Decongestive Lymphoedema Management

Decongestive Lymphoedema Management

Your doctor may have suggested to youthat you need to see a lymphoedema therapist for treatment of your swollen limb or other body part. Lymphoedema Management is an individual approach depending on your specific presentation. In most cases there is a six step process in effectively treating your lymphoedema.

Step 1 – Manual Lymphatic Drainage (MLD)

The Dr. Vodder Method of Manual Lymph Drainage or Lymphatic Massage is successfully applied at our Center. This special massage technique uses circular and spiral shaped movements. The strokes involve gentle skin-to-skin contact resulting in the skin being moved over the underlying tissue: the Dr. Vodder Method of MLD works with the skin and not on the skin.

It increases and decreases pressure, this change in pressure creating the necessary pumping effect. The direction of the increase of pressure lies in the direction of the lymph flow.

The technique is generally applied to dry skin. If the skin does not move in certain areas (e.g. due to scars, ulcer margins, firm edemas), or if the skin is very dry or rough, some oil may be applied.

These special strokes will not cause redness of the skin, nor will they cause pain. The speed at which strokes follow on one another is determined by the maximum frequency of lymphangiomotoricity, i.e. the rate of contraction used by the lymphangion to transport the lymph fluid.

The Dr. Vodder technique always begins with treating the lymph nodes and lymph vessels found at the neck and the junction of the large lymph channels in the venous arch on both sides of the body.

For MLD to be effective, use of the proper specialist technique and adaptation of the length of individual therapy sessions to meet the needs of the pathology concerned are essential. A typical MLD session requires 30 to 45 minutes, but may be extended to 90 minutes depending on the indication.

Step 2 – Bandaging

Bandaging increases both lymph and venous return, and also serves to soften fibroses. Fibroses are changes in skin texture frequently associated with lymphedema. The proteins accumulated in the tissue cause the tissue to harden.

I use Lohmann-Rauscher long stretch and short stretch bandaging. The specific properties of these different bandages produce specific effects in the lymphedematous arms or legs.

Bandaging consists of using various foams in accordance with both La Place and Pascal’s law bandaging is appropriate to ensure the correct curvature and pressure to continue to reduce you oedema.

Step 3 – Excercises

Once you have your bandages on the next important step is to excercise, depending on your individual physical abilities you will be given excercise to perform at home. The Dr. Vodder Method of Manual Lymph Drainage results in a marked reduction of edema. To maintain this result or improve it further, the therapist bandages the affected limb(s). Any movement with the bandaged limb will reduce edema volume for the following reasons:

a) In addition to the “pressure” of the bandages moving the extremity creates a strong compression with the muscels. All vessels (veins and lymphvessels)who are in between bandage and muscles will be drained by this force.

This leads to an quicker bloodstream and improves a better backflow of the lymphatic system.

b) Needing more oxygene the arterial bloodstream will be raised automatically by an higher muscleacitivy. Close to the arteries a lot of lymphvessels are situated.

The higher pulsation of the arteries has an stimulating effect on the lymphatic system. That’s why we have a better drainage of the deep lymph vessel system.

Step 4 – Skin Care

Correct skin care is vital to the health of your lymphoedema. Lymphoedema stretches the skin which amongst other problems causes a disturbance in the acid mantle. The skin provides a barrier and it is vital to ensure there is no disturbance to this defence. We teach you how to care for your skin and will provide samples of proven products to ensure good skin care.

Step 5 – Nutrition

The currently most effective conservative therapy for lymphedema is Combined Decongestive Therapy or CDT. It consists of Manual Lymph Drainage (Dr. Vodder Method), compression bandaging, special skin care and accompanying physical therapy regime.  Nutrition plays an important medium and long term role within this CDT approach.

A long term solution can only consist in a healthy diet.

Being overweight is one of the main reasons for the development of edema. The accumulated excess fatty tissue allows more body water to be stored. Hence a first step in disease management should be to achieve an appropriate degree of targeted weight.

A positive attitude and an I’m-doing-something-for-myself mindset are the best preconditions for dietary change. Learning more about one’s own eating habits offers the opportunity to change them effectively and durably. Lose fat while retaining muscular strengthDuring weight loss muscles need to be kept in shape or built up. This is how your Basal Metabolic Rate (BMR, i.e. the number of calories your body burns to sustain vital functions) is maintained, thus avoiding the yo-yo cycle. Moreover, trained muscles support the venous and lymphatic system and thus help drain excess fluid accumulated in the body. Hence muscle building proteins should not be neglected in your daily diet.

Common salt contains sodium, which binds water in the body. In other words: if you consume too much salt, your body will retain unnecessary body fluid and therefore enhance edema formation.

A high salt diet also increases blood pressure, no matter whether you use table salt, herb salt, sea salt or Himalayan salt.

1 teaspoon of salt per day (approx. 5 g) corresponds to the recommended daily amount.

Cheese or convenience food, ready made sauces, etc., contain a lot of salt. Hence make an effort to eat fresh natural food as often as possible. Use generous portions of herbs and spices as an alternative to salt.

Step 6 – Compression Garments 

After the Decongestive phase of treatment ends you will be measured and fitted for a compression garment, the style, make and cost will vary based on your individual presentation. There are various garment subsidy schemes available depending on your medical reason for your oedema, health fund staus and income status we are able to assist you in working through this information.

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