What is the “gold standard” treatment for lymphoedema?
Note: this is the full text of an article which was published in our Spring 2018 Member Newsletter.
Complete Decongestive Therapy or CDT is the “gold standard” for lymphoedema treatment. CDT consists of two distinct phases. Phase 1 is when the Certified Lymphoedema Therapist (CLT) reduces the size of the limb and improves the skin. Phase 2 is when the patient is able to do their own treatment well enough to maintain the reduction achieved in Phase 1 and incorporate it into their daily lives, for their lifetime.
What are the side-effects of CDT?
CDT is a both a safe and effective treatment.
What are the results and benefits of CDT?
- Less swelling in the swollen limb
- Improved lymph drainage
- Improved skin condition
- Less pain, stiffness and easier movement
- Fewer cellulitis episodes and less antibiotic use
- Independence in activities of daily living (ADLs)
- Ability to participate in age appropriate activities
- Improved well-being and quality of life
What exactly is CDT?
There are several components of Phases 1 and 2 of CDT that together form the “gold standard” treatment to yield the desired results over the long term.
Components of Phase 1:
- Manual lymph drainage or MLD
- Multi-layer, short-stretch bandaging
- Drainage exercises
- Meticulous skin and nail care
- Compression garments
- Patient education in self-care
Why is Phase I called the “intensive” phase?
Optimally, a lymphoedema limb may be bandaged daily for five days of the week for up to 2-8 weeks. This means daily therapy and daily bandaging for several weeks without interruption – hence the label “intensive”. Patients may need both psychological and logistical support to get through the phase especially when it’s their first time. For example, a patient may still be recovering from their cancer diagnosis and treatment and must now cope with their new lymphoedema diagnosis. Supportive family and employers are also key as the patient needs time off from their other responsibilities. Others may need logistical support with transportation and activities of daily living (ADLs) e.g. food shopping, child care, housework etc.
Why is daily CDT optimal?
With each bandaging, the excess fluid moves up out of the limb to the regional lymph nodes at the pelvis or the armpit reducing the size of the limb. The bandages loosen as the limb shrinks. Daily re-bandaging will keep a consistent and gentle pressure on the lymphatic vessels, maintaining the flow up and out of the limb. Ultimately, daily bandaging helps the patient reach their plateau point sooner and reduces their length of time in bandages.
Are there specialised INPATIENT lymphoedema centres in the EU?
Yes, patients who cannot access the standard of care locally may decide to go to the specialised inpatient centres in the EU for phase 1 of their CDT. Before they go, it is recommended that the referring consultant request the Clinic send the patient home with a discharge summary in English – and that the patient has a Certified Lymphoedema Therapist lined up to support them through Phase 2 to monitor their progress. For information on availability and cost see:
- Földiklinik in Germany: www.foeldiklinik.de
- Wittlinger Lymphedema Clinic in Austria: www.lymphedema-clinic.com
How many days and weeks does Phase 1 take and when does treatment stop?
The patient wears the multi-layer bandages day and night. After waking each morning they remove their bandages, shower, moisturise their skin and return to the clinic for their next treatment. Treatment includes MLD, drainage exercising, education and re-bandaging. It’s repeated daily until the changes in limb size plateau. During these sessions the patient may be prepared and educated in self-management for Phase 2.
Once the reduction is complete, the limb is measured for 2 sets of compression garments (so they can wash one and wear one). Custom made flat-knit garments are an excellent choice and will need to be replaced every 4-6 months when the latex no longer provides the correct amount of compression to maintain the reduction.
What skills can patients learn in Phase 2?
- Self-Manual Lymph Drainage (S-MLD).
- Lymphatic exercises – e.g. at home or in a swimming pool
- Meticulous skin and nail care
- Compression therapy e.g.
- Compression garments
- Garments with Velcro
- Pneumatic pumps.
Is medical monitoring useful and how often should a patient be monitored?
As with all chronic conditions, a patient’s long term success will benefit from monitoring by their medical team and therapists to ensure that they have the support and advice that they need. For example, compression garments and equipment suffer from wear and tear and need to be routinely checked for safe and effective use. Patients themselves change over the years and their self-care skills may need to be updated and modified so they remain appropriate. The medical team will monitor changes in the patient over time to guide their clinical decision making and recommendations, for example, they may monitor:
- Resting respiratory and heart rates, blood pressure and body temperature
- Limb size or limb volume
- Skin and nail condition
- Body weight and or Body Mass Index (BMI)
- Pain intensity and location
- Range of motion (ROM) of the affected upper or lower limb joints
- Manual muscle test (MMT) of the affected upper or lower limb
- Functional capacity testing to assess independence in Activities of Daily Living
- Psychological screen to assess mental health status
Written by: Siobhan O’ Reilly Bracken MISCP MPA MSc CLT PINC
Updated: January 2018.
If you have comments or questions please contact Siobhan at www.theoreillycentre.ie