Long Term Management of Lymphedema Michael Ann Snyder, PTA, CLT

Early Intervention Best to get into lymph therapy as early as possible. Much easier to decrease volume when tissue is soft. Once the tissue is hard, due to protein build up in the tissues, the treatment time by lymph therapist is longer.

Complete Decongestive Therapy Manual Lymph Drainage – Daily treatment by Lymph Therapist Compression Wraps –Daily by Therapist and training of family members Exercise – For the involved limb and overall exercise Skin Care

Typical Lymph Treatment 4 weeks or longer as needed by patient 1st Week Daily treatment of Manual lymph drainage and wrapping – working towards teaching patient or family member to wrap properly over the weekend. Done until fluid reduction plateu 2nd week 3-4 days a week –depends on patient or care giver skill with wrapping. Consists of Manual lymph drainage, wrapping and exercises

Tpyical Lymph Treatment 3rd week 2-3 times per week – working on skin care and exercises as well as teaching self manual lymph drainage and wrapping 4th week 2-3 time per week – Making sure that patient/caregiver is independent with self manual lymph drainage, wrapping, skin care and exercises. Also order any supplies that patient will need

Patient Education Most Important piece of lymph puzzle Patient needs to understand that this is not going to go away and that they are going to have to manage the symptoms on a DAILY basis Need to get the best options to allow the patient to manage the swelling on their own

Compression Garments Multilayer Short Stretch Bandages – Applied by Certified Lymph Therapist after Manual Lymph drainage – Need to be removed and reapplied on a daily basis by Therapist or Family member after training in how to apply.

Compression Garments Flat Knit – Higher Containment – More difficult to don – Custom made Circular Knit – Less Containment than Flat - Easier to don – Off the Shelf

Compression Garments Velcro Closures – made by multiple vendors – Easier for some patients/caregivers to apply

Compression Garments Custom Night Garments

Donners Assist in the donning/doffing of the compression product

Compression Pumps Sequential Gradient Pumps – Require preparatory phase by Lymph Therapist or Self Manual Drainage to prepare the Lymph system to receive the drainage before the pump garment is donned

Compression Pumps Multi-chamber Sequential Pump – Completes both treatment phases (preparatory and drainage phases)

Compression Pumps Leg and Core sequential compression

Compression Pumps Acitouch pumps – Worn while awake 2 hrs intermittent compression and 10 hrs of sustained compression

Exercise Lower extremity exercises: Deep abdominal breathing Easy Biking Swimming Water Aerobics Yoga Walking is a GREAT exercise for people with lymphedema

Thank You for your time Contact info: Michael Ann Snyder, PTA, CLT Physical Therapy, JACC 850-912-2377 Michael.Snyder2@va.gov