Program Design and Plan of Care
Lymphedema affects millions of Americans. It is the accumulation of protein-rich fluid in the soft tissue spaces due to a compromised lymphatic system. It can be present in the extremities, trunk, abdomen, head and neck, external genitalia and inner organs. Lymphedema may be inherited (primary) or caused by injury to the lymphatic vessels (secondary). Lymphedema can occur immediately post-operatively, within a few months, a couple of years, or in 20 years. Most people are unaware of their swelling until they see it in their hands or feet or they have difficulty wearing shoes and clothing. However, with proper education and care, lymphedema can be avoided or, if it develops, kept well under control.
If your lymphedema is treated early on and is mild, you may only need a few sessions to individually address your problem areas and control symptoms. This could include manual lymph drainage only with compression garment wear when flying or doing heavy work such as cleaning, heavy exercise or yard work.
The treatment of lymphedema by specially trained therapists is called Complete Decongestive Therapy or CDT. The therapists here at Arlington Lymphedema Center will give you caring and competent hands-on treatment. Your treatment plan is designed individually and specifically for your needs. You can always expect to be treated with the utmost dignity and confidentiality.
Our lymphedema program is designed in two phases:
Phase I-- is the most intense and is concentrated on removing the excess lymph fluid from your involved area and redirecting it to the areas of your body where the lymph system is functioning normally. There are six treatment components:
- Manual Lymph Drainage (MLD)
- Sequential wrappings with short stretch elastic bandages
- Therapeutic exercises
- Skin Care
- Education and instruction in lifelong self-management of lymphedema
- Compression Garments
Manual Lymph Drainage involves a hands-on massaging technique (decongestion therapy) that returns the lymph fluid out of your involved area and back towards normal functioning lymph nodes. When the arm or leg has been decongested as much as possible for that session, the limb is then wrapped with special compression bandages to keep the fluid from refilling. The bandages are kept in place until the next session. In this manner the fluid is gradually reduced. The treatment process requires multiple sessions depending on the severity of the edema and how well you respond to treatment. You will also be given an exercise program to enhance the lymph removal and to help with any range of motion or strength difficulties you may have developed.
During this phase you will also be shown how to care for your skin as lymphedema causes special skin nourishment problems. You may also be taught self-manual lymph drainage to be done at home. Your educational process begins on the first day and is continued throughout the whole course of treatment. When your treatment has reached the point where the fluid is reduced, controlled and maintaining its’ size, you are ready to be measured for your compression garment.
This garment will take the place of your daily compressive wrappings. The arm sleeve, glove or stocking may be ready-to-wear or customized. There are a large variety of products designed just for the person with lymphedema and your therapist will help you explore the many options to meet your specific needs.
Phase II-- is the self-care phase of your lymphedema. It consists of six treatment components:
- Compression garments (during the day)
- Bandaging (at night)
- Therapeutic exercises
- Skin and Nail Care
- MLD as needed
- Follow-up visits
If you wear a garment, it will need replacing every 4-6 months. If your swelling has increased or decreased you will also need to be re-measured to ensure you have the proper garment fit. This is because the arm sleeve’s fabric wears out over time and loses its’ ability to control symptoms or you may have lost circumference in your arm. In this phase, you will also be expected to have become independent in your exercises and care of your arm. If you are physically not able to do your own bandage wrapping or apply the garment due to arthritis, weakness, etc., your therapist will assist in either training a caregiver or using adapted equipment. We recommend that you develop a strong support system, both for emotional support and to stay current on information about prevention and treatment of lymphedema. You may want to join a support group or participate in an Internet chat room (see our links list).