First Long Haul Trip

5 months after my surgery I took my first long haul flight.  The flight was approx 11.5 hours and was travelling to West Coast USA so to a hotter country than the UK.  

For the actual flight itself I wore: Solidea Arm Sleeves., some Marks & Spencer firm compression thigh shorts/pants and Sigvaris Comfort tights.

I took a bag with me to put on the floor as a footrest, so I could get some more comfortable elevation of my feet, rather than trying to keep them on the little footrest from the seat infront.  

I made sure I was in my compression from early in the day before I flew, so I was starting off with very little swelling - other than the arm sleeves which I forgot to put on and had to pull them on in the airplane loo!  I also kept the compression on at the other end until I got to my hotel when I removed my arm sleeves.  

In flight I did some walking and stretching but nothing exceptional, and just checked my compression for wrinkles/ensured it was staying in place from time to time.  

On arrival at my hotel I found my ankles were around 1-1.5 cms larger than normal.  This took a few days to go back down.  Do bear in mind that I did not have liposuction below the knees, so this could be a normal part of my lymphatic circulation and so doesn't mean this will happen to anyone else.  

I didn't have all my measurements with me so can't be quite sure if I was bigger all the way up my legs or not.  

I had no pain or discomfort.

I wore my compression garments daily, wearing a combination of the Sigvaris Comfort Class  2, Sigvaris Diaphane Class 3 (so the same mmHg as different class system) and Mediven Ellegance Class 2.  The Comfort were the coolest and most comfortable in the heat but the ellegance were OK too.  

The main thing I did that I think got my leg swelling down after 3-4 days was a daily pool session. I either went to an actual aqua class or did a session in the hotel pool so was doing around 45 mins to 1 hour a day.  I went to Walmart and purchased a couple of pool noodles for less than £5 and a childs inflatable ball to help me get a good solo workout.

I had travelled on business so in the office I elevated my lower legs on a chair wherever possible.  

Flying back to the UK again my lowers swelled up and took several days to reduce - again I was going to the pool as much as I could but not as easily as in the US.  

    

Week 4 - return to exercise

My first proper exercise other than walking since surgery was a gentle badminton practice on day 21.  I think my balance was better so I'm thinking that might be because my knees have had their inner fat pads removed, so are able to move better.  

I really enjoyed the exercise.  I've been feeling a bit looser in that I can pull my knees up higher (but not as high as they would naturally go pre-surgery as the backs of my thighs feel tight and a painful pulling sensation as I get my knee high towards my chest).  I'm also able to lie on both sides but it still feels tender lying on them - no surface bruising but they still feel sore when I put weight or pressure on them.  

I've been a bit more tender this week.  I don't know if it is being back at work every day, driving, moving around, or just natural healing.  I've also been really tired in the evenings so am happy about the public holidays this weekend - but not about the clocks changing and stealing an hour of my sleep!

I followed up the success of badminton by going bowling - the surgery hasn't improved my game!  Although my outer thigh became tender from my arm repeatedly rubbing against it with the ball in hand, I didn't need any pain relief and was fine in the car afterwards.  

The day after bowling I felt really stiff walking around, but so did my hub so maybe we are just getting a bit old!  The back of his thighs hurt too so I'm thinking it might be unfamiliar form of exercise rather than my surgery!

Week 3 day 15 - 18

Today during my MLD I pointed out that I'm developing a hard lump in one inner thigh.  My therapist then found a smaller lump on the other side, slightly further round.  I blamed the groin edge of my garment for causing it, as the groin is open so I have elastic seamed edges that can drift a little down my inner thighs.  

She worked on the lump by hand, sort of kneading at it and said that made it softer.  It hurt when she did it but I don't want a visible lump or a lump I can feel that may be a future problem so I'm happy to take the pain of being kneaded.  

I could see the lump - well a dimple next to it - on my inner thigh, so I sent an email to Hanse checking up on it, plus my feedback that I'm still slightly dripping after a shower from my stubborn left knee incision.  It is the tiniest amount of leakage but frustrating to find I can dab my knee with gauze after a shower and see a bead of red liquid.  

Dr  Baumgartner emailed me back to say I'm looking good, it's all normal and that I can apply a new strip to that knee, pulling the incision together a bit tighter when I apply the strip to encourage it to heal.  Hub and I didn't understand we could pull the edges like that - feel a bit daft as we wanted to, but thought we shouldn't!

Bruising is looking better, but still present.

By my second MLD of the week my thigh lumps were definitely softer and smaller.  The massaging of them really helped.  It wasn't as painful having them massaged the second time.  

I also removed strips from the dry incisions (after the photos were taken), following Dr Baumgartner's reassurance.  Can't wait for the knee to heal so I can lose the last one!

End of week photos... drumroll...

  

 

Compression

I was already wearing compression before I had my surgery, and I expect to wear compression afterwards, for the rest of my life (as medical science/technology currently stands).  

Hanse-Klinik generally recommend that you wear compression after your surgery for 24 hours a day (other than washing it and you) and then in the daytime only for the next 3 weeks.  This means that one month post surgery they believe you would be able to stop wearing compression - and keep it off provided you don't see changes or feel better for wearing it.  

In my case, my lymphoscintigram results (I had the test pre-surgery as part of my NHS lipodema care) indicated that my legs were already not functioning as effectively as the average person.  They were slower, or more sluggish, at circulating my lymph fluid.  They were not so slow that surgery was advised against, and there were no clinical signs of lymphodema (I am still symmetrical so neither leg is visibly that much bigger than the other, and I am negative for the Stemmer sign - which is described about half way down this page).  They indicated that I was more likely to have lymphodema or lipolymphedema than just lipodema, but it isn't possible to say whether I was born this way or whether my lipodema has already affected my lymphatic functioning.  

Because this impaired lymph circulation places me at higher risk of lympodema, St George's (where I have my NHS care) want me to continue with wearing compression, regardless of how I look or feel after surgery.  I definitely have to do this whilst awake - the question is whether I'm safe to sleep without it or not.  Opinions vary so for now I'm taking Professor Schmeller's advice and trying a few nights without it.  

Compression classes mean different things depending on where you live.  The compression measurement is taken from the ankle in leg garments and the compression reduces from that point up the leg, to encourage flow up to the lymph nodes and reduce pooling.  Compression is measured in mmHg or millimetres of mercury.  

The differences mean that a UK class 2 equates to an EU/RAL class 1.  

The following information is taken from Daylong (an online seller of compression garments by private and NHS prescription):

                                          UK Class 1 14 - 17 mmHg
EU Class 1 18 - 21 mmHg,UK Class 2 18 - 24 mmHg US Class 1 15 - 20 mmHg
EU Class 2 23 - 32 mmHg UK Class 3 25 - 35 mmHg US Class 2 20 - 30 mmHg
EU Class 3 34 - 46 mmHg                                           US Class 3 30 - 40 mmHg

Source: Daylong 

MLD (Manual Lymphatic Drainage) and SLD (Self Lymphatic Drainage)

You'll need to find a therapist to give you manual lymphatic drainage massages (MLD) for around a month after surgery.  I'm going twice a week as recommended by Professor Schmeller and wish he'd recommended three times as it feels so good!

I went to see an MLD practitioner before surgery and had a couple of massages, to ensure I liked her and would want to have post surgery treatment with her.  I also figured having a well drained lymph system pre-surgery sounded a good idea, so I had one close to my trip to Hanse.

There are official qualifications in MLD.  Vodder training is most common in the UK I think (and the one that Professor Schmeller was happy my lady has).  Lymphatic specialists are DLT (decongestive lymphatic therapy) Members of the MLD UK body.  The MLD UK website has a page where you can find a local therapist and filter to Member DLT only.  

Professor Schmeller recommended I waited a week to settle before starting massages so I would book at least that date in with your therapist/check the notice they need to organise your appointments. 

My massages cost £55 each and last around 1 hour.  The therapist is paying particular attention to my bruises and I was amazed that in the first session she gave some effort to my big cannula bruise in my hand and it vanished very soon afterwards!  I think the MLD is really helping speed up my healing and it feels great :)

I also asked if she would teach me some SLD techniques as I was given a handout by St George's at my first NHS appointment with them and told that it is a good thing to do to yourself, but I feel it is hard to learn a self massage technique from a sheet of paper.  My therapist is happy to work through it with me so I become competent.  It might have been good to do that before going for surgery.