Can Lymphedema Therapy "Work" For Everyone?

When I started Lymphedema Therapy, I was excited to help people with what I knew was the gold standard of treatment, Complete Decongestive Therapy (CDT). In a nutshell, this therapy involves five components.

1. Manual Lymphatic Drainage: A special type of lymphatic massage that involves gentle rhythmic strokes to stimulate lymphatic vessels to carry excess fluid away from the swollen area.

2. Compression Therapy: Bandaging of the affected limb, either by short stretch wraps applied to the body by hand, or compression through specialized garments.

3. Exercise: While the edemic area is compressed, the patient moves to keep the fluid moving toward lymph nodes and away from the congested area. Exercise also strengthens the body, increases flexibility, and encourages good breath work.

4. Skin and Nail Care: Lymphedema is often complicated by skin and nail problems which can lead to infection. Regular cleaning and moisturizing are required.

5. Maintenance and Self-Care: after the initial treatment, the limb size is reduced, and the patient may then manage their own long term care. Self massage, self bandaging and compression, and exercise are all part of success.

Many people with lymphedema are able to incorporate this therapy into their lifestyle and manage lymphedema very well. 

But is CDT for everyone?

Once I started working with clients with lymphedema, I discovered that there is really no "textbook" client. Everyone has a level of competence and comfort with these five components. (The one thing everyone loves, and is compliant with, is the massage part! Haha.)

For example, I have an 85-year-old client whose wonderful family wants the best care for her. When her swollen legs began to weep with sores, they called me to help. I initially did a lymphatic massage on her lower legs to assess the situation and feel her leg tissue to see how well she'd respond to massage and if the area was quick to drain. She was a great candidate for lymphedema therapy, so we all agreed to keep trying. 

Over the next week of massage every other day, we discovered that there were some parts of CDT that worked, some activities that probably would not likely become part of the client's regular practice. For example, massage was very effective. Her legs became softer, and the skin sores healed quickly with some zinc and moisturizer under the bandages.

The compression was another issue altogether. The first compression was more intense, as I incorporated short stretch bandages on her more swollen leg. (See image above.) I wanted to get things off on the right foot ('scuze the pun; it was actually the left) so I wrapped it well, although not as tightly as I might have. She was not even keen on wearing socks up to this point, so I figured she would remove the bandaging as soon as she felt constricted. Which she did.

Still, for the period that she did keep it on, her legs responded well and decreased a couple of centimeters overall, which was very encouraging! Over the next week, we kept up with the massages, but I only asked her to wear a compression sock after the massage, and to keep walking... up and down the hall, to the dining room, out to lunch and shopping with her children. 

I would say, she was "compliant enough." The truth is, CDT works well for almost everyone, however the client/patient must want it for herself. Most families of older parents want to see their loved ones in the best health and sometimes that means we want success more than they do. For someone with early signs of dementia, and a propensity for loose clothing, the entire CDT regimen is too much. This doesn't mean we give up altogether; it just means we must tailor a treatment plan that works. So we tweak some things.

While we are still in the phase of multiple massages each week, I predict that we'll drop back to once a week once the legs stabilize at a smaller volume and size. They are getting there quickly. Since she is sensitive to articles of clothing, the client also does not like the toes on the compression socks, so I found some socks without toes. Hopefully she'll keep them on longer. She said she will try. By the way, toe less socks are easier to don. Every little bit helps. 

I think we'll end up with a compression situation that looks a lot like this picture below: a toe less sock as an underlayer and a compression garment for her lower leg that has velcro closures so that she can add pressure as needed. (This one is made by Sigvaris, which I ordered with high hopes that it will be just right for my client.)

My client's legs are feeling better already. She says she wishes she discovered lymphatic massages many years ago, since she tells me often, "my legs have always hurt." It doesn't have to be this way. Painful, swollen legs impede easy movement and lower the chances for exercise. It's vicious circle. Legs hurt, so you don't walk as much. You stop moving, and your legs hurt more. The sooner you start searching for answers, the better the results. 

Complete Decongestive Therapy is effective for most everyone, however each treatment looks a bit different from the next. I'm always happy to help you or an older parent or family member get the relief and results you desire. Yes, the patient's lifestyle will change somewhat, and it does take some effort and expense, however the outcome is almost always worth it.