The 411: Lymphedema Treatment
Lymphedema is a chronic condition that, if left untreated gets progressively worse over time. This post will cover the treatment of lymphedema – check out our previous posts to learn what lymphedema is and what we know about lymphedema prevention.
Combined Decongestive Therapy (CDT)
Combined Decongestive Therapy (CDT) is considered to be the gold standard for the treatment of lymphedema. The four components of Combined Decongestive Therapy are:
- Manual Lymph Drainage
- Compression bandaging
- Skin Care
Manual Lymph Drainage
Manual Lymph Drainage is a very gentle type of massage performed without lotion that promotes the flow of lymph and blood. It is not painful and the pressure is light.
Performed by a certified Vodder Therapist, this treatment is very effective in treating lymphedema. The therapist will encourage lymph nodes to uptake fluids and move fluids away from the damaged lymph nodes towards functioning ones. Very specific sequences are used for each body part in order to reduce the edema (swelling). Treatments might vary at each appointment and are tailored to the patient’s symptoms at the time of treatment.
If axillary lymph nodes have been surgically removed or radiated, fluids will naturally want to accumulate in the arm or the bra line, even in some cases in the chest wall, back or clavicle area. Manual Lymph Drainage would then be a very effective way to reduce stagnated fluids and direct them appropriately.
Manual Lymph Drainage can also be very helpful to reduce and soften axillary web syndrome, also referred to as cording. Cording usually develops as a side effect of ALND (Axillary Lymph Node Dissection) or SLNB (Sentinel Lymph Node Biopsy).
There are contra-indications to manual lymph drainage (such as congestive heart failure). Please check with your health care practitioner before you receive treatment.
Compression comes in many shapes or forms depending on your therapeutic needs as well as your preferences. Some compression bandages are more appropriate to use in the intensive phase of treatment, whereas some should be used at a later point. In the initial (decompression) phase of CDT, your lymphedema therapist might apply multi-layer short-stretch bandages to maintain the effect of the treatment. In phase 2 of CDT, the patient will “graduate” to elastic compression garments.
Both compression bandages and garments have many therapeutic effects:
- Prevent the reaccumulating of evacuated lymph fluid and maintain the results of the Manual Lymph Drainage treatment
- Increase the tissue pressure during active movement
- Stimulate the contraction of lymphatic vessels
- Soften subcutaneous tissue
- Improve venous and lymphatic return
- Help to soften scar and connective tissue
There are many compression garment options on the market, both custom-made and ready-made. As a therapist, my recommendation is to go with custom-made garments which are specifically tailored to your measurements and compression needs. There are many options such as sleeves, gauntlets and gloves, to choose from.
Custom-made garments are usually sold through fitters. Fitters in your area will help you choose the best garment type for your specific needs but the following companies are great options to check out styles and garment types:
The usual prescription grade for arm lymphedema is 30-40 mm/Hg. Depending on many factors, such as how early lymphedema is treated, tissue health, and type of surgeries/radiation, some patients are able to get away from bandaging altogether, whereas some would not be able to function without them.
Did you know that in Ontario, the Government (through the Assisted Devices Program) can assist with the cost of custom-made compression garments? If you qualify, ADP will cover the cost of 75% of 2 sleeves every 4 months.
Most of us are aware of the health benefits of regular exercise but, for patients with lymphedema or at risk of lymphedema, exercise has profound benefits. Exercise performed during the intensive phase of CDT is called “remedial exercise”. Remedial exercises will be done under the supervision of your therapist or will be given to you by your therapist to be performed at home. These specific exercises will be performed with the compression bandages in order to help the decongestion of the affected limb. It is recommended for a patient to have good control over their lymphedema before starting a new exercise program. Strength training might be a great option for lymphedema patients but gradual progression is imperative. It is strongly advised to wear compression garment while exercising (except in the water).
Beneficial activities for upper extremity lymphedema might include:
- Swimming or water aerobics
- The pressure of the water exerted on the skin actually increases the lymphatic and venous return. Please make sure that the water temperature is below 35 degrees Celsius.
- Walking on a treadmill or outdoors while wearing your compression garment will stimulate both circulatory and lymphatic systems
- Cross country skiing
- Yoga is known for its healing emotional and physical properties. The yogic diaphragmatic breathing stimulates the lymphatic system at a very deep level. Many cancer centers have yoga classes tailored to cancer and lymphedema patients.
Lymphedema patients are prone to skin infections that may lead to cellulitis so skin care should be a priority and meticulous skin inspection should be part of your routine. A cut or crack might be the perfect entry point for a pathogen to enter the body and because lymphedematous tissues are very rich in protein, bacteria can thrive in them. Your skin should be cleansed with mild, pH neutral products and moisturized with products with no fragrance and as few additives as possible.
According to personal preferences and budget, the following skin creams are recommended:
- Eucerin Aquaphor
- Glaxal Base
- Lipikar Baume AP+
- Cetaphil Restoraderm
- Avène TriXera Nutrition
- Aderma Exomega
- Any oil, preferably not perfumed
Take good care of your skin if you are prone to lymphedema or if you have lymphedema. Wear gloves while gardening and doing dishes, do not get your cuticles cut when getting manicures and always keep an eye out for cracks and cuts on your skin. When in doubt, apply antibiotic cream and consult your health care professional.
Next month, we will discuss self-management such as self-manual lymph drainage, lymph taping and exercises. For more information on lymphedema, read our first two parts in this series:
Emmanuelle Ravez Gomez is a RMT and Combined Decongestive Therapist specialized in the treatment of lymphedema at her practice The Body Mind Clinic.