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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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.

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

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

10. Compression Garments
Custom Night Garments

11. Donners
Assist in the donning/doffing of the compression product

12. 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

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

14. Compression Pumps
Leg and Core sequential compression

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

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

17. Thank You for your time
Contact info: Michael Ann Snyder, PTA, CLT Physical Therapy, JACC