Treatment of Lymphedema at

Westbury Total Health Care

The Client will start a Phase I decongestive Vodder-type complex lymphatic drainage program of 4-5 sessions per week for 4 weeks. Compression therapy that consists of multilayered, inelastic bandaging of the limb, including each toe and finger, is performed immediately following the decongestive lymphatic drainage.

Multi-layered Compression bandaging is performed distal to proximal. Between bandage layers are interspersed with foam rubber pads to evenly distribute the force of the bandage and to apply increased pressure to the particularly fibrotic areas.” Bandages are to be worn 24/7 until the treatment is complete and proper compression garments are prescribed.

Therapeutic Decongestive Exercises with compression bandages are performed to evacuate from the peripheral to centralized drainage channels.

The bandaged patient is assisted through exercises that included AROM with the muscle and joints functioning within the closed space of the bandaging.

The Client is to schedule for a baseline L-DEX, used to assess unilateral lymphedema of the arm. This tool measures the amount of fluid surrounding the cells which make up the muscle and tissues of the arm.

The Client will be scheduled for a baseline CROM and MT.

The Computerized Muscle Testing and Range of Motion establishes the baseline data for accessing expected rehabilitation potential, setting realistic goals, and measuring progress. The CMT/ROM will be completed initially to set a baseline of information, and approximately midway and at the end/discharge, to follow the function and progress with changes throughout the period of the patient’s treatment.

RECOMMENDATIONS FOR SELF MANAGEMENT:

The Client is educated and instructed immediately on the signs and symptoms of infection with instructions to seek immediate medical attention if they should appear. Concomitant skin and nail care instructions have been given to the patient in the form of a handout (The NLN has distributed a Eighteen Steps to Prevention information sheet, covering topics such as; Keep the arm or leg on the side of the cancer treatment clean. Keep your skin and cuticles soft and moist by regular use of a lotion or cream. Do not cut or clip cuticles. Use an electric shaver for removing underarm and leg hair instead of a blade razor or hair removal cream. Use an insect repellent and sunscreen to avoid bug bites and sunburn. Avoid extreme heat or cold. Use standard first aid measures to treat any cuts, scrapes, burns, insect bites, hangnails, or torn cuticles. Avoid blood drawing or blood pressure being taken on the affected arm. The wearing of compression garments while flying)

Upper Extremity Lymphedema

Example: This illustration below shows acute Lymphedema affecting the right arm and hand (left picture) and the results of effective complex lymphedema therapy treatment (right picture)

complex lymphedema therapy001012complex lymphedema therapy001011

Lymphedema Lower Extremity

Example: This illustration below shows acute Bilateral Lymphedema affecting the legs. (left picture) and the results of effective complex lymphedema therapy treatment (right picture).

lymphedema001011lymphedema001007lymphedema023001lymphedema023002

Lymphedema Compression Bandaging & Garments

Example: This illustration below shows a compression garment for the right arm (left picture), bilateral stockings of the legs (center picture), and compression bandaging of the left arm and hand (right picture).

complex lymphedema therapy002003complex lymphedema therapy003002complex lymphedema therapy002004

STAGES OF LYMPHEDEMA

LATENCY STAGE

  1. Lymphatic transport capacity is reduced
  2. No visible/palpable edema
  3. Subjective complaints are possible

STAGE I (Reversible Lymphedema)

  1. Accumulation of protein-rich edema fluid
  2. Pitting edema
  3. Reducible with elevation (no fibrosis)

STAGE II (Spontaneously Irreversible Lymphedema)

  1. Accumulation of protein-rich edema fluid
  2. Pitting becomes progressively more difficult
  3. Connective tissue proliferation (fibrosis)

STAGE III (Lymphostatic Elephantiasis)

  1. Accumulation of protein-rich edema fluid
  2. Non-pitting
  3. Fibrosis and sclerosis (severe induration)
  4. Skin changes (papillomas, hyperkeratosis, etc.)