a health professional for a thorough cleaning and evaluation for stitches or antibiotic treatment.
If you are going to see a health professional immediately, the wound can be cleaned and treated at the medical facility.

Minor wounds can be cleaned at home

For mild bleeding, clean the wound first and then stop the bleeding.
Remove large pieces of dirt or other debris from the wound with cleaned tweezers. Do not push the tweezers deeply into the wound.
Wash the wound with a large amount of water to remove all the dirt, debris, and bacteria from the wound. Cool water and mild soap, such as Ivory dishwashing soap, are the best. (Note: If you are cleaning a wound near the eye, do not get soap products in the eye.)
- Hold the wound under cool running tap water; the more water, the better.
- Scrub gently with water, soap, and a washcloth. (Moderate scrubbing may be needed if the wound is very dirty.) Hard scrubbing may actually cause more damage to the tissue and increase the chance of infection. Scrubbing the wound will probably hurt and may increase bleeding, but it is necessary to clean the wound thoroughly.
- If you have a water sprayer in your kitchen sink, try using the sprayer to wash the wound. This usually removes most of the dirt and other objects from the wound. Avoid getting any spray from the wound into your eyes.
- Large minor dirty wounds may be easier to clean in the shower.
If some dirt or other debris remains in the wound, repeat the cleaning process:
- Try to remove the debris with clean tweezers.
- Scrub again with a washcloth.
If the wound starts to bleed, apply steady direct pressure to stop the bleeding.

Revolution Health

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Related Lymphedema People Medical Blogs and Pages:

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Antibiotics

http://antibioticinformation.blogspot.com/

Antibiotic Glossary

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=34

Antibiotic Therapy, Types of Antibiotics

http://www.lymphedemapeople.com/thesite/lymphedema_antibiotics.htm

Bacterial Infections

http://bacteriainfections.blogspot.com

Boils

http://www.lymphedemapeople.com/thesite/lymphedema_carbuncles_boils.htm

Carbuncles

http://www.lymphedemapeople.com/thesite/lymphedema_carbuncles.html

Cat Scratch Fever

http://www.lymphedemapeople.com/wiki/doku.php?id=cat_scratch_fever

Cellulitis

http://cellulitisinfections.blogspot.com/

Cellulitis

http://www.lymphedemapeople.com/thesite/lymphedema_cellulitis.htm

Complications of Cellulitis

http://www.lymphedemapeople.com/thesite/lymphedema_complications_celluli.htm

Erysipelas

http://www.lymphedemapeople.com/thesite/lymphedema_erysipelas.htm

Folliculitis

http://www.lymphedemapeople.com/thesite/lymphedema_folliculitis.htm

Impetigo

http://www.lymphedemapeople.com/wiki/doku.php?id=impetigo

Infectious Disease Doctor

http://www.lymphedemapeople.com/wiki/doku.php?id=infectious_disease_doctor

Lymphadenitis

http://www.lymphedemapeople.com/thesite/lymphedema_lymphadenitis.htm

Lymphangitis

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphangitis

MRSA Information Blog

http://mrsainformation.blogspot.com/

Methicillin Resistant Staphylococcus Aureus - MRSA

http://www.lymphedemapeople.com/thesite/MRSA_Methicillin_Resistant_Staphylococcus_Aureus.htm

Necrotizing Fasciitis

http://www.lymphedemapeople.com/thesite/lymphedema_and_necrotizing_fasciitis.htm

Preventing Hospital Infections

http://www.lymphedemapeople.com/wiki/doku.php?id=preventing_hospital_infections

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Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe:

AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

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For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

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Lymphedema People - Support Groups

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

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Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

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MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

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All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

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Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

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All About Lymphedema

For our Google fans, we have just created this online support group in Google Groups:

Homepage: http://groups-beta.google.com/group/All-About-Lymphedema

Group email: All-About-Lymphedema@googlegroups.com

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Lymphedema Friends

http://groups.aol.com/lymphedemafriend

If you an AOL fan and looking for a support group in AOL Groups, come and join us there.

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Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet? Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more. Come and take a stroll!

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema

Arm Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema

Leg Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema

Acute Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema

The Lymphedema Diet

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet