Lymphedema Patients Adherence to Combined Decongestive Therapy Treatment (CDT) by Jim Kresse

The lymphedema patient must understand the importance of being pro-active and involved in the treatment of their primary and/or secondary lymphedema.

During my initial patient consultation, I review the lymphatic system, its function, and what occurs when the system fails thereby creating a primary or secondary lymphedema. The best patient is a knowledgeable patient. When the patient understands this information at the onset of treatment, the chances of the patient adhering to the treatment protocol and recommendations increases dramatically. They can visualize what is occurring when the treatment is being administered.

As treatment begins, it is important for the lymphedema therapist to emphasize that success of CDT is based on a team effort between the therapist and the patient, and that 80% of the effort will ultimately be by the patient and 20% by the therapist’s. This means during both Phase I & II of CDT the patient MUST be an active and involved participant. This will include regular attendance at scheduled frequent CDT treatments in spite of a busy schedule, wearing bandages (Phase I) or properly fitted custom compression garments (Phase II), meticulous skin care, diaphragmatic breathing exercises, dietary management, and weight loss (if necessary), daily exercise, use of nocturnal compression bandages, daily wearing of compression garments for the long term, and following the recommendations and guidelines published by the NLN.

However, it is important for the therapist to understand not only their medical and surgical history, but also the emotional impact that illnesses and medical procedures may have had on the individual, including biopsies, lumpectomies, mastectomies, hysterectomies, prostatectomies, venous insufficiency, psycho-social problems or other medical concerns and conditions.

During the consultation and subsequent treatment sessions, the therapist will generally recommend ways for the patient to become actively involved in the treatment. Spouses, family and friends are encouraged to participate in the patient’s treatment regime as well. Information may be provided about lymphedema support groups and about web sites offering information on new research or products that will b useful during both Phases of the treatment. The therapist may help the patient evaluate information about supplements such as horse chestnut extract , dandelion, lemongrass or fennel. All nutritional and exercise changes should be done with the consent of a physician.

Determination, Communication, Trust, Encouragement, Knowledge and Understanding are the quintessential tools for the patient to help achieve success in reducing and maintaining their lymphedema. This became apparent to me when I treated a patient with secondary lymphedema after a axillary lymph node dissection. The patient was angry, depressed, stressed and suicidal. She started the CDT treatment protocol and quit after a week of therapy. Upset with the seemingly barbaric bandaging treatment, and the long stressful daily drive from Brooklyn to Long Island for treatment. I gave her encouragement and told her it was her choice to terminate the treatment but that if she changed her mind I would be there for her.

After two weeks, the patient called an with desperation in her voice, explained that her arm looked like a mannequins arm, no feeling, hard, swollen and heavy. She had no range of motion when lifting and no strength. We made a pact and committed as a team to do whatever was necessary and proceeded with the therapy. After 4 weeks of daily therapy, we were able to start the maintenance phase of her treatment. Her arm circumference reduced by 75%, there was an increase in her range of motion and her arm and hand were softer. Feeling returned to the area, her skin tone and color change were noticeable and she was able to be fitted with a one-piece custom compression hand/arm garment.

She hugged and thanked me for saving her life and her arm and surprised me with a custom plaque naming me as her Guardian Angel which I have displayed proudly in my office for over 10 years. Since then, she has developed lymphedema in her right arm and has proceeded with the treatment. She now wears two one-piece custom compression hand/arm garments to maintain the reduction. This patient has since moved to Virginia and commutes to New York every six to eight weeks for maintenance therapy. The treatment works! Just do it! She now has a slogan, “I have lymphedema but lymphedema does not have me”.

As a therapist, I have felt gratification and pleasure in knowing I have helped patients by sharing knowledge and expertise. For the patients, we ARE winning the battle against this dreadful disease. There is hope. However, we still need better insurance coverage for lymphedema treatment and supplies from Medicare and other insurance companies, on a local and federal level. You can help by contacting your Senators and Congressional representatives.

The success rate for properly performed CDT is high. A lymphedema therapist can be a massage therapist, physical therapist, occupational therapist, nurse or physician who has attended a recognized Lymphedema training course. Make sure to ask if your therapist is certified in CDT, CPT or CDP, depending on which school they have attended. The Lymphology Association of North America (LANA) has high standards of training to qualify a candidate for their examinations to obtain a Lymphedema Therapist (CLT) certification. It is also important to do your research and use the information that the National Lymphedema Network, American Cancer Society and other non-profit groups provide you with on lymphedema.

Patient Adherence Phase I

• Daily CDT, CPT or CDP during Phase I of treatment
• Daily compression bandaging and eventual fitting of daily compression garments
• Daily exercise while wearing compression
• Meticulous skin care
• Weight management
• Diaphragmatic breathing

Maintenance Program Phase II

• Compression garments, compression bandaging, skin care, exercise and diaphragmatic breathing as in Phase I
• Regular replacement an review of compression garments and bandages and alternative compression devices
• Patient Support
• Attend or help start a Lymphedema Support Group
• Become a patient member of the NLN
• Attend the NLN Patient Summit offered once every two years
• Ask for help from your spouse, family, neighbor or friend(s)
• Associate yourself with positive minded individuals for motivation and confidence

Knowledge

• Research
• Internet / Web sites
• Libraries

Alternative Therapies

• Tai-Chi
• Chi Gong
• Yoga
• Meditation
• Acupuncture
• Reiki
• Acupressure
• AMMA Therapy®
• Shiatsu
• Nutritional Support
• Aromatherapy or Ayurveda application
• Homeopathy

Contraindications to CDT, CPT or CDP

• Active untreated cancer
• Acute infection
• Acute or decompensated congestive heart failure
• Acute deep venous thrombosis (blood clots)

Copyright James F. Kresse, AOS, LMT, CLT-LANA, MLDT has been practicing CDT for 14 years. Is the owner of the Creséra Wellness Center in Williston Park, New York, which is a Sponsoring Treatment Center for the National Lymphedema Network, Certified in CDT at the Wittlingers Clinic, Austria. A Facilitator of the 1 in 9: The Long Island Breast Cancer Action Coalition Lymphedema Support Group at Hewlett House. Has assisted Senator Fuschillo’s office with Senate Bill S3015. Has met with NYS Senator Hillary Rodham Clinton asking for her support for better insurance coverage for treatment and supplies. Mr. Kresse can be contacted by e-mail at cresera1@optonline.net or web at www.creserawellness.com.