For people with chronic lymphedema, the most successful form of treatment is Combined Decongestive Therapy (CDT). CDT is a group of modalities that are used in combination with each other to improve the edematous condition. These modalities include Manual Lymph Drainage (MLD), compression bandages or devices, skin care, therapeutic exercises and self manual lymph drainage techniques. Once the edema has improved, these modalities are then used by the patient at home to maintain the benefits that were initially achieved during therapy by a certified lymphedema therapist. It is important to note that there is no "cure" for chronic lymphedema. However, through the use of CDT, and close medical and therapeutic supervision, lymphedema can be greatly improved and managed.

1. Initial Evaluation
2. Treatment for patients with lymphedema
   1. Intensive Combined Decongestive Therapy (CDT) - Phase I
   2. Developing a Home Maintenance Program - Phase II
   3. Ongoing Optimization Therapy
3. Treatment for patients with mild lymphedema
4. Prevention Counseling
5. Insurance Reimbursement

1. The Initial Evaluation
   The purpose of an initial evaluation is to meet the patient and determine the best course of treatment for the lymphedema. A prescription and referral from a physician is necessary in order to complete the initial evaluation process. If a patient is having difficulty obtaining a referral from a physician, please contact us and we will help in this process. Once an appointment has been made for the initial evaluation, the patient will be mailed a medical history form to complete. The history form should be brought with the patient on the day of the scheduled appointment along with any medical records that the patient may have and a list of current medications.
   The initial evaluation includes the following:
   1. A review of the patient's medical and surgical history.
   2. A review of the patient's lymphedema history.
   3. A physical evaluation by an Occupational or Physical Therapist. May include limb volume measurements, palpation of the tissue, evaluation of strength and Range of Motion, and pictures of the affected area.
      (Please note: pictures are taken of the affected area only with permission
      from the patient. Most typically pictures are taken on the first day of
      treatment.)
   4. Establishment of a treatment care plan.
   5. Education materials are given concerning lymphedema and its course of treatment

    

2. Treatment for patients with lymphedema
   1. Intensive Combined Decongestive Therapy (CDT) - Phase I
      During the initial evaluation it may be determined that daily therapy, called intensive therapy, is recommended for the treatment of the patient's lymphedema. Daily therapy is provided five days a week and can last from one to 4 weeks or longer depending on the severity of the lymphedema. An average treatment course is two weeks. We recommend that the patient wear loose and comfortable clothing during the intensive phase of treatment. Daily therapy includes the following components of CDT:
      1. Manual Lymph Drainage (MLD)
      2. Application of compression bandages or other compression devices
      3. Skin care
      4. Therapeutic exercises. Exercises are adapted for each individual's capabilities.
      5. The education of self manual lymph drainage techniques.

      view photographic examples

      1. Developing a Home Maintenance Program - Phase II
         Once a patient has completed the daily program of CDT, they are then set up with a home program utilizing the tools of CDT to be used ongoing to optimize the benefits achieved through daily intensive therapy. These tools include the following:
         1. Measuring and fitting the patient into a nighttime compression device.
            Wearing compression at night stimulates the lymph system to drain while the patient is sleeping. Lymflo Therapies works with many different companies including the makers of the Reid Sleeve and Jovi-Pak in order to find the most appropriate compression device to help the patient control and manage their lymphedema.
         2. Measuring and fitting the patient into a daytime compression arm sleeve or leg stocking.
            Wearing compression during the day keeps the patient from swelling during daytime hours. It is important that the garments fit appropriately in order to be effective. We work closely with many garment companies to find the most appropriate and comfortable garments to control the lymphedema. Lymflo Therapies also has the ability to fabricate and design custom made garments on site. This is a very unique service in the world of lymphedema management and can be very helpful for difficult-to-fit patients.
         3. Establishing a program of daily self manual lymph drainage techniques and therapeutic exercises.
            Utilizing self MLD and therapeutic exercises at home will continue to optimize and improve the lymphedema.
         4. Establishing a daily skin care program.
            For people with lymphedema, it is important to learn proper skin care techniques in order to prevent skin infections, called cellulitis. Learning to keep the skin healthy will greatly reduce the risk of getting infections.

          

      2. Ongoing Optimization Therapy
         Once patients complete their daily intensive therapy and a home program has been established, it is important that they continue to be followed at Lymflo Therapies. We call this the optimization phase of therapy which means we want patients to continue to improve their lymphedema and maintain the progress achieved with daily therapy. We have found that for patients with chronic lymphedema, they will continue to improve and do better at home if they are followed on an ongoing basis. Initially, once the intensive phase of therapy is completed, patients are followed once to twice a week for approximately one month with manual lymph drainage therapy. The frequency of visits is then extended and optimally patients are followed every four to twelve weeks. Optimization therapy can include the following:
         1. One manual lymph drainage session.
         2. Obtaining measurements of the involved extremity to ensure that compression therapy is effective.
         3. Reviewing self manual lymph drainage techniques, therapeutic exercises and skin care.
         4. Re-measuring for or altering garments and/or compression devices as conditions improve.
         5. According to Medicare guidelines, All Medicare patients are re-certified for treatment by a Physical or Occupational Therapist. Physicians re-certify the treatment provided by an OT or PT. Re-evaluation is done at least every 90 days unless there is a change in condition. If there is a change in condition, the physician is notified. Lymflo Therapies is responsible for these Medicare requirements. Therefore, it is important to notify the office of any changes in medical condition, physician, insurance plans, etc.. The physician may require an office visit to his/her office before re-certification is granted.

       

3. Treatment for patients with mild lymphedema
   It may be determined during your initial evaluation that daily intensive CDT is not
   needed. For patients with a more mild form of lymphedema, some, but not all, of
   the components of CDT may be beneficial. These components may include:
   1. One session of manual lymph drainage every 4-8 weeks
   2. Learning and utilizing self manual lymph drainage techniques
   3. Learning and utilizing therapeutic exercises
   4. Learning and utilizing proper skin care techniques
   5. Wearing a compression arm sleeve or leg garment on a daily or as needed basis.

    

4. Prevention Counseling
   If a patient is at risk for lymphedema (patients who have had lymph nodes removed, radiation therapy, a traumatic injury, a severe infection, or a family history of congenital lymphedema ) but has not yet developed any signs or symptoms of lymphedema, Lymflo Therapies offers the following:
   1. An educational session, called Lymph 101. During Lymph 101, the lymphatic system is discussed including how the patient's medical condition may have disrupted the lymph system. Precautionary measures are then discussed and recommendations are made to prevent the possible onset of lymphedema.
   2. Learning and utilizing self manual lymph drainage techniques.
   3. Learning and utilizing therapeutic exercises.
   4. Learning and utilizing proper skin care techniques.
   5. Fitting the patient into a mild compression arm sleeve or stocking to be used on an as needed basis. These guidelines are discussed and include any activity that may put a stress on the lymphatic system. Use of a compression garment is recommended during exercise, during an airplane flight, and during any activity that requires repetitive motion.

    

5. Insurance Reimbursement
   During the initial evaluation, patients have the opportunity to meet and discuss any insurance issues with the office managers and insurance experts. The patient's initial evaluation and all treatment sessions will be filed through their insurance provider. If a preauthorization is required, Lymflo Therapies will assist the patient in getting the preauthorization. Patients are encouraged to inform the office managers if they have any questions concerning their insurance policy and coverage for the treatment of lymphedema.

Treatment at Lymflo Therapies is covered by most insurance plans including Medicare.

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