I FOUND MY LYMPHEDEMA THERAPIST – NOW WHAT?
As I discussed in my last post, sometimes it is difficult to find a lymphedema therapist. However, once you have found a therapist, what exactly can you expect from your lymphedema treatment program? Of course, all therapists are individuals and not all therapists practice the same way. However, there are a few things to look for to ensure you are getting good lymphedema therapy.
WHAT TO EXPECT AT YOUR LYMPHEDEMA TREATMENT
In general, your overall treatment of your lymphedema will begin with an evaluation. Your therapist will not only measure limb volume, but also will identify functional goals and limitations. Your therapist will then come up with a treatment program for your complete decongestive therapy (CDT). This will include manual lymphatic drainage (MLD), multi-layer compression bandaging, compression garments, therapeutic exercises and self care. Some therapists may also use pneumatic pumps, Kinesio tape and aquatic therapy.
EVALUATION OF YOUR LYMPHEDEMA
Starting with the evaluation and throughout your lymphedema treatment, you want to be as involved as your therapist. Lymphedema is a chronic disease and the more informed you are, the better you will be able to maintain and control your disease. Likewise, the more you inform your therapist about your medical history, the better able they will be to assist you in your treatment and healing.
YOUR TREATMENT PLAN
Once your therapist has completed the evaluation, she will come up with a treatment program for your Complete Decongestive Therapy (CDT). Linda Roherty PT, CLT-LANA notes that, “In Germany, it is five days a week. Yes, that model can be adopted in the USA. Four to five times a week for two to three weeks for an uncomplicated limb, then three times a week for two weeks.”
Different clinics and therapists may recommend different schedules, but studies have shown that scheduling the appointments this way is the most effective. Linda Hodgkins, MS OTR/L CLT-LANA, gave a keynote speech at the 2019 Klose Lymphedema Conference in which she explains how and why it’s best to schedule appointments close together rather than spreading them out over a longer period of time. Each appointment will last between 60-90 minutes. “A therapist cannot expect to do MLD and bandage in any less than 60 minutes,” Roherty said.
THE ACTUAL LYMPHEDEMA TREATMENT
Your therapist will start with MLD Manual Lymph Drainage, which is a light, skin-stretching massage. This massage helps promote the movements of lymphatic fluid. Therapy is applied to unaffected areas first, making it possible for the fluid to move out of the affected area. Deep breathing techniques are usually done at the beginning and end of the therapy to open the deep lymphatic pathways.
Your MLD will most likely be followed by multi-layer compression bandaging. Multi-layer lymphedema bandaging usually has four to five components to it, including:
- Finger/toe gauze, which is soft and stretchable for comfortable wear.
- A tubular stockinette to protect the skin under the other layers of compression.
- A soft padding bandage which ensures even distribution of pressure from the short stretch bandage layer.
- Foam pads and pieces in areas that have become fibrotic, as well as foam to fill out any skin folds.
- A short-stretch bandage layer specially made to provide high working pressure and lower resting pressure.
In some cases if a patient is not able to tolerate the bandaging, a therapist may elect to use a compression wrap garment specifically designed to replace this procedure. Medi’s Reduction Kit is a good example of such a garment.
Eventually, when your therapist feels you have reached your maximum reduction, you will be fitted for compression garments to replace the bandaging. However, bandaging may still be required at night depending on the severity of the lymphedema.
EXERCISE AND LYMPHEDEMA
Your therapist will most likely give you therapeutic exercise that you can do on your own to help move lymph fluid. Besides these exercises, there are several low impact exercises that would be beneficial to your lymphedema. Ask your therapist for recommendations and be sure to get your doctor’s approval. When we move our bodies, we move lymph.
THE IMPORTANCE OF SELF CARE
Again, lymphedema is a chronic condition. The more you understand the disease and its treatment, the more empowered you will be. Your self care should include how to perform self MLD (manual lymphatic drainage), exercise, how to apply bandages and how to care for your skin. It is also important to learn about lymphedema compression garments, and how to wear and maintain them for both day and nighttime care. Be sure that before you are finished with treatment, you are leaving with a plan and specific goals for self management and control.
WORKING WITH YOUR THERAPIST
“A good CLT must build a relationship with their patients and acknowledge the fact that lymphedema is not curable past a certain stage. The relationship built is truly the foundation of a long-term relationship for years to come. Both the patient and therapist must realize that,” said Maria Geriane, a PT, DPT-CLT. The relationship you have with your lymphedema therapist will hopefully be a long and rewarding one.
Lymphedema can be a challenging disease to deal with. Working with your therapist and gaining as much knowledge as you can about lymphedema will help give you the best results. It is a team effort, together we are stronger! Together we are empowered to live our best life.
For more information about lymphedema check out these websites: