Combined Decongestive Therapy
Most U.S. physicians have all but ignored Lymphedema, which is typically called the stepchild of modern medicine. An important fact to remember is that there is no cure for lymphedema, only therapy. Today the most effective lymphedema treatment is known as Combined Decongestive Therapy (CDT). CDT effectively reduces swelling and reverses the tissue changes of lymphedema. Depending on the severity of the condition, the intensive phase of the treatment is 3 to 5 times per week and lasts 4 to 8 weeks. Then, as needed, maintenance visits are scheduled bi-weekly or monthly.
CDT includes the following components:
1. Manual Lymph Drainage (MLD): MLD is a specific pattern of very slow, light and rhythmic stretching of the skin in circular movements to stimulate the lymphatic vessels and nodes. The movement of the skin accelerates the re-absorption of tissue fluid into the lymphatic channels, increasing the effectiveness of excess lymph fluid filtered through the lymph vessels and nodes. Through consistent MLD, alternate pathways (anastamosis) are created by re-routing stagnant fluid to healthy lymphatic vessels and nodes. MLD also stimulates the parasympathetic nervous system, and therefore, causes people to feel relaxed and often fall asleep during treatment. To be effective, treatments need to be performed at least 45 minutes to 1 hour.
|2. Compression Bandaging
: Compression by short stretch non-elastic bandages. We use “low” stretch bandages (Not ACE bandages) to prevent the re-accumulation of lymphatic fluid. Compression Bandages increase the efficiency of the muscle and joint pumps and is used until the limb is sufficiently reduced to be fitted for compression garments. Bandages are worn overnight until the next CDT session. We have a huge selection in stock of all bandaging supplies necessary for therapy.
Remedial range of motion exercises, with the bandages in place enhance the movement of lymph fluid out of the limb by activating the muscle and joint pump. Instruction in diaphragmatic breathing exercises improves lymphatic flow. Each exercise program is customized depending on the patients needs. We encourage walking, swimming and safe yoga exercises and have created a “Vintage Wellness Program” for patients to attend.
|4. Skin care/Hygiene:
Meticulous skin and nail care inspection is essential to observe for any sign of bacterial or fungal infection. Before each bandaging session, pH balanced moisturizing skin lotion such as Eucerin or Lymphoderm is applied to the skin.
We work along with local wound care centers and physicians following wound care protocols. If there are wounds present of any origin, each therapist is qualified and knowledgeable about caring for the wound with the appropriate wound care products.
At Healing Hands of Lymphatics we have incorporated our own unique Lymphedema Treatment program to include the following:
|5. Patient education:
Lymphedema management is an ongoing process and each patient is educated in a unique and specific program of self-care. The treatment program ensures that each patient remains confidently in control of his or her lymphedema, decreasing reliance on continuous treatment in the future.
Our patient education of self care includes a customized program of:
Self MLD, Self Bandaging, Range of Motion exercise program, Nutritional Diet Counseling, Self Kinesio Taping, Day time and Night time compression garments. We also review all options for readymade and custom garments and the benefits of each from Juzo, Jobst, Medi, BioConcepts and Lymphdivas and instruction in how to properly wash garments and how to apply and remove on a daily basis with use of assistive devices if needed. We review samples of alternative night time compression garments from Reid Sleeve, Tribute, Circaid, Farrow Wrap, Biacare or Jovipak and discuss options for maintaining long term reduction of swelling. We also review the pros and cons of using compression pump devices for home maintenance. We provide a review of precautions to better understand the effectiveness and physiological reasons to incorporate such a device into a home maintenance program. The only device we recommend at this time due to its research based effectiveness and safety is the Flexitouch Device from Tactile Systems. See Specialty Services below for a more detailed description.
LYMPHEDEMA PREVENTION AFTER BREAST CANCER
We have developed a “Lymphedema Prevention” program aimed at educating the general population, patients and all healthcare professionals about prevention and precaution techniques. We encourage all people who have undergone any cancer surgery, lymph node biopsy or radiation treatment to come in for prevention education. Our education program consists of sitting down with a lymphatic therapist to discuss: 20 steps to prevention/precautions, nutritional diet counseling, exercise program review, and fitting of a prevention garment-arm sleeve/glove/gauntlet.
There is NO CURE for lymphedema…only prevention! Once someone starts to develop swelling there is treatment available and should be treated as soon as possible. Treatment by physical, occupational or massage therapist who are not Lymphedema certified may be harmful and may cause more risk of developing swelling by doing inappropriate exercises and therapeutic activities which may not be recommended by a therapist more knowledgeable about the lymphatic system functions. Many insurance plans dictate where patients go for therapy. If you are referred elsewhere, please make sure to ask if there is a lymphatic therapist on staff who has had at least 135 hours of Lymphedema Training to ensure you receive the appropriate information. Healing Hands of Lymphatics employs therapists that are Certified Lymphedema Therapists.
COMBINED DECONGESTIVE THERAPY IS THE MOST EFFECTIVE METHOD TO TREAT THE FOLLOWING CONDITIONS:
LYMPHEDEMA CHRONIC SWELLING
Lymphedema (chronic swelling) occurs when an interruption of lymphatic flow results in the accumulation of lymphatic fluid causing abnormal swelling in the arms, legs, feet, breast, abdomen, neck or head. When lymphatic vessels are impaired, missing or when lymph nodes are removed, the remaining lymph pathways become congested or blocked. These fluids (waste products) can build up in the connective tissues and becomes thicker and the affected areas feel heavy. This thickening of lymphatic fluid is called fibrosis (hardening of the skin and underlying tissue).
LYMPHEDEMA FOLLOWING BREAST CANCER
Secondary lymphedema following cancer treatment is more common than usually assumed. Patients that undergo lumpectomy or mastectomy because of breast cancer develop secondary lymphedema in the upper extremity (arm, back, abdomen or chest wall) in approximately one-third of cases. Swelling is primarily treated by conservative methods (exercises and fitting for compression sleeves) that should be applied at an early stage, largely to avoid progression of lymphedema with development of fibrous tissue. This can also reduce the incidence of bacterial infection and discomfort that occurs with chronic lymphedema. The main goal of combined decongestive therapy (CDT) is to increase lymphatic transport capacity and if possible to restore the normal size of the limb. At Healing Hands of Lymphatics a lymphatic therapist will evaluate your condition and design a treatment protocol specific to your needs.
Click here to learn how we can help you manage your lymphedema in the upper extremity.
CHRONIC VENOUS INSUFFICIENCY
Chronic venous insufficiency creates state of high-protein edema and fibrosclerosis. The valves in the veins channel the flow of blood toward the heart. When these valves are damaged or aged, the blood leaks and pools in the legs and feet. Symptoms include swelling of the legs, pain in the extremities, including dull aching, heaviness, cramping and accumulation of blood in the skin. Cardiac bypass patients should keep a close watch to ensure that venous insufficiency does not develop in the leg(s) or arm(s) where the vein was removed. At Healing Hands of Lymphatics a lymphatic therapist will evaluate your condition and design a treatment protocol specific to your needs. Click here to learn how we can help you to reduce the swelling.
WOUND CARE HEALING
When the body's natural healing process is delayed by medical conditions such as diabetes or vascular disease, the wound becomes an ongoing problem. A major emphasis is to reduce wound deterioration and to promote wound healing. By utilizing CDT, we have great success with patients who have been undergoing treatment for months or years without successful healing. The majority of our patients’ wounds heal with consistent CDT treatment within 4 to 8 weeks. There are many factors that can impede the wound healing process including tissue swelling, pressure, trauma, and infection. Wounds kept in a moist environment heal three to five times faster, with less pain, than those exposed to a dry environment. Other factors that can impede healing at a wound site are age, body build/weight, chronic disease such as diabetes or renal failure, diet/nutritional status, poor circulation, insufficient blood supply, suppressed immune system, and radiation therapy. We utilize state of the art wound healing techniques and products to make wounds heal faster. At Healing Hands of Lymphatics a lymphatic therapist will evaluate your condition and design a treatment protocol specific to your needs. Click here to see how CDT can help you heal quicker.
Patients who have had any type of orthopedic surgery such as hip, knee, shoulder replacement or arthroscopic surgery will experience postoperative swelling. We have been successfully treating orthopedic surgery patients with Manual Lymph Drainage (MLD) and Combined Decongestive Therapy (CDT). Patients are always referred to physical therapy after surgery. Usually physical therapy post-surgically is painful and the operated area has swelling. In some cases the swelling does not subside in a timely manner. These patients can benefit from CDT and be fitted with compression stockings. MLD has been proven to aid in the absorption of toxins, enhance fluid circulation and induce deep relaxation. Orthopedic surgeons nationwide are seeing the benefits of lymphatic therapy for their patients in preparation for surgery and post-surgical healing. Physicians typically express that the final results of any procedure will be seen in 6 months to one year due to the body’s natural healing time frame. The final results of any procedure will be seen in a shorter period of time with CDT and compression garments. Click here to learn more about healing quicker with less pain and swelling.
PRE-POST COSMETIC OR PLASTIC SURGERY
Recent studies show that plastic surgery patients often experience postoperative edema which peaks 2 to 4 days following surgery and is followed by soft-tissue fibrosis of the operated area. At Healing Hands of Lymphatics we have been treating surgery patients with Manual Lymph Drainage (MLD). It has been proven to aid in the absorption of toxins, enhances fluid circulation, stimulates the immune system, absorbs fat molecules and induces deep relaxation. More and more plastic surgeons are seeing the benefits of lymphatic therapy for their patients in preparation for surgery and post-surgical healing. Physicians typically express that the final results of any procedure will be seen in 3 to 6 months due to the body’s natural healing time frame. The final results of any procedure will be seen in a shorter period of time. MLD is commonly used in countries such as Germany, France, Italy, Austria, Colombia, Brazil, Mexico, Venezuela and Argentina.
Click here to learn more about how MLD therapy benefits pre and post cosmetic or plastic surgery.
Holistic MATERNITY PROGRAM is a completely safe, natural, drug-free method of relieving the aches and pains of pregnancy. It supports the mother-to-be with physical health and vitality, and can help her more easily adjust to the many changes in her body and the demands of her new life. Also there are other benefits like increased circulation, which helps reduce swelling and improves the oxygen supply to the baby, relieves depression and nervousness caused by hormonal changes and eases painful contractions during labor. At Healing Hands of Lymphatics we utilize pregnancy massage (on a pregnancy massage table so you can lay on your stomach safely), Manual Lymph Drainage Massage (to reduce swelling in your feet, ankles and legs), Kinesio Tape (to reduce back pain), fitting for maternity compression stockings (to give you support, keep you comfortable and less swollen) and safe range of motion exercises (to keep you flexible and less stiff). All of these components will provide you with greater comfort and improve the quality of health of your developing baby.
At Healing Hands of Lymphatics a lymphatic therapist will evaluate your condition and design a treatment protocol specific to your needs. Kinesio Tape is a proven, safe and effective method that provides excellent results to eliminate pain and muscle discomfort for those illnesses and disorders which are not healed by other treatments. The name comes from the science of Kinesiology, because the taping method and tape allow the body and muscles to move while it assists in rehabilitation. There are no adverse side effects. The Kinesio Tape method must be applied by a trained therapist. The tape is placed over the muscles to reduce pain and inflammation, to relax overused muscles and to support muscles in movement on a 24 hours per day basis. This is not a restrictive type of physical therapy taping, and allows for full range of motion. In contrast, traditional sports’ taping is wrapped around a joint strictly for stabilization and support during a sporting event. Kinesio Tape is used for anything from headaches to foot problems and everything in-between. The tape is water-proof and can be left on the skin for up to five days. At Healing Hands of Lymphatics we have been utilizing this tape with amazing results for all types of swelling and pain problems. Patients are taught to apply the tape themselves at home for continued effectiveness of the treatment.
COMPRESSION GARMENTS (Day time)
Gradient Compression therapy helps manage and prevent the progression of lymphedema, vein-related diseases or any swelling. Gradient compression garments help lymphatic fluid and blood flow in the right direction. At Healing Hands of Lymphatics our therapists are trained to help and instruct every patient to be independent with applying and removing their compression garments and provide adapted devices to facilitate ease of application. Upon evaluation, a therapist will determine which compression class is appropriate for your condition such as 8-15 mmHg, 15-20 mmHg, 20-30 mmHg, and over 30-40 mmHg or custom requires a doctor’s prescription. We have compression stockings such as knee highs, thigh highs, pantyhose and ankle/ knee braces; Also we carry compression sleeves and gloves for arm(s) and hand(s) swelling. We have a huge selection of different brands such as JUZO, Medi, Sigvaris, L&R Solaris and JOBST in custom and ready made sizes.
COMPRESSION GARMENTS ( Night Time)
Compression Garments for night time use play a vital role in maintaining the reduction of swelling after a course of CDT therapy. Every patient who goes though CDT treatment is instructed in self-bandaging with short stretch compression bandages. However, not all people can or want to bandage themselves at night. Therefore, the following products are available to help to maintain the reduction of swelling in the limb(s):
- Solaris Tribute
- Farrow wrap