I FOUND MY LYMPHEDEMA THERAPIST – NOW WHAT?
As I discussed in my last post, finding a lymphedema therapist is sometimes difficult. However, what can you expect from your lymphedema treatment program once you have found a therapist? Of course, all therapists are individuals, and not all therapists practice the same way. However, there are a few things to consider to ensure you get 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 develop 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; the more informed you are, the better you can maintain and control your condition. Likewise, the more you inform your therapist about your medical history, the better they will assist you in your treatment and healing.
YOUR TREATMENT PLAN
Once your therapist has completed the evaluation, she will develop a treatment program for your Complete Decongestive Therapy (CDT). Linda Roherty, PT, CLT-LANA, notes, “In Germany, it is five days a week. So 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 appointments this way is the most effective. Linda Hodgkins, MS OTR/L CLT-LANA, gave a keynote speech at the 2019 Klose Lymphedema Conference. She explained how and why it’s to schedule appointments close together rather than spread them out over a more extended period. As a result, each appointment will last between 60-90 minutes. “A therapist cannot expect to do MLD and bandage in less than 60 minutes,” Roherty said.
THE ACTUAL LYMPHEDEMA TREATMENT
Your therapist will start with MLD Manual Lymph Drainage, 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 protects the skin under the other layers of compression.
- A soft padding bandage ensures even pressure distribution from the short stretch bandage layer.
- Foam pads and pieces in areas that have become fibrotic and foam to fill out any skin folds.
- A short-stretch bandage layer is specially made to provide high working pressure and lower resting pressure.
Sometimes, if a patient cannot tolerate the bandaging, a therapist may use a compression wrap garment designed to replace this procedure. Medi Reduction Kit is an excellent 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 exercises you can do independently to help move lymph fluid. Besides these exercises, several low-impact activities would benefit your lymphedema. Ask your therapist for recommendations, and be sure to get your doctodoctor’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 performing self-MLD (manual lymphatic drainage), exercising, applying bandages, and caring for your skin. Learning about lymphedema compression garments and how to wear and maintain them for day and nighttime care is also essential. 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 relationships with their patients and acknowledge that lymphedema is not curable past a particular stage. However, the relationship built is the foundation of a long-term relationship for years. The patient and therapist must realize this.” 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. However, working with your therapist and gaining as much knowledge as possible about lymphedema will help give you the best results. Although 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:
Disclaimer – This blog is for general information purposes only. Furthermore, the information contained in this blog is not a substitute for medical advice – always consult a licensed healthcare professional for advice on your specific condition.