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Clarifying lymphedema treatment

In regard to your article “Compression bandages effective for lymphedema treatment: McMaster study,” I would like to make a comment. Complex Decongestive Therapy, or CDT, is the established gold standard for the treatment of lymphedema worldwide. As a lymphedema therapist for 15 years I can tell you that I have seen many patients who were given a compression sleeve and glove which did nothing to arrest the development of their lymphedema. The treatment that these patients responded to was CDT, a regimen of regular Manual Lymph Drainage, compression bandaging, decongestive exercise, patient education and meticulous skin care.


November 20, 2013
By John Mulligan RMT

Topics

CDT as the gold standard for treatment of lymphedema is supported by the
International Society of Lymphology
, the International Lymphedema
Framework
, the Canadian Lymphedema Framework, the Lymphology Association of North
America
and the National Lymphedema Network
in the US. The National lymphedema
Network
also has a position paper on the question of treatment of
lymphedema. If you will look up the
position papers on the NLN website you will see that the paper on
treatment of lymphedema cites over 200 sources.
 
The
headline of the article states that “compression bandages are effective
for lymphedema treatment.”  In the study, however, you will see that
bandages were used as part of CDT, and that this was compared to the use
of elastic sleeves and gloves.
 
While I do not advocate
over-treating patients who are in the very earliest stage of lymphedema,
I do recognize that lymphedema is a progressive condition. Patients who
have lymphedema that has progressed into Stage 2 require knowledgeable
and thorough treatment. (Lymphedema has 4 Stages: Stage 0 or latent;
Stage 1, or spontaneously reversible; Stage 2 or spontaneously
irreversible, and Stage 3, or elephantiasis.) Patients in the Stage 0 or
Stage 1 may find that a compression sleeve adequately addresses their
needs. However, the physician and the clinician need to be able to
differentiate between the stages of lymphedema to adequately arrive at
treatment strategies. The sleeve-and-glove approach to lymphedema
therapy as a panacea is an outmoded approach that has resulted in
distress and inadequately treated lymphedema.
 
Please encourage
those who have lymphedema to seek out a qualified lymphedema therapist
with 135 hours or more training in CDT. Massage therapists should
network with the lymphedema therapists in their area to create a
referral network to see that patients are adequately assessed for
treatment, then treated according to their assessment. If a patient who
needs treatment for the lifelong condition of chronic lymphedema
receives only a sleeve and a glove, then they should indeed feel that
their health care has been compromised.

My colleague at Toronto Physiotherapy, Ryan Davey, ran a blog post about this study in late September, after the study was initially published. I think he offers a concise analysis of what the study actually said. You can read his blog post here.

Thank you.
John Mulligan
Registered Massage Therapist
Certified Lymphedema Therapist
Lymphedema Therapy, Education & Consulting


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