If you’ve been around the therapy world for awhile, you’ve probably encountered the word “lymphedema.” But you may be surprised to learn about the complexities involved in treatment of patients with lymphedema.
As a Certified Lymphedema Therapist, I have spent years teaching patients and other therapists about the many different facets of lymphedema therapy. The current gold standard for treatment of lymphedema is considered to be Complex Decongestive Therapy (CDT). It is “complex” due to the comprehensive nature of the treatment including manual lymphatic drainage, bandaging, proper skin care and diet, compression garments, remedial exercises, self-manual lymphatic drainage and bandages and a long-term maintenance program. It has been my experience that all of these components of the CDT are valuable but not all are possible or even beneficial for each type of patient.
In my opinion, several other factors need to be addressed before implementing the CDT program. Some areas to consider include:
1. Emotional status Is this patient a cancer survivor? Are they still going through radiation? Is the diagnosis of lymphedema a worse fate in the patient’s eyes than anything they have previously experienced? Are they overwhelmed?
2. Support system Do they have someone that can help them manage their condition long term? Will they need someone to learn how to assist with bandaging or garment donning/doffing?
3. Resources available Will they be able to pay for the garments and bandages that are necessary for the treatment, but not covered by insurance? Are there other resources available through grants, private foundations, churches, agencies, friends?
4. Severity of condition How long have they had swelling? How long is it going to take to reduce it? What complications are there? Wounds, history of infection, trunk edema, genital edema?
5. Education What is the patient’s current understanding of the condition? What have they been told or researched on their own? Is their understanding accurate?
6. Lifestyle changes Are they willing and ready to make lifestyle changes to manage their swelling on a daily basis?
7. Compliance Are they able and willing to follow through with recommendations made? Can they commit to the lifelong maintenance program? What modifications may need to be made to the program to make it do-able for this individual?
The outcome and overall success for the patient’s treatment and long-term management will be more beneficial if the above are addressed in addition to the basics of the CDT program.
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July 31, 2014