How Lymphedema is Treated

COMPLETE DECONGESTIVE THERAPY (CDT)

Complete Decongestive Therapy (CDT) is considered to be the gold standard of lymphedema treatment and this treatment is described as being a two-phase program.

To demonstrate the different types of compression, the right leg is bandaged and the patient is wearing a knit stocking on her left leg. © Lymph Notes

PHASE 1

Phase 1, which is also known as an intensive, the treatment phase, decongestive phase, or as an intervention.

During this phase the patient is seen daily by a therapist and usually wears bandages (wrapping) for 23 hours a day, 7 days a week.

The primary goals of this phase are:

• To reduce the swelling in the affected area.
• To teach the patient the self-care skills needed to continue this treatment at home. During this phase, which usually lasts one or two weeks (or longer) the patient should goals of self-care, or to have a care-giver learn how to perform these steps. 
• Often a member of the patient's care team will make a video showing the steps involved here.

PHASE 2

A lymphedema therapist performing Manual Lymph Drainage.  @LymphNotes.com

Phase 2 is also known as the maintenance phase, optimization phase, or self-care phase. During this phase the patient takes over the responsibility of performing this daily treatment that is required to control the lymphedema. If the patient is unable to do this, a caregiver is trained to take over this role.

These treatments include:Self-Massage to move stagnant lymph out of the tissues.

• Compression to prevent the swelling from returning to the tissues again.
• Skin care to maintain the health of the tissues so that breaks in the skin will not allow infections.
• Exercise to maintain the flow of lymph, increase mobility, control weight, and improve the patient’s general health and sense of well-being.

MASSAGE TECHNIQUES

The purpose of massage is to gently guide excess fluid out of the swollen tissues so that they can return to the circulatory system. To learn more about this massage read the article Manual Lymph Drainage.

The differences in names of these techniques described who is performing the treatment. None of these massage techniques should be attempted by an individual who is not properly trained in the use of that technique for a specific patient.

• Manual Lymph Drainage (MLD) is performed by the patient’s appropriately trained lymphedema therapist.
• Self-massage is performed by the patient as instructed by his or her lymphedema therapist during phase 1 of the treatment.
• Simple lymph drainage (SLD) is performed by the patient’s caregiver. The patient’s lymphedema therapist trains the caregiver how to perform this modified massage technique.

COMPRESSION METHODS

The use of compression, at all times, is an important factor in maximizing gains between professional visits. The goals of compression are to:

• Retain the progress in reducing swelling that was made during the massage treatment.
• Prevent, or minimize, additional swelling.
• Support natural draining of lymph from the tissues.

For details on these types of compression read the articles: Compression (1) for Lymphedema Treatment, Compression (2) Bandaging, Compression (3) Knit Garments, and Compression (4) Specialized Aids.

Skin and nail  care are important.

CARE OF THE SKIN, NAILS, AND FEET

Proper daily skin care is essential to prevent deterioration of the skin and feet, to maintain skin health of the skin and to prevent infections. To learn more, read Self-Care: Healthy Skin, Self-Care: Healthy Feet, and Proper Nail Care.

EXERCISES

Daily exercise is essential to:

• Maintain the flow of lymph,
• Increase the mobility of joints and muscles,
• Maintain general health
• Control weight, and
• Improve the patient’s sense of well-being. To learn more about this topic read,  Exercise and Lymphedema, and Water Exercises for Lymphedema.

REFERENCES 

• The book, "Lymphedema Caregiver’s Guide" by M. K. Kearse, PT. CLT-LANA, E. McMahon PhD and A. Ehrlich MA. Lymph Notes, 2009.
• The book, Living Well with Lymphedema" by Ann Ehrlich, A. Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes, 2005.
• Lymphedema: What interventions are effective in reducing risk for and treating secondary lymphedema?" Lymphedema Putting Evidence Into Practice (PEP) Card, Oncology Nursing Society, 2008. Available from www.ons.org/Research/PEP/Lymphedema.
• Lymphedema: A primer on the identification and Management of a Chronic Condition in Oncologic Treatment" by B.D. Lawenda, T. E. Mondry, et al. CA Cancer J. Clinic 2009; 59-8-24
• Lymphedema Management: The Comprehensive Guide for Practitioners 2nd ed. by J.E. Zuther. Thieme, 2009
• The National Lymphedema Network. NLN Position Paper: The Diagnosis And Treatment Of Lymphedema. Februrary 2011 Update.

© LymphNotes.com 2015. This information does not replace the advice of a qualified health care professional.

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Category: How Lymphedema is Treated Updated: 2015-10-21