Treatment of Lymphedema
The only effective long-term treatment and the international standard of care for lymphedema is Complete Decongestive Therapy (CDT). It consists of five major components Manual Lymphatic Drainage (MLD), compression bandaging, exercise, skin care and ultimately providing adequate elastic lymphedema compression garments. A good lymphedema therapist will treat and educate you in all above areas. The length of treatment depends on the severity and duration of the lymphedema.
The primary goals of CDT are to:
- Decrease edema
- Increase lymph drainage from the congested areas
- Reduce hardened skin areas
- Improve skin condition
- Enhance patients functional status
- Enable patient to perform independent self care program
- Control lymphedema at all times
Manual Lymph Drainage (MLD)
MLD is a gentle hands-on technique that stimulates the activity of the lymph vessels and manually moves lymph fluid. Even though most patients refer to MLD as “the massage” it should be performed by therapists that are specially trained in this technique. A series of MLD treatments will generally decrease the volume of the affected extremity to a normal or near normal size. MLD can be very effective in the treatment of facial, limb, trunk and genital edema. The sequence of MLD will change depending on the location of the lymphedema. Treatments usually take 45 minutes to one hour.
Bandaging follows MLD treatments. Low stretch bandages prevent re-accumulation of lymph fluid in the tissues. Bandages are worn overnight or until the next MLD session. Most patients learn to self bandage within one or two treatments. At Avicenna Lymphedema Care we are happy to teach your significant other or caregiver how to bandage correctly. At the end of the treatment course, a ready made or custom measured garment is ordered.
Exercises need to be performed while the limb is bandaged. At Avicenna, Petra Schalk, OTR/L, CLT will teach you individual exercise routines and recommend certain types of activities that are beneficial for the reduction of lymphedema.
You will be provided with information about skin care to avoid bacterial and fungal growth in the affected area. This is especially important for all patients with skin changes and/or lymphedema in the foot and leg.
Follow up and maintenance
During the intensive phase of treatment you will be taught all elements of CDT (complete decongestive therapy). You should continue your treatments independently at home on a daily basis. Follow up visits are recommended every month at first and after that every 3-6 months depending on your condition.
Lymphedema Compression Garments
There are many solutions for compression garments. Those options should be discussed with your lymphedema therapist or a practitioner that is specialized in fitting patients with lymphedema.
Daytime compression garments are essential to maintaining the reduced limb size after finishing your therapy. They replace the bandages that are used earlier in treatment. They are worn during the day while you are active. The compression garment assists your muscle pump in moving lymph fluid towards the middle of the body. Properly fitted garments are crucial for long term control and management of lymphedema. Garment style and compression strength should be discussed and prescribed by your lymphedema therapist.
Nighttime compression garments can replace bandaging at nighttime. They are much bulkier than daytime garments and usually more expensive. Nighttime compression is not always necessary. This is something to discuss with your lymphedema healthcare professional.
Avicenna Lymphedema Clinic is licensed to measure and fit you for custom and off the shelf garments with all the big name brands in the lymphedema industry. Petra Schalk OTR/L, CLT is one of the few therapists in Colorado who provides garment fitting. She is a specialized fitter, well known and recruited to the University Hospital of Colorado, Aurora frequently to advise other therapist and their patients in expert fitting.