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Manual Lymph Drainage and Combined Decongestive Therapy
Case studies coming soon
The Lymphedema Management Team
Shauna Perry, Natalie Mooy-Beebe and Andrea Burde all
Registered Massage Therapists at the Lavallee Centre in
Pembroke, have completed advanced training with
certification in the Dr. Vodder method of Manual Lymph
Drainage (MLD) & Combined Decongestive Therapy (CDT),
offered by the internationally recognized Dr. Vodder School.
The program included pathology instruction, advanced MLD
techniques, compression bandaging and examination with the
medical director of the school.
Completion of this post-graduate 160-hour intensive training
allows the Registered Massage Therapists at The Lavallee
Centre to count themselves among the roughly 1000 therapists
in North America who are currently certified to practice
this specialized technique.
CDT allows these therapists to manage patients with
lymphedema and venous insufficiency edema, using a
combination of Manual Lymph Drainage, Compression Bandaging,
Exercise Therapy and Skin Care. This allows advanced care of
patients with lymphedema, whether from surgery, radiation or
congenital malformation. Suitable venous edemas may also be
managed successfully with these techniques.
MLD can also be used in the care of patients with conditions
such as venous stasis ulceration, wounds, scar tissue,
burns, traumatic edema, dermatological indications such as
rosacea, orthopedic indications such as adhesive capsulitis,
arthritic conditions, acute whiplash, menieres syndrome,
migraines, etc.
Apart from increasing lymph flow, MLD also has a pain
relieving effect and can be used with recent trauma, such as
sports injuries. Patients find the techniques soothing and
relaxing with no side effects. It is a gentle, rythmic
massage-like movement, performed with a great deal of
precision and requires a well-trained therapist to obtain
good results.
The Lymph Vessel System
The lymph vessel system consists of vessels and lymphatic
tissue, including lymph nodes and is found in most parts of
the body. A healthy lymphatic system is incredibly important
in maintaining good health and fluid balance and removing
wastes and pathogens.
Lymph vessels transport water, proteins and wastes from the
connective tissue to the lymph nodes where the lymph is
cleaned, filtered and concentrated. The remaining fluid is
then returned to the blood volume. The lymph nodes have a
very important role concerning immune reactions and
detoxification. If the lymph vessels or nodes are damaged or
removed during surgery, become congested or blocked, then
fluids can build up in the connective tissue leading to
edema and a thickening of the tissue called fibrosis. This
may lead to disruption of the normal functioning of the cell
and eventually to disease. If there is already a problem in
the connective tissue such as ulceration, haematoma, burns
or chronic inflammation the lymphatic system must remove the
excess fluid, damaged cells and toxins away from the area.
The faster this process occurs the more rapid the healing.
To see a video of the Lymph Vessel System please visit
http://www.vodderschool.com/lymph_vessel_system.
LYMPHEDEMA
What is Lymphedema?
Lymphedema is the accumulation of protein rich fluid in the
interstitial space. This occurs when the lymphatic system is
damaged and can no longer function at optimal. It is
characterized by a non- painful swelling in the affected
region (usually the arms or legs) that may progress through
different stages that involve skin changes, fibrosis, and
loss of function. If left untreated, the condition will
worsen and the area will be prone to skin breakdown and
infection. In severe cases, it can lead to a rare from of
lymphatic cancer called lymphangiosarcoma.
There are 2 types of lymphedema: Primary and Secondary
Primary lymphedema is caused by a congenital malformation or
deficiency of the lymphatic tissues. It can sometimes be
diagnosed at birth, but may also appear later in life
(puberty, pregnancy).
Secondary Lymphedmea is caused by deficiency of the
lymphatic tissues due to an external source such as surgery,
radiation, infection, trauma and long standing skin
disorders. The most prevalent cause of secondary lymphedema
continues to be associated with cancer treatment and/or the
course of the disease itself.
What causes lymphedema?
The major cause of lymphedema in developed countries is
damage to the lymphatic system secondary to cancer
surgery/radiation or the course of the disease itself.
Although rare, due to increased travel to developing
countries, we should also consider a condition called
Filariasis as a cause of lymphedema. This is an infection
with nematode worms that are transmitted through mosquito
bites and can lead to lymphedema. It is estimated that in
tropical and developing countries approximately 15 million
people already have chronic damage due to the filarial
infection. (Weissleder et. al. Lymphedema Diagnosis and
Therapy Viavital, 2008).
What causes the swelling?
When there is damage to the lymphatic vessels and nodes, the
ability of the lymphatic system to transport fluids,
proteins and waste material is decreased. Because of this
water and proteins build up in the interstitial space.
Protein has a water attracting property, and therefore more
water is pulled out of the blood volume by the protein
building up in the tissue. The lymphatic system is not able
to remove this fluid due to damage or blockage and swelling
occurs.
How do I know if I have Lymphedema?
Diagnosis of Lymphedema is obtained through a thorough case
history and physical examination. Swelling is the most
obvious sign of lymphedema. Swelling may occur at birth or a
later age (puberty, pregnancy) in the case of primary
lymphedema and usually after cancer treatment (surgery and
or radiation) in the case of secondary lymphedema. Anyone
who has had surgery and or radiation for treatment of cancer
may develop lymphedema days or years after the surgery. Some
people never developed lymphedema post cancer treatment.
How can lymphedema be treated?
Lymphedema is treated using Combined Decongestive Therapy
(CDT). CDT consists of manual lymph drainage, compression
bandaging, exercise therapy and skin care. There are 2
phases of treatment with CDT. The initial phase consists of
daily intensive MLD sessions and compression bandaging for
two to four weeks, followed by a maintenance phase where the
patient wears an elastic compression garment and follows an
exercise program to maintain the benefits achieved during
the intensive phase.
Manual lymph drainage techniques are similar to a skin
stretch and are very light. This technique encourages the
lymph to move from the area of congestion through alternate
pathways to intact lymph tissue, where the lymph can be
processed.
Compression bandaging helps prevent tissue refilling by
increasing tissue pressure. Several layers of a specific
type of bandage are applied after the MLD portion of the
treatment to compress the tissue. Foam pads may be placed
under the bandages on areas of heavy scarring to help soften
the tissue. Bandages are worn 24 hours a day between the
daily MLD treatments during the intensive phase
Decongestive Exercises are important as they increase tissue
pressure through muscle contraction and encourage lymph
flow. Daily exercise will help to build muscle, improve
lymph flow and maintain or improve mobility of the joints
and soft tissue. Your therapist may also suggest aqua
therapy.
Skin care involves specific instruction to help reduce the
risk of infection, which is a common concern with lymphedema.
Information will be given on properly cleansing and drying
the affected limb and the use of an appropriate moisturizer
to prevent tissue breakdown. Cuts, abrasions, injections and
incisions on the affected limb are to be avoided.
Compression Garments differ from compression bandages, as
they are a sleeve of elastic material that is usually custom
fit and designed to be worn long term. Compression garments
are meant to be worn after the initial phase of treatment
once the limb has reduced in size. The aim of the garment is
to prevent further swelling of the affected limb.
Financial Assistance for Lymphedema
Related Costs
Insurance Providers
Combined decongestive therapy is in the scope of practice of
a Registered Massage Therapist and therefore is billed as
massage therapy. Clients may use their third party insurance
to cover a portion of the therapy costs.
Community Organizations
There are some community-based groups that provide financial
assistance for cancer related expenses to low-income
individuals. They do require special application procedures
with criteria for eligibility. Examples of groups that have
provided support for the cost of compression garments and
MLD are:
www.frontlinecollingwood.ca
www.kellyshiresfoundation.org
www.bcakingston.org
www.fjmp.org (Quebec only)
Check www.cancer.ca for
an extensive database on the community services available to
assist patients.
Assistive Devices Program
Compression garments and sleeves for chronic lymphedema and
extremity pumps for primary lymphedema are partially covered
through the Assistive Devices Program (ADP), Ministry of
Health and Long Term Care. Any resident of Ontario with a
valid health card is eligible to apply for ADP funding. ADP
will pay 75 percent of the approved cost of the device.
Those receiving social assistance benefits may be eligible
to receive more money. Lymphedema compression garments are
replaced as needed to a maximum of three sets of two outfits
each, within a 12-month period.
Solaris Tiny Tributes Policy
Solaris is a manufacturer of compression garments. They have
developed a program called the Tiny Tributes Policy. Through
this program Solaris offers compression garments for free or
at a reduced price for individuals 13 years of age or
younger.
Please contact Lymphedema Depot for more information:
info@LymphedemaDepot.com
Phone: (905) 687-8500
Ministry of Community and Social Services
If you are currently on Disability through The Ministry of
Community and Social Services, you may be eligible for
assistance with treatment costs and travel related expenses.
You must apply and meet certain criteria to be eligible.
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