Lymphedema Management

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Lymphatic System

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.

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lymphedema management and prevention

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.

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post-surgical cancer patient

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

So, if you are following my series on the lymphatic system, then recall that last month the topic was causes of lymphedema. Today I will dive into how modern medical care and disease processes can affect the lymphatic system

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lymphedema and the lymphatic system

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

If you had a chance to read last month's blog on thelymphedema and the lymphatic system, you're probably still amazed that such a wonderful system that provides immunity and handles fluid in our bodies exists in such secrecy. This blog discusses what can go wrong with the lymphatic system. Because this network has many parts throughout the body, with cells that generated and living in different areas, whose complexity needs consideration with other disease processes or surgery, and must be constructed in 9 months of gestation... A lot could go wrong!

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the lymphatic system

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

When I talk to my patients with lymphedema, I often need to tell them about their lymphatic system. Beyond knowing of lymph nodes or glands in their neck, most don't recall having heard anything about it. Surprisingly, today's medical students often have less than 1 hour on the lymphatic system education in medical school. In physical therapy school (35 years ago), instruction was woefully inadequate. Today, more is known - and most therapy schools do spend significant time on the lymphatic system and lymphedema. For those who missed it, here is the lymphatic system in a nutshell.

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compression therapy for lymphedema

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

The intersection of wounds and lymphedema has been on my mind this week as challenging patients and a new reduction garment cross my dual specialty life. One patient with chronic swelling with weeping for more than a decade, another referred a few days before discharge who will need a few weeks Complex Lymphatic Therapy and a reduction garment that he and his spouse can manage for showering. Still another experiencing light weeping, chronic edema and is post-heart failure. They are all inpatient rehab clients attempting to improve their mobility and self care enough to go home. So, the wish list for reduction compression and absorbent wound care products needs to fit some special needs.

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new research in the field of lymphedema management

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

At the beginning of September, I attended the National Lymphedema Network International Conference in Dallas, TX. As with most conferences it was chock-full of new research, meet-ups with former colleagues, vendors with wonderful new and upgraded products, and clinical topics to improve direct care. Continue reading for some highlights that can improve care in your wound clinic for venous disease patients, as well as lymphedema and lipedema patients. Preoperative awareness of lymphedema was also highlighted at the conference.

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total knee replacement surgical wound healing

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

If you read my last blog on therapeutic interventions to stimulate wound healing, then you may recall the asset that a lymphedema trained therapist can be to your wound care department. A recent patient at the inpatient rehab facility where I am currently the Wound Care Coordinator illustrates this wonderfully.

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electrical stimulation therapy in wound healing

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

I know we have all had those patients with diagnoses that impair their wounds forming granulation tissue to fill wound depth. Perhaps there are comorbidities such as diabetes, peripheral artery disease or malnutrition. Skin flaps, cellular and/or tissue-based products for wounds, and hyperbaric oxygen therapy are alternatives, but not every patient can tolerate surgery or a hyperbaric chamber, has a shallow enough wound or enough arterial supply to make these other options successful.

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patient treatment

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

Long ago, in a Physical Therapy Department far away, I met my first lymphedema patient, but did not know that was the cause of her recurring wounds. Into the next decade, I treated more patients with chronic swelling in their legs and we put something called Unna boots on them. But the boots did not work for everybody. By the end of the decade, there were layered compression wraps and I had started to see courses for therapists in manual lymphatic drainage. Hmmm, curious…