Raven Hill Certified Hand Therapy Occupational Therapy

Lymphedema Management at Raven Hill Integrated Therapies

Please see the Patient Information page of this web site for instructions on how to obtain a referral for treatment, and what to bring with you for your initial visit.

The recognized treatment for lymphedema is Complete Decongestive Therapy, sometimes referred to also as Complex Decongestive Therapy. Both are commonly called CDT by therapists. An initial evaluation is required, followed by the scheduling of treatment if no contraindications to treatment are found during the evaluation. Patients will be told where they may purchase the special pressure bandages required for treatment, and are expected to bring those bandages with them to the first session. These bandages will be used throughout treatment.

Patients have frequently been placed on diuretic medication in an attempt to reduce fluid and swelling. These medications have the unfortunate effect of thickening the lymph, and may actually interfere with treatment. Discussion with the referring physician should be made to decide whether to reduce or discontinue diuretic medications before beginning treatment.

Treatment for Lymphedema is ordinarily provided in two phases:

Phase I treatment involves meticulous skin and nail care (to help avoid infection), specialized massage techniques known as Manual Lymphatic Drainage (MLD), special pressure bandaging and garments, and an exercise program. Phase I typically requires two weeks of treatment, 5 days per week, but this can vary depending upon the specifics of the condition. Initially, treatment sessions may be up to two hours in length, shortening somewhat as the program progresses.

It is important that patients make a commitment to focus on treatment of their lymphedema during this first phase, so a time period for treatment needs to be selected that will allow the patient to fully participate. Vacations and other trips will interfere with treatment, so they should be either delayed or scheduled before the first phase of treatment. Patients should bring a full, loose garment to wear over the pressure bandages after treatment. For lower extremities, very large shoes, sandals or "cast shoes" should be brought for bandaged feet, as regular shoes will not fit. (Cast shoes may be purchased at area drug stores.) During Phase I, the patient is professionally fitted with a pressure garment to be used in Phase II of treatment.

Phase II treatment follows discharge from daily treatment, and involves the patient continuing with independent management of his or her own condition. The patient uses a specialized pressure garment during the day during normal activities, for which he or she was fitted during Phase I treatment. The patient has been taught skin care, therapeutic exercises and how to either apply bandages independently, or use an alternative means of applying pressure at home. Such alternatives include custom fitted pressure wraps or sophisticated pneumatic pumps which simulate the massage techniques of manual lymphatic drainage. The patient can expect to make follow up visits to therapy in 3-6 months for additional MLD, or for the fitting of new pressure garments, as these can be expected to have worn out and require replacement after 4-6 months of daily use.

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