The physician-directed program employs a safe and effective method of treatment known as Complete Decongestive Therapy (CDT). CDT is the gold standard for lymphedema treatment.
The very specialized treatment plan will be designed for the patient after the initial evaluation. The plan may include components outlined below.
Lymphedema management services are appropriate for patients with swelling of face, head, neck, chest, back, breast, upper and lower extremity, abdomen and the groin. The lymphedema may be primary or as a consequence of tumor, surgery, radiation, obesity, trauma, infection, connective tissue or vascular disorder.
Many patients who are at risk for lymphedema or have swelling for other reasons will visit the Lymphedema Center for consultation regarding prevention, appropriate diagnosis and triage.
The Greater Baltimore Lymphedema & Rehabilitation Center sees patients from all over the country. Not infrequently, patients will visit the Center for consultation. The Center's medical director and therapists will work to support the patient's needs that might include care at GBMC or through their local lymphedema therapists.
Most patients will be referred to the medical director for consultation. Evaluation will include a history and physical and review of prior care. The doctor will communicate with the patient's referring or primary care physician regarding concurrent medical issues, medications that have side effects of swelling, and wound care (if needed). Critical to the evaluation is a review of exercise and dietary components.
The medical director will work with the therapy team to refine the prescription for therapy and appropriate garments and therapeutic devices. He will periodically follow up during Phase I and Phase II of care to address issues such as infections, phlebitis, peri-operative preparation, medications and changes in other medical conditions.
Meticulous skin care is provided and taught to the patient to prevent bacterial and fungal infections. Careful management of skin and nails is necessary and can be done by the patient, care giver or podiatrist.
The goal of specialized therapeutic massage is to improve the transport capacity of the lymphatic system and to redirect the fluid to areas where it can be reabsorbed. The lymph vessel system is a drainage system. There are specific directions of lymph fluid flow the therapist will promote with massage stroke sequences that depend on the severity and location of the swelling. The therapists also, at times, will address the concurrent presence of tumor, mass, injury, scar or other impediments.
Low stretch bandages, foam and special padding are applied to the affected areas to help dissipate fluid and to soften hardened tissues. These gradient bandages will be worn continuously between daily therapy visits during Phase I of therapy.
Exercise is a critical component to complete decongestive therapy. Fluid mobilizing exercises will be performed and taught to promote lymphatic flow, and can be tailored to individual physical abilities. Patients with all levels of mobility will be addressed. The GBMC rehabilitation gym is dedicated to the needs of our patients. There is up-to-date equipment not only for the use of patients with swelling but also those with bariatric, oncology, or orthopedic exercise needs.
For a number of patients, range of motion and stiffness is a result of surgery, radiation, chemotherapy, and periods of immobility. The therapist will create a plan that addresses a safe approach to recover flexibility and mobility. Other patients have decreased strength, stamina and goals for these areas will also be outlined.
Fibrosis that is visible (scar) or internal (adhesions) can impede lymphatic flow and can result in pain, swelling, infection, and limitation to motion. The scars can be hypertrophic and unsightly. Therapist's can employ techniques to soften scars, ease fibrosis, and minimize symptoms. This results in greatly improved mobility and enhanced function.
Enhancing the activities of daily living (ADL) are critical to the quality of life to the patient. Improving the ability to care for one self will be addressed to promote the patient and caregiver's independence in the safe management of the Lymphedema.
The patient and caregiver will learn new skills and be provided with tools to properly manage the condition. Prevention of progression and loss of function will be emphasized. These steps include issues of concurrent disorders, nutrition, ADL's (activities of daily living), exercise, wounds, skin infections, medications, garments, and travel. 18 Steps to Prevention
Lymphedema patients are at higher risk for the development of wounds and skin infections (cellulitis). A wound often needs specialized care before lymphedema treatment can begin. Some wounds heal only if the lymphedema is managed and reduced concurrently. The medical director will determine the sequence of the patient's care. A patient who first needs specialized wound care services may be referred to a wound care center. The patient has the option of being treated at the affiliated GBMC Wound Care Center - one of the largest centers on the east coast. Cellulitis is a common disorder often requiring hospitalization in lymphedema patients. Early recognition and treatment usually prevent these hospitalizations.
The success of the program will depend on the patient's ability to attend regular appointments and solve any type of transportation or work-leave issues. It is the patient's responsibility at the time of evaluation to address concerns that may impede the success of the program they wish to embark on.
For those who require using gradient compression garments (sleeves, stockings, or face/neck band), these will be carefully measured for and prescribed. The responsibility in Phase II will be on the patient or caregiver to wear the compression garments as prescribed, which often is daily.
It will be the patient's responsibility to continue with therapeutic exercises that benefit lymphatic flow. There may be individual instructions geared for those challenged by bariatrics, orthopedics, or oncology.
Part of the home management of Lymphedema sometimes includes the use of a gradient compression pump. It will be the patient's responsibility to follow the prescribed regimen in use of such a pump. It is the responsibility of the team to recommend the type of pump appropriate for the patient.
Because extra pounds make it more difficult for the patient to control lymphedema, weight loss is emphasized. The staff may include referrals to dietitians or weight management programs. The therapist may guide the patient in exercise that promotes weight loss. In addition to exercise, those with weight loss goals will essentially be expected not to gain weight and work toward healthier lifestyle. Certainly referrals to specialists will be made if requested. Such specialists might be dietitians or bariatric physicians.
For the oncology patients who are on a plan to regain weight, every effort by the Lymphedema & Rehabilitation Center will be made to coordinate and support recommendations made by the oncology team treating the patient. For GBMC oncology patients, there is a registered dietitian who is specialized in nutritional needs offering consultation for the recovering GBMC cancer patients.
Lymphedema is usually a chronic condition which requiring ongoing self-management. Regular follow up visits will be recommended for optimal results.