Before & After
The following article originally appeared in the newsletter of
(Lymphedema Association of Ontario) http://www.lymphontario.ca
Your First Visit to a Manual Lymph Drainage Therapist
by John Mulligan, RMT/CLT-LANA
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
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
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
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!