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Lymphedema Management

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Lymphedema Management

  • Hi all,

    I was recently certified in August and am working at a SNF/Rehab center.  I have several residents who have edema/lymphedema in their UE's and really have little idea how best to treat this.  I know that massage is often effective but that if it is done improperly can actually result in increased swelling.  Any tips or ideas would be greatly appreciated as this is not something that was really covered in school!!

    Thanks! Caryn

    ~*Caryn*~

  • Caryn you are so right that you can do more damage if you don't do the CDT protocols correctly.  I completed the lymphedema management course.  You do need to attend one of the many courses out there that focuses on teaching you the correct techniques.  You can do a search by typing in lymphedema and then compare the various schools for lymphedema and choose one that you feel comfortable with.  It is worth your time and money to do this and I find this technique very rewarding to work with.  You can see improvement in a very short period of time. 

    Jane

  • Thanks Jane,

    Courses are definately something I am looking into as I know this is something I will continue to encounter if I stay at the nursing home.  Any suggestions that I can do until then - I really am clueless!!

    ~*Caryn*~

  • How about contrast baths?  I haven't really come across anything saying yea or nea to this for lymphedema.....  Just trying to come up with some options that I as an entry-level therapist can do...

    ~*Caryn*~

  • Hi Caryn

    I am a Certified Lymphedema therapist... here are a few things that you can do....

    Do simple AROM exercises with the patients...there is nothing better than the muscle pump action to decrease lymphedema. Also are your pts in the early phases where edema is reduced by elevation? if so then ask them to elevate their UE's. Remember heat increases circulation and worsens edema... so no hot baths... cold usually works.... Decongestive therapy includes superficial techniques to reduce edema vs. massage which more deep techniques to increase blood flow to the region...

    Hope this helps...

    J.Z

     

     

     

  • Thank you, that was a big help!  I started working with her on Monday and have already started to see an improvement.

    ~*Caryn*~

  • HI Caryn, 

    I am working with a pt with edema (not early phases) that is limited PROM to form fists.  He has central cord syndrome with slow return in both extremities, especially the right hand.  I have been doing kinesio taping and edema massage as well as educating his caregivers in doing edema massage.  I feel like we're plateuing.  I also just added the tubigrip.  After one day, I have not noticed significant change, but he also is working with PT where he is often up and walking (via Lokomat).  Any other tips?  The edema truly limits the PROM, but is not severe/pitting.  Please help.

    Monika

  • How about e-stim to R wrist/finger flex/ext? Active muscle movement - even if induced by e-stim is more effective than passive.

    Audra Ray, OTR/L

    --- On Wed, 11/18/09, Monika wrote:

    > From: Monika
    > Subject: Re: [practitioner] Lymphedema Management
    > To: audrayot@yahoo.com
    > Date: Wednesday, November 18, 2009, 7:28 PM
    > HI Caryn, 
    > I am working with a pt with edema (not early phases)
    > that is limited PROM to form fists.  He has central
    > cord syndrome with slow return in both extremities,
    > especially the right hand.  I have been doing kinesio
    > taping and edema massage as well as educating his caregivers
    > in doing edema massage.  I feel like we're
    > plateuing.  I also just added the tubigrip.  After
    > one day, I have not noticed significant change, but he also
    > is working with PT where he is often up and walking (via
    > Lokomat).  Any other tips?  The edema truly limits
    > the PROM, but is not severe/pitting.  Please help.
    > MonikaFrom: OTindependence
    >
    > Sent: 2/4/2009 5:21:44 PM
    > Hi Caryn
    > I am a Certified Lymphedema therapist... here are a few
    > things that you can do....
    > Do simple AROM exercises with the patients...there is
    > nothing better than the muscle pump action to decrease
    > lymphedema. Also are your pts in the early phases where
    > edema is reduced by elevation? if so then ask them to
    > elevate their UE's. Remember heat increases circulation
    > and worsens edema... so no hot baths... cold usually
    > works.... Decongestive therapy includes superficial
    > techniques to reduce edema vs. massage which more deep
    > techniques to increase blood flow to the region...
    > Hope this helps...
    > J.Z
    >  
    >  
    >  
    >
    >
    >



    FLAGS (\Seen \Recent)

    Audra Ray, OTR/L

  • We are doing that already with Bioness.  Deep breaths:)  Sometimes it's just humbling to be trying all we can and not see the difference we/I want.
     
    Sincerely,
    Monika Lukasiewicz, OTR/L
    Nationally Certified Occupational Therapist

    "The world is in desperate need of irresistible women: women who are willing to be enthusiastic, alive, and expressive--regardless of the circumstance; women who ...speak up for what they believe in; women who feel at ease being intelligent, sensual, and compassionate all at once; women who ...see everyone for who they really are--fellow human beings also in search of a great life, in search of love." Marie Forleo



    From: audramray <bounce-audramray@aota.org>
    To: n2strengths@yahoo.com
    Sent: Sat, November 21, 2009 8:41:33 PM
    Subject: Re: [practitioner] Lymphedema Management

    How about e-stim to R wrist/finger flex/ext? Active muscle movement - even if induced by e-stim is more effective than passive.

    Audra Ray, OTR/L

    --- On Wed, 11/18/09, Monika <bounce-mcl57015@aota.org> wrote:

    > From: Monika <bounce-mcl57015@aota.org>
    > Subject: Re: [practitioner] Lymphedema Management
    > To: audrayot@yahoo.com
    > Date: Wednesday, November 18, 2009, 7:28 PM
    > HI Caryn, 
    >  I am working with a pt with edema (not early phases)
    > that is limited PROM to form fists.  He has central
    > cord syndrome with slow return in both extremities,
    > especially the right hand.  I have been doing kinesio
    > taping and edema massage as well as educating his caregivers
    > in doing edema massage.  I feel like we're
    > plateuing.  I also just added the tubigrip.  After
    > one day, I have not noticed significant change, but he also
    > is working with PT where he is often up and walking (via
    > Lokomat).  Any other tips?  The edema truly limits
    > the PROM, but is not severe/pitting.  Please help.
    >  MonikaFrom: OTindependence
    > <bounce-OTindependence@aota.org>
    > Sent: 2/4/2009 5:21:44 PM
    > Hi Caryn
    >  I am a Certified Lymphedema therapist... here are a few
    > things that you can do....
    >  Do simple AROM exercises with the patients...there is
    > nothing better than the muscle pump action to decrease
    > lymphedema. Also are your pts in the early phases where
    > edema is reduced by elevation? if so then ask them to
    > elevate their UE's. Remember heat increases circulation
    > and worsens edema... so no hot baths... cold usually
    > works.... Decongestive therapy includes superficial
    > techniques to reduce edema vs. massage which more deep
    > techniques to increase blood flow to the region...
    >  Hope this helps...
    >  J.Z
    >   
    >   
    >   
    >
    >
    >


         
    FLAGS (\Seen \Recent)

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    View this message online at http://otconnections.aota.org/forums/p/613/47836.aspx#47836 or reply to this message
    --

  • How about positioning during the night? Is it elevated? Is the tubigrip tight enough? I've got a pt. with L LE lymphedema that I had to tightly ace wrap for almost 3 months before we were able to get him to almost "normal" levels before receiving a Jobst garment. The tubigrip didn't provide enough mmHG (pressure) to keep his edema down.

    Audra Ray, OTR/L

    --- On Sun, 11/22/09, Monika wrote:

    > From: Monika
    > Subject: Re: [practitioner] Lymphedema Management
    > To: audrayot@yahoo.com
    > Date: Sunday, November 22, 2009, 7:50 AM
    > We are doing
    > that already with Bioness.  Deep breaths:)
    >  Sometimes it's just humbling to be trying all we
    > can and not see the difference we/I want.
    >  Sincerely,
    > Monika Lukasiewicz, OTR/L
    > Nationally Certified Occupational Therapist
    >
    > "The world is in desperate need of irresistible
    > women: women who are willing to be enthusiastic, alive, and
    > expressive--regardless of the circumstance; women who
    > ...speak up for what they believe in; women who feel at ease
    > being intelligent, sensual, and compassionate all at once;
    > women who ...see everyone for who they really are--fellow
    > human beings also in search of a great life, in search of
    > love." Marie Forleo
    >
    > From:
    > audramray
    > To:
    > n2strengths@yahoo.com
    > Sent: Sat,
    > November 21, 2009 8:41:33 PM
    > Subject: Re:
    > [practitioner] Lymphedema Management
    >
    >
    > How about e-stim to R wrist/finger flex/ext? Active muscle
    > movement - even if induced by e-stim is more effective than
    > passive.
    >
    > Audra Ray, OTR/L
    >
    > --- On Wed, 11/18/09, Monika
    > wrote:
    >
    > > From: Monika
    > > Subject: Re: [practitioner] Lymphedema Management
    > > To: audrayot@yahoo.com
    > > Date: Wednesday, November 18, 2009, 7:28 PM
    > > HI Caryn, 
    > >  I am working with a pt with edema (not early
    > phases)
    > > that is limited PROM to form fists.  He has
    > central
    > > cord syndrome with slow return in both extremities,
    > > especially the right hand.  I have been doing
    > kinesio
    > > taping and edema massage as well as educating his
    > caregivers
    > > in doing edema massage.  I feel like we're
    > > plateuing.  I also just added the tubigrip.
    >  After
    > > one day, I have not noticed significant change, but he
    > also
    > > is working with PT where he is often up and walking
    > (via
    > > Lokomat).  Any other tips?  The edema truly
    > limits
    > > the PROM, but is not severe/pitting.  Please
    > help.
    > >  MonikaFrom: OTindependence
    > >
    > > Sent: 2/4/2009 5:21:44 PM
    > > Hi Caryn
    > >  I am a Certified Lymphedema therapist... here
    > are a few
    > > things that you can do....
    > >  Do simple AROM exercises with the
    > patients...there is
    > > nothing better than the muscle pump action to
    > decrease
    > > lymphedema.
    > Also are your pts in the early phases where
    > > edema is reduced by elevation? if so then ask them to
    > > elevate their UE's. Remember heat increases
    > circulation
    > > and worsens edema... so no hot baths... cold usually
    > > works.... Decongestive therapy includes superficial
    > > techniques to reduce edema vs. massage which more
    > deep
    > > techniques to increase blood flow to the region...
    > >  Hope this helps...
    > >  J.Z
    > >   
    > >   
    > >   
    > >
    > >
    > >
    >
    >
    >      
    > FLAGS (\Seen \Recent)
    >
    > --
    > View this message online at http://otconnections.aota.org/forums/p/613/47836.aspx#47836
    > or reply to this message
    > --
    >
    >
    >
    >
    >
    >
    >
    >
    >
    >
    >



    FLAGS (\Seen \Recent)

    Audra Ray, OTR/L

  • mmm, good ideas.  I'll check on that.  And do you do tubigrip first or wrap with ace-ish bandage?
     
    Sincerely,
    Monika Lukasiewicz, OTR/L
    Nationally Certified Occupational Therapist

    "The world is in desperate need of irresistible women: women who are willing to be enthusiastic, alive, and expressive--regardless of the circumstance; women who ...speak up for what they believe in; women who feel at ease being intelligent, sensual, and compassionate all at once; women who ...see everyone for who they really are--fellow human beings also in search of a great life, in search of love." Marie Forleo



    From: audramray <bounce-audramray@aota.org>
    To: n2strengths@yahoo.com
    Sent: Sun, November 22, 2009 1:20:48 PM
    Subject: Re: [practitioner] Lymphedema Management

    How about positioning during the night? Is it elevated?  Is the tubigrip tight enough?  I've got a pt. with L LE lymphedema that I had to tightly ace wrap for almost 3 months before we were able to get him to almost "normal" levels before receiving a Jobst garment. The tubigrip didn't provide enough mmHG (pressure) to keep his edema down.

    Audra Ray, OTR/L

    --- On Sun, 11/22/09, Monika <bounce-mcl57015@aota.org> wrote:

    > From: Monika <bounce-mcl57015@aota.org>
    > Subject: Re: [practitioner] Lymphedema Management
    > To: audrayot@yahoo.com
    > Date: Sunday, November 22, 2009, 7:50 AM
    > We are doing
    > that already with Bioness.  Deep breaths:)
    >  Sometimes it's just humbling to be trying all we
    > can and not see the difference we/I want.
    >  Sincerely,
    > Monika Lukasiewicz, OTR/L
    > Nationally Certified Occupational Therapist
    >
    > "The world is in desperate need of irresistible
    > women: women who are willing to be enthusiastic, alive, and
    > expressive--regardless of the circumstance; women who
    > ...speak up for what they believe in; women who feel at ease
    > being intelligent, sensual, and compassionate all at once;
    > women who ...see everyone for who they really are--fellow
    > human beings also in search of a great life, in search of
    > love."  Marie Forleo
    >
    > From:
    > audramray <bounce-audramray@aota.org>
    > To:
    > n2strengths@yahoo.com
    > Sent: Sat,
    > November 21, 2009 8:41:33 PM
    > Subject: Re:
    > [practitioner] Lymphedema Management
    >
    >
    > How about e-stim to R wrist/finger flex/ext? Active muscle
    > movement - even if induced by e-stim is more effective than
    > passive.
    >
    > Audra Ray, OTR/L
    >
    > --- On Wed, 11/18/09, Monika <bounce-mcl57015@aota.org>
    > wrote:
    >
    > > From: Monika <bounce-mcl57015@aota.org>
    > > Subject: Re: [practitioner] Lymphedema Management
    > > To: audrayot@yahoo.com
    > > Date: Wednesday, November 18, 2009, 7:28 PM
    > > HI Caryn, 
    > >  I am working with a pt with edema (not early
    > phases)
    > > that is limited PROM to form fists.  He has
    > central
    > > cord syndrome with slow return in both extremities,
    > > especially the right hand.  I have been doing
    >  kinesio
    > > taping and edema massage as well as educating his
    > caregivers
    > > in doing edema massage.  I feel like we're
    > > plateuing.  I also just added the tubigrip.
    >  After
    > > one day, I have not noticed significant change, but he
    > also
    > > is working with PT where he is often up and walking
    > (via
    > > Lokomat).  Any other tips?  The edema truly
    > limits
    > > the PROM, but is not severe/pitting.  Please
    > help.
    > >  MonikaFrom: OTindependence
    > > <bounce-OTindependence@aota.org>
    > > Sent: 2/4/2009 5:21:44 PM
    > > Hi Caryn
    > >  I am a Certified Lymphedema therapist... here
    > are a few
    > > things that you can do....
    > >  Do simple AROM exercises with the
    > patients...there is
    > > nothing better than the muscle pump action to
    > decrease
    > > lymphedema.
    >  Also are your pts in the early phases where
    > > edema is reduced by elevation? if so then ask them to
    > > elevate their UE's. Remember heat increases
    > circulation
    > > and worsens edema... so no hot baths... cold usually
    > > works.... Decongestive therapy includes superficial
    > > techniques to reduce edema vs. massage which more
    > deep
    > > techniques to increase blood flow to the region...
    > >  Hope this helps...
    > >  J.Z
    > >   
    > >   
    > >   
    > >
    > >
    > >
    >
    >
    >      
    >  FLAGS (\Seen \Recent)
    >
    > --
    > View this message online at http://otconnections.aota.org/forums/p/613/47836.aspx#47836
    > or reply to this message
    > --
    >
    >
    >
    >
    >
    >
    >
    >     
    >
    >
    >


         
    FLAGS (\Seen \Recent)

    --
    View this message online at http://otconnections.aota.org/forums/p/613/47844.aspx#47844 or reply to this message
    --

  • What I usually do is wash the extremity, lotion, then ace wrap. More pressure distally, less proximally.
    With the hand, I would use 2 inch ace wrap or 1 inch coban at the fingers, then wrap distal to proximal, using 3-4 inch ace wrap for the wrist and proximal (covering as much edema as you can). Leave the fingernails open to check circulation. If circulation is decreased, it's too tight and you have to rewrap.

    Audra Ray, OTR/L

    --- On Mon, 11/23/09, Monika wrote:

    > From: Monika
    > Subject: Re: [practitioner] Lymphedema Management
    > To: audrayot@yahoo.com
    > Date: Monday, November 23, 2009, 7:58 PM
    > mmm, good ideas.
    >  I'll check on that.  And do you do tubigrip
    > first or wrap with ace-ish bandage?
    >  Sincerely,
    > Monika Lukasiewicz, OTR/L
    > Nationally Certified Occupational Therapist
    >
    > "The world is in desperate need of irresistible
    > women: women who are willing to be enthusiastic, alive, and
    > expressive--regardless of the circumstance; women who
    > ...speak up for what they believe in; women who feel at ease
    > being intelligent, sensual, and compassionate all at once;
    > women who ...see everyone for who they really are--fellow
    > human beings also in search of a great life, in search of
    > love." Marie Forleo
    >
    > From:
    > audramray
    > To:
    > n2strengths@yahoo.com
    > Sent: Sun,
    > November 22, 2009 1:20:48 PM
    > Subject: Re:
    > [practitioner] Lymphedema Management
    >
    >
    > How about positioning during the night? Is it
    > elevated?  Is the tubigrip tight enough? 
    > I've got a pt. with L LE lymphedema that I had to
    > tightly ace wrap for almost 3 months before we were able to
    > get him to almost "normal" levels before receiving
    > a Jobst garment. The tubigrip didn't provide enough mmHG
    > (pressure) to keep his edema down.
    >
    > Audra Ray, OTR/L
    >
    > --- On Sun, 11/22/09, Monika
    > wrote:
    >
    > > From: Monika
    > > Subject: Re: [practitioner] Lymphedema Management
    > > To: audrayot@yahoo.com
    > > Date: Sunday, November 22, 2009, 7:50 AM
    > > We are doing
    > > that already with Bioness.  Deep
    > breaths:)
    > >  Sometimes it's just humbling to be trying
    > all we
    > > can and not see the difference we/I want.
    > >  Sincerely,
    > > Monika Lukasiewicz, OTR/L
    > > Nationally Certified Occupational Therapist
    > >
    > > "The world is in desperate need of irresistible
    > > women: women who are willing to be enthusiastic,
    > alive, and
    > > expressive--regardless of the circumstance; women who
    > > ...speak up for what they believe in; women who feel
    > at ease
    > > being intelligent, sensual, and compassionate all at
    > once;
    > > women who ...see everyone for who they really
    > are--fellow
    > > human beings also in search of a great life, in search
    > of
    > > love."  Marie Forleo
    > >
    > > From:
    > > audramray
    > > To:
    > > n2strengths@yahoo.com
    > > Sent: Sat,
    > > November 21, 2009 8:41:33 PM
    > > Subject: Re:
    > > [practitioner] Lymphedema Management
    > >
    > >
    > > How about e-stim to R wrist/finger flex/ext? Active
    > muscle
    > > movement - even if induced by e-stim is more effective
    > than
    > > passive.
    > >
    > > Audra Ray, OTR/L
    > >
    > > --- On Wed, 11/18/09, Monika
    > > wrote:
    > >
    > > > From: Monika
    > > > Subject: Re: [practitioner] Lymphedema
    > Management
    > > > To: audrayot@yahoo.com
    > > > Date: Wednesday, November 18, 2009, 7:28 PM
    > >
    > > HI Caryn, 
    > > >  I am working with a pt with edema (not
    > early
    > > phases)
    > > > that is limited PROM to form fists.  He has
    > > central
    > > > cord syndrome with slow return in both
    > extremities,
    > > > especially the right hand.  I have been
    > doing
    > >  kinesio
    > > > taping and edema massage as well as educating
    > his
    > > caregivers
    > > > in doing edema massage.  I feel like
    > we're
    > > > plateuing.  I also just added the tubigrip.
    > >  After
    > > > one day, I have not noticed significant change,
    > but he
    > > also
    > > > is working with PT where he is often up and
    > walking
    > > (via
    > > > Lokomat).  Any other tips?  The edema
    > truly
    > > limits
    > > > the PROM, but is not severe/pitting.
    >  Please
    > > help.
    > > >  MonikaFrom: OTindependence
    > > >
    > > > Sent: 2/4/2009 5:21:44 PM
    > > > Hi Caryn
    > > >  I am a Certified Lymphedema therapist...
    > here
    > > are a few
    > > > things that you can do....
    > > >  Do simple AROM exercises with the
    > > patients...there is
    > > > nothing better than the muscle pump action to
    > > decrease
    > > > lymphedema.
    > >  Also are your pts in the early phases where
    > > > edema is reduced by elevation? if so then ask
    > them to
    > > > elevate their UE's. Remember heat increases
    > > circulation
    > > > and worsens edema... so no hot baths... cold
    > usually
    > > > works.... Decongestive therapy includes
    > superficial
    > > > techniques to reduce edema vs. massage which
    > more
    > > deep
    > > > techniques to increase blood flow to the
    > region...
    > > >  Hope this helps...
    > > >  J.Z
    > > >   
    > > >   
    > > >   
    > > >
    > > >
    > > >
    > >
    > >
    > >      
    > >  FLAGS (\Seen \Recent)
    > >
    > > --
    > > View this message online at http://otconnections.aota.org/forums/p/613/47836.aspx#47836
    >
    > > or reply to this message
    > > --
    > >
    > >
    > >
    > >
    > >
    > >
    > >
    > >     
    > >
    > >
    > >
    >
    >
    >      
    > FLAGS (\Seen \Recent)
    >
    > --
    > View this message online at http://otconnections.aota.org/forums/p/613/47844.aspx#47844
    > or reply to this message
    > --
    >
    >
    >
    >
    >
    >
    >
    >
    >
    >
    >



    FLAGS (\Seen \Recent)

    Audra Ray, OTR/L

  • Thank you for all your help.  I ended up doing massage to the arm and medial epicondyle of his elbow and then sweeping gently towards his armpit across his upper arm.  We'll see how it went (over the weekend).  I found a lymphedema trained PT at work, too!