Treatment

While there is at present no cure for lymphedema, it can be successfully managed. Treatments focus on the benefits of compression and on improving the drainage of lymphatic fluid. Specially trained lymphedema therapists will assess the degree of lymphedema, help set realistic treatment goals, provide treatment and instruction in self-care, and monitor progress. A physician’s referral for lymphedema is normally required to ensure that no other health conditions could affect the lymphedema treatment.

Combined decongestive therapy (CDT)

Combined decongestive therapy (CDT) is presently considered the most effective treatment available and should be provided by specifically trained and certified CDT therapists. Treatment consists of an intensive phase to reduce swelling as much as possible and a long-term maintenance phase to keep swelling down and promote functioning. CDT combines manual lymph drainage (MLD), compression bandaging, decongestive exercises and skin care.

Manual lymph drainage (MLD)

Manual lymph drainage (MLD) is a specific, gentle light pressure technique different from regular massage. MLD stimulates lymph flow and redirects the lymph fluid to areas of the body where the lymphatic system is functioning. Special techniques help to break down fibrous tissue. MLD can be taught to patients, and to family members or friends under the supervision of a trained therapist.

During the intensive phase, CDT treatments may take place on a daily basis over a period of two or more weeks, depending on the severity of the swelling. During this intensive phase the therapist performs the treatment and teaches the client self care techniques for the maintenance phase.

Compression bandaging

Compression bandaging is essential to CDT success. Compression bandaging (wrapping) is the application of layers of gauze, foam, and low-stretch bandages to replace skin pressure lost from lymphedema, to aid muscles in stimulating lymph flow and to prevent re-accumulation of swelling. Compression bandaging is applied by trained therapists and worn both day and night during the intensive phase. Patients can be taught to bandage themselves. During the maintenance phase, bandaging may be required at night. A variety of other non-elastic compression products are also available for night use.

Compression garments

Compression garments keep swelling down by providing support and are an essential part of the maintenance phase of treatment. Garments must be prescribed by a doctor and fitted by a trained measurer. They can be ready-made or custom-made, but they must fit properly. Compression garments are worn during the day, especially and removed at night. When compressions garments are worn regularly, over time they lose their ability to sustain proper compression. Proper care of garments requires frequent washing, air drying, and regular replacement approximately every six months.

Decongestive exercises

Regular, light decongestive exercise is important during the intensive phase of treatment and afterwards. CDT therapists instruct and demonstrate decongestive exercises appropriate to each individual.

Stretching, aerobic exercise and strength training are also important, especially during the life-long maintenance phase. As everyone has different physical ability and needs, and as severity of lymphedema varies from individual to individual, it is best to consult your physician, lypmphedema therapist and\or a trained exercise therapist to determine frequency, duration and level of activity that may be appropriate for you.

When starting a new exercise program, take care to progress gradually and to monitor the response of your body. If swelling increases, reduce the amount of exercise. It is also important to wear compression bandages or garments during exercise.

Exercising in a group can be fun and offer support. Aquatic exercises, integral tai chi, and dance exercise groups are offered in some regions of Quebec.

Exercises

Skin care

Meticulous skin care is emphasized at all times. Skin should be kept clean, adequately moisturized to prevent cracking, and infections, and sufficiently dry to prevent fungal infections.

CDT in summary

Commitment to all four components of CDT is essential during both phases. During the intensive phase the therapist performs MLD and applies compression bandages that are worn day and night. During the maintenance phase, compression garments are worn during the day and bandages, or other devices used at night, as necessary. Self-massage, self-bandaging, regular exercise and skin care all require patience and commitment.

Contraindications to treatment

Treatment is contraindicated in certain situations, for example if cellulitis or a deep vein thrombosis occurs. Antibiotics may be required to treat infections, particularly cellulitis. Signs of cellulitis include: red itchy skin, increased swelling, increased temperature of the skin and sudden onset of high fever and chills. Consult your physician immediately if you have concerns about infection.

Sudden increase in swelling, sudden swelling in another area of the body, or sudden or persistent pain should be investigated by a physician and may be reasons to halt or delay treatment.

Caution about other treatments

Pneumatic pumps are sometimes used to treat lymphedema; however, they have the potential complication of pushing fluid upwards and causing swelling and fibrosis above the treated area. Pumps are best used in conjunction with CDT.

Diuretics are generally not recommended for the treatment of lymphedema because they extract water from the lymph, worsening the build up of protein that can harden tissues.

Lymphedema research and resources

Lymphedema is a poorly researched and under-treated condition that is not recognized as a serious health problem. Physicians may fail to diagnose lymphedema. Standardized assessment and accurate measuring techniques are needed. Only then can the effectiveness of treatments and therapies be evaluated. With improved clinical research, lymphedema and its treatments may enjoy better recognition from medical practitioners and higher funding priority from our governments.

For information about lymphedema, risk reduction, and management in PDF format, download the LAQ patient pamphlet "Living with Lymphedema" from the LAQ Home Page

Other useful links:

http://www.lymphovenous-canada.ca/
http://www.breastcancer.org/cmty_trans_2002_07_18.html
http://www.u.arizona.edu/~witte/2003consensus.pdf
http://www.lymphnet.org/pdfDocs/nlntreatment.pdf
http://www.lymphnet.org/pdfDocs/nlnexercise.pdf

DISCLAIMER: This site is for information and community support only, and should not be used as a substitute for professional medical care. Always seek the advice of your physician with any question about a health problem or medical condition. This site also includes links to websites providing information about lymphedema, but the LAQ cannot be responsible for the content of those sites.