COMPLETE DECONGESTIVE THERAPY
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THE GOLD STANDARD FOR EDEMA MANAGEMENT
The Five Corner Stones of Treatment
Lymphedema is a chronic disease that often goes unrecognized. If left untreated, it tends to prgoress and can lead to skin changes, wounds, frequent infections and reduced mobility. This is a chronic inflammaotry condition which results from excess water and protiens in the tissues due to lymphatic system dysfunction/deficit. This disease can be something that you are born with, primary lymphedema. Or secondary lymphedema is a result of injury to the lymphatic system. This may include lymph node removal, surgeries (often after breast cancer), trauma, radiation, obesity, and chronic venous insufficiency to name a few.
1. Manual Lymphatic Drainage Treatment
This specialized technique is utilized to increase fluid and protein uptake into the lymphatic system for elimination and decongestion (or reduced edema) in a region. This is completed during phase 1 of treatment which is considered the ACTIVE phase of treatment which can last anywhere from 1-4 weeks. This portion of treatment is powerful for edema reduction and will be monitored by girth reduction until a plateau has been reached. You will also be taught how to do self massage in order to prepare yourself for self management.
2. Compression Bandaging
During phase 1 of treatment compression bandaging is utilized to reduce the excess limb volume, promote lymphatic drainage and prevent re-accumulation of fluid into the limb. Typically short stretch bandages are used with varying padding layers to achieve the desired result. These bandages are to be worn 24 hours a day, unless removed for hygiene and re-wrapping. During treatment you will be responsible for purchasing the supplies required and will be guided on what is needed. You will then be taught how to apply these bandages on your own or with the help of your support system. This is a very important step in the process. I often call it a "temporary annoyance."
3. Exercise
Exercise is instructed and expected during and after treatment. Mobility and exercise are very important while wearing the compression bandages. The effectiveness of the bandaging system is enhanced by movement. You will be provided with a simple home exercise program to go along with self massage. This is not meant to be exhaustive, it can be incorporated into your ordinary activities of daily living.
4. Skin Care
Skin care is vastly important in lymphedema patients as skin becomes unhealthy and fragile with this disease, which can result in openings in the skin for which bacteria can enter and lead to infection and wounds. Daily skin care is expected and you will be provided with education and guidance on this topic.
5. Compliance with self management program
During the active phase of treatment it will be vitally important to learn and educate yourself as much as possible on this disease and how you can manage it yourself as this is a lifelong process. You will be expected to complete self massage, self bandaging and exercise to be successful.
What's Next?
After the active phase of treatment has reached a plateau, meaning you are no longer seeing girth reduction, you will be in the MAINTENANCE phase of treatment. You will be assisted with fitting of a compression garment that will be worn here on out. There are many different options for compression garments on the market and this can often times be a trial and error process before finding your perfect fit. There are daytime garments and nighttime garments. You may not necessarily need both. These garments can be expensive, but are a necessary component of lifetime management.
Each clients need will be different
The cause of the swelling will determine the treatment provided. Therefore a medical history is important to acquire. Not all clients may need all 5 aspects outlined above. Some clients just need compression bandaging and not MLD. Others will need the entire regimen. This is why trusting your care to a certified lymphedema therapist with advanced training is so important.
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I can also help my clients obtain a vasopnuematic pump for managing edema. This is a great self care/home management option for those who need daily manual lymphatic drainage.
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Treatment options will vary based on need. See the most common options below.