Janet Wolfson's blog

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

A 55-year-old African American male was admitted to our inpatient rehabilitation facility (IRF) with a right trochanter stage 4 pressure injury, sacral stage 3, and left below the knee amputation (L BKA) with comorbid diabetes mellitus (DM) and end-stage renal disease (ESRD). A 2-person skin assessment was completed on admission by 2 RNs, one of whom had worked in a wound clinic for several years. While changing his negative pressure wound therapy device on his right hip 1 week later, I decided to check his right heel. He had evidence of callus and ashy skin, but I thought I could see an injury curved around the callus area, as seen in image 1. Upon further inspection, I discovered a stage 2 blister approximately 4x5 cm. The skin had the texture of dry, crumpling, thin cardboard. He had no sense of pain in the area. As an amputee, he did not have another heel to compare temperature, texture, or color.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

Reflecting back on "In the Trenches With Lymphedema," WoundSource's June Practice Accelerator webinar, many people sent in questions. I have addressed some regarding compression use here.

by Janet Wolfson, PT, CLWT, CWS, CLT-LANA

As the 116th Congress ruffles its feathers and dusts out the corners, it's another chance for the Lymphedema Treatment Act (LTA) to become law. The Senate bill was given bill number S 518, whereas the House bill is pending. In the previous Congress, the bill had a super majority support in both Senate and House. One can only speculate what else might have consumed their time.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

My current job as wound coordinator has pulled me into the world of incontinence and the many disciplines that care for people challenged by this disorder. I was previously acquainted with the therapy side as I worked with therapists certified in pelvic floor therapy. My work with venous edema acquainted me with medications that caused continence-challenged people to resort to absorbent adult briefs. As I work more closely with physicians, I am more familiar with medications to support weakened or sensitive pelvic muscles and nerves. On the nursing side, I have researched support surfaces, incontinence pads, and barrier creams. I see patients and occupational therapists working together to regain continence independence through problem-solving mobility issues.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

Last spring, I encountered that specific type of patient we sometimes meet, the one who has been through the chronic wound care revolving door so many times that he or she sets out on his or her own path and refuses any byways diverting from it.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

by Janet Wolfson, PT, CLWT, CWS, CLT-LANA

by Janet Wolfson PT, CLWT, CWS, CLT-LANA

By Janet Wolfson PT, CLWT, CWS, CLT-LANA

Introduction, History, and Practitioner Background

Manual lymphatic drainage (MLD) was developed by Emil and Estrid Vodder in the 1930s. They dedicated their lives to the study of lymphatic anatomy and physiology. Since then, others have modified the original techniques, including Foeldi, Leduc, Casley-Smith, and Bjork. They all involve manual contact with the client, deep diaphragmatic breathing, stimulation of the lymph nodes, and movement of fluid from proximal and then distal areas. The manual contacts are slow, gentle, and rhythmic. Practitioners are typically occupational or physical therapists, physical and occupational therapy assistants, nurses, massage therapists, and physicians. Many practitioners, after a required 135-hour training program, complete the Lymphedema Association of North America (LANA) certification exam.

By Janet Wolfson PT, CLWT, CWS, CLT-LANA

With increased awareness of the impact of the lymphatic system on all other systems of the body, there are now multitudes of research studies on lymphedema and thus new approaches and treatments by the medical profession. These include medications, prevention, detection, surgery, and regeneration. Despite cursory education on the lymphatics in medical school, research in the United States and elsewhere has managed to progress treatment.