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      John Mulligan, RMT/CLT-LANA

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Before & After




The following article originally appeared in the newsletter of the LAO

(Lymphedema Association of Ontario)

Your First Visit to a Manual Lymph Drainage Therapist
by John Mulligan,

You've been through the battle with cancer, the surgery, the chemo, the radiation, and you're amazed and happy to have survived and just want to get on with your life. Then, you notice your arm – the one the lymph nodes have been removed from it feels uncomfortable and heavy. You ignore it for a while. Then, after a few weeks, you notice that the sleeves of your blouses aren't fitting on one side: they're too tight. Finally, when you go to your doctor for a follow-up visit, you mention that you think your arm is swollen. The doctor diagnoses you with Lymphedema, a chronic swelling of the arm, and, ideally, sends you to a specialized therapist.

This is not the only scenario that might occur before a visit to a Lymphedema specialist. Lymphedema can be inherited and develop in the legs. Or, it can accompany poor circulation in the legs (chronic venous insufficiency), progressing over time into swollen legs below the knees. Lymphedema can present in a number of ways, and your Lymphedema therapist is qualified and experienced in the treatment of this condition however it develops.

What should you expect from your first visit to a Lymphedema therapist?

First of all, you should expect to learn more about your condition, its causes and what adjustments you should make to your daily life to minimize the effects of the condition. Your therapist should be able to explain all of this clearly, and answer any questions you might have. You will be told that while there is no cure, Lymphedema is a condition that is manageable through treatment. You should be told at this time that you will be participating in your therapy. You will be expected to learn to manage your condition yourself, over time, and to make adjustments in your lifestyle to accommodate this new condition.

Many Lymphedema patients, especially cancer survivors, find this news especially devastating. After the struggle with cancer, they are now told that they have a permanent condition, which they perceive to be disfiguring. However, with appropriate management, Lymphedema doesn't necessarily cause disfigurement. However, adjustments in lifestyle will be required.

What else happens at that first visit? The therapist will take an extensive health history as well as recording the history of your condition. You will probably have to answer questions you've already answered several times before! Afterwards, your therapist will outline what you can expect over the course of treatment, what steps will be taken; what you can do as a patient and approximately how long your course of treatment will last.

The therapist will then take measurements of your swollen arm or leg, as well as measurements of its opposite, unaffected limb. This will help to chart your progress through treatment, and to discover what amount of swelling reduction is the long-term, ideal goal of the therapy.

Next, the therapist might want to take a picture of your limb – both the swollen limb, and the unaffected limb. Not all therapists will include this step, but as a patient, you may wish to bring your own camera and request that a photo record be included in your treatment. The photo can be a valuable reference tool later. While it might make you somewhat uncomfortable to be photographed, you will be pleased following treatment to see both the 'before' and 'after' pictures and realize how much the swelling has been reduced.

You will be asked to disrobe for your treatment. Typically, the therapist will leave the room while you disrobe, and you will be provided with sheets so that you are not uncomfortable or inappropriately exposed. The therapist will only expose the area of the body that is being worked on at a given time.

The Manual Lymph Drainage treatment at your first visit will be shorter than subsequent treatments, due to the amount of other work, such as record- taking and education, that needs to be done at the first appointment. Manual Lymph Drainage (MLD) is a very pleasant specialized form of massage that will include more than just the swollen limb. You will lie on the treatment table on your back for the first part of the therapy. The technique should be very relaxing, and it should relieve some of the tightness and discomfort in your limb at the very first treatment. At subsequent treatments, MLD should last about an hour for an arm patient or slightly longer for a leg patient.

Following MLD, the therapist will apply compression bandaging to your affected limb. The entire limb will be wrapped in several layers of special 'short-stretch' bandages, starting with a thin layer of foam. The bandaging may seem heavy and bulky, and the correct procedure of applying it may seem complicated at first. Eventually, though, you will learn to apply the bandaging to yourself. Bandaging is an important component of your care and contributes tremendously to the success of your treatment. After you are through the initial phase of treatment, which has the most dramatic impact on swelling reduction, you will be fitted for a compression garment, which will replace daytime bandaging. Some patients will continue to bandage routinely at night, depending on the severity of their condition.

After the bandaging, your first session will be over. In the initial phase of treatment, your next treatment will ideally take place the next day. You will be expected to wear your bandages overnight, removing them only to shower just before your treatment. The bandaging should not cause pain, tingling, or numbness. If it does, you should try removing a layer, or even more, until it is no longer causing discomfort and discuss it with the therapist the next day.

Congratulations! You have now begun a partnership with your therapist that will result in a significant reduction in swelling and discomfort. You will be learning to manage your own condition and be the master of it. You may have Lymphedema, but with good self -care and support, you can live with it in a way that is not too disruptive of your life. After all, you have now taken charge of it!




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