Helping Patients with Lymphedema

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The following article was provided by Pam Renneberg, member of the RMTAO and member of the Lymphedema Association of Ontario, who discusses her experiences as a Certified Lymphedema Therapist and why she believes it is an important tool that RMTs can add to their practices.

Please allow me to introduce myself both personally and professionally.

I have been practicing as a Registered Massage Therapist since 2000. The same year I opened my clinic my mom was diagnosed with breast cancer. I came to the realization that I would require additional training to assist with her potential lymphedema requirements. I pursued further education in Combined Decongestive Therapy and became a Certified Lymphedema Therapist in 2008. Additionally I have since received an Authorizer status with the Assisted Device Program offered through the Ministry of Health. This allows me to assist patients to pursue financial funding toward their compression garments.

After receiving my Combined Decongestive Therapy certification my practice became more Lymphedema focused by the day primarily treating breast cancer patients.Ironically, I unfortunately also became diagnosed with breast cancer in 2010. Upon my return to the office, I resumed my passion for treating Lymphedema patients. The Lymphedema patient base has now grown to the point of being the primary focus of treatment at my office. I now look at my breast cancer diagnosis as a blessing in disguise. I know my personal journey with breast cancer offers comfort to my patients. My goal is to provide my skills as a professional and share my personal experience openly. Sharing stories, discussing symptoms, feelings or simply validating thoughts has provided a great deal of comfort to many of my patients.

I will now provide some background to help you understand this practice focus.

Lymphedema is a chronic form of swelling due to various causes which impair the lymphatic system. Secondary lymphedema is commonly caused by cancer related procedures such as lymph node removal and/or radiation. It can also occur due to obesity, various traumas or an impaired circulatory system. Secondary lymphedema in essence presents in the localized region of the impaired lymphatics.

Primary lymphedema is a congenital form of lymphedema, therefore individuals are born with an abnormality of the lymphatic system. Primary lymphedema is subdivided in to various categories resulting in onset at various stages of life. Primary lymphedema essentially involves the lower extremity however it can be present in other areas of the body.
Currently there is no cure for lymphedema. It is essential anyone living with or at risk of developing lymphedema seek a Combined Decongestive Therapist to receive instruction on how to control and manage their lymphedema.

Alongside obvious swelling, lymphedema can cause pain, burning, tightness and heaviness. Disfigurement and immobility can occur with some progressive conditions. Clothing and/or footwear may need to be modified. Social anxiety can develop. Financial strain is frequently experienced.

I have had the pleasure to assists many patients with their lymphedema over the last 13 years. Initially, I provide a consultation/assessment. Education is provided so the patient understands the condition they are facing. Education regarding how to manage the risks of lymphedema, what to avoid and awareness of cautionary risks such as cellulitis are discussed in detail. Discussion includes how to control and manage their lymphedema with manual lymphatic drainage treatments, skin care, exercise, bandaging and/or compression use. Baseline measurements are taken. A follow up appointment is scheduled so the patient can experience a treatment and receive instruction on self-massage. A treatment plan is then established as per the patient’s presentation and suitable to their individual needs. It is definitely a team effort. The aim is to establish independence and strive for improved quality of life. I ensure the patient is aware that what care they provide themselves at home is just as important as what care I provide in the office. In fact in some ways it’s greater as their self-care keeps them going in the right direction between office visits.

I have experienced tremendous gratification assisting patients with their lymphedema. Patients are appreciative to receive their self-management education. They are grateful to receive validation regarding what they have been experiencing. It is extremely rewarding when a patient expresses relief experienced post-treatment or the thrill of discovering a device that assists in the application of their garments. All establishing independence for their care and resulting in improved quality of life. I fondly remember a patient who presented with bilateral lower extremity lymphedema. Her feet so involved she had to wear her husband’s shoes to the appointment. I initiated an intensive phase of treatment incorporating manual lymphatic drainage and decompression bandaging. The patient was extremely compliant. One day I hear the clicking of women’s shoes walking down the hallway toward my office. It was her! We had achieved our goal. It was such a feeling of triumph and a pure delight that I will always hold dear.

Currently one million Canadians are living with lymphedema yet it remains under-recognized, underfunded and access to qualified care remains limited. For Registered Massage Therapists interested in becoming a certified as Lymphedema therapist a minimum of 135 hours of Combined Decongestive Therapy must be completed. This is definitely a rewarding area to work in, and I would recommend this training if you’re interested in helping patients with lymphedema. For additional information contact the Lymphedema Association of Ontario or the National Lymphedema Network.

For those who do not have the training, here are a few additional tips to assist you in recognizing the signs of lymphedema so you can refer out to a Certified Lymphedema therapist when necessary. Your patient may present with swelling, discomfort, tightness, burning sensation, heaviness, fullness, noting their clothing or jewelry is fitting tightly or there is less wrinkling in their skin. Signs of infection could be redness, increased swelling, increased localized warmth, and feeling of malaise. If any redness appears to be spreading the patient is advised to seek immediate emergency assistance.

Anyone entering into or has previously received cancer treatment should be referred to a qualified therapist. The earlier they can receive the education regarding how to control and manage potential lymphedema the better. Ideally treatment should be initiated prior to an obvious sign of swelling at a subclinical stage where no measureable difference is apparent. There are a small number of RMTs who are Certified Lymphedema Therapists, and if you don’t have the training yourself, you can help your patients find a qualified therapist in their area on lymphontario.ca/directory. 

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