National Lymphedema Network
Lymph e-Channel vol. 4 May-June 2011
In This Issue · Welcome · Therapist's Article · Patient Perspective · MySassySleeve · Sponsor A Patient · Educate Your Legislator Patients: We want to share your stories! Don't forget to send us a short paragraph of your experiences with lymphedema for us to publish! You can also send us photo to accompany your article if you are interested. All submissions should go torobin@lymphnet.org. Net Pals / Pen Pals Looking to correspond with with a special person in a faraway (or not so faraway) place who also has lymphedema? Look no further than the NLN Lymphedema Pen Pals/NetPals Network! Net Pals / Pen Pals Position Papers    Diagnosis & Treatment of Lymphedema     New! Breast Cancer Related Lymphedema  Risk Reduction     Exercise       Air Travel Quick Links National Lymphedema Network Cafepress Store	Welcome to Lymph e-Channel  Dear friends of the NLN, My staff and I are thrilled to send you our latest issue of Lymph e-Channel. In this May/June edition you will find a range of inspirational and educational articles contributed by therapists and patients. This month we highlight a perplexing phenomenon - cording. Cording frequently occurs shortly after breast cancer surgery, and it is only in the last decade that practitioners have seriously addressed these unknown painful symptoms. Jodi Winicour, a lymphedema therapist and expert in BC rehabilitation, shares her knowledge and guidance on this subject. Dr. Nancy Hutchison, the chair of the NLN Medical Advisory Committee, recently invited her state representatives to visit her hospital where she educated them about lymphedema. One of her patients even showed the representatives her leg and demonstrated self-care. We are lucky to have a knowledgeable LE doctor who makes time to advocate for patients rights, and we hope that you will organize a similar meeting in your community. In our patient perspective, Margaret Omori recounts her initial dismay with her lymphedema diagnosis following BC surgery, but also how she found a positive outlook from it all. Margaret and her sister, Monica, created a fashionable lightweight stretchable coverlet which adds a "sassy" flair to her sleeve. The sisters are co-founders of "MySassySleeve" company and their brand of colorful and fun coverlets are shared in our product review section. I am also excited to introduce a new regular feature to e-Channel - patient stories from our Marilyn Westbrook Garment Fund (MWGF). The MWGF directly impacts a patient's life and in this issue we share the story of one beneficiary, Ms. Gray. Hopefully these stories inspire you to share your own experiences and go out and make a difference in your communities. This issue is full of interesting articles and information, and I hope you take the time to read and thoroughly enjoy this Lymph e-Channel. In Good Health,  Saskia RJ Thiadens, RN Executive Director, NLN Painful Cording of the Arm by Jodi Winicour PT, CMT, CLT-LANA *References listed at the bottom of issue.    If you have upper extremity lymphedema caused by breast cancer surgery or treatments, you may have experienced a painful and bothersome condition called axillary web syndrome, or AWS. [Figure 1] Unfortunately, most lymphedema certification programs do not have the time to teach the treatment of AWS, which leaves lymphedema patients well treated for their swelling conditions but inadequately cared for regarding their cording. As few as 6% [1] to as many as 72%  [2] of women who have had lymph nodes removed from their armpit (axilla) will develop AWS. Considering the pain it causes along with its frequent relationship with lymphedema, knowledge of its characteristics, onset and treatment is necessary to provide safe, holistic care for breast cancer survivors. AWS characteristics: AWS has certainly been around since the first radical mastectomies of the early 1900s, but the phrase "Axillary Web Syndrome" was coined in 2001 by Alexander Moskovitz, MD et al. [1] He describes painful cords of tissue that originate in the axilla, run along the inside of the upper arm to the elbow, and sometimes even to the wrist or the base of the thumb. These cords are made more taught by reaching out to the side and frequently can be seen as well as felt.  Painful cording typically limits overhead and forward reaching along with elbow and forearm movements which makes activities such as cooking, cleaning, exercise, reaching and dressing difficult or impossible during the more painful stages. How and when does AWS happen? Typical onset of cording is 2 to 4 weeks after axillary node removal. [1, 2, 4, 5] Some with AWS have so much pain that it is difficult to use their arm while others feel that stretching and massage techniques are very helpful.  Studies consistently report that the AWS will resolve on its own between 3 and 4 months after onset, but therapists who treat AWS have noted it lasting up to 1 year or longer without treatment.  Untreated AWS may cause problems during the planning period for radiation therapy in those not needing chemotherapy. If unresolved, the cording can make CT scanning for radiation planning a very painful procedure which can delay the start of radiation therapy. It is much less common to see AWS after chemotherapy is completed, which is typically 3 to 6 months post surgery, but it does occur. What is the stuff called AWS? Although there are few tissue samples of AWS that have been looked at under the microscope, we do know that AWS can be hardened and enlarged lymphatic vessels that are filled with lymphatic fluid. This fluid cannot exit the arm normally through lymphatic pathways to the axilla due to lymph node removal.  [1, 5, 10]  AWS may also be small veins near the skin that are clotted or hardened. [1]  In some cases, the webbing is hardened and clotted lymphatic fluid that causes inflammation of the vessels and makes them stick to the fatty tissues of the arm resulting in pain when moving or stretching the arm. What increases my risk of having AWS? While weight gain [11,13], obesity [11,13]  & higher Body Mass Index (BMI of 25-26 kg/m2 [2,12,13]) have been associated with the onset of lymphedema,  a lower BMI of 23[2] and 25.1 [ 3]) have been associated with the onset of AWS.  These are confusing findings especially considering that both lymphedema and AWS seem to be caused by the axillary node removal and tissue scarring. Thinner women have both the increased risk of AWS and difficulties with shoulder movement after lymph node surgeries for breast cancer, while their risk for lymphedema should be lower than heavier women. [2, 11, 13] What can I do about AWS? While studies written by physician researchers  state that AWS will resolve on its own, therapists around the world who frequently treat AWS  agree that gentle massage, manual lymphatic drainage techniques and range of motion exercise can accelerate pain relief and tissue healing. Physical therapy may shorten the natural course of AWS to 6-8 weeks. [3] In some cases, the AWS presents with a mild lymphedema of the forearm. While traditional CDT (Complete Decongestive Therapy) techniques may reduce the lymphedema, it may become a chronic condition unless the AWS is treated. Soft tissue techniques for cording include very gentle tissue "bending" or "traction" techniques applied along the taut cord in a comfortable position of stretch. Localized thumb and whole handed MLD techniques along the cording is also useful. Do combine active stretching with massage techniques to further improvements and do not be surprised if a "pop" is heard along the cording during your gentle treatments or during stretching. This "pop" will usually ensure immediate pain relief during movement but can also lead to lymphedema on rare occasions. Please avoid being overly aggressive (causing pain) during your treatments as this can cause an inflammatory reaction that may increase the lymphedema risk of your affected arm. Knowledge of safe and effective techniques to hasten the resolution of AWS is necessary in the treatment of those recovering from breast cancer treatments and arm lymphedema.  Hopefully reading this article will help to ease you or your patients' discomfort and increase your awareness of the treatments that are available. Jodi Winicour PT, CMT, CLT-LANA Longmont United Hospital, Longmont, Colorado. Jodi is a full time clinician specializing in the treatment of lymphedema and cancer related dysfunction. She also is a Lymphedema Certification and Breast Cancer Rehabilitation Course instructor for Klose Training & Consulting. Contact her at: Jodi@KloseTraining.com   Be Sassy!   by Margaret Omori      I didn't know enough, in the summer of '04, to be devastated by the news that I had developed lymphedema. I didn't know about the physical limits that would forever dictate how much I could lift, or the precautions that I would have to take in order to work in my garden. I didn't count on the huge financial burden that accompanied that diagnosis. The cost of multiple, custom-made compression garments that had to be factored into our family budget every three or so months or the expense of periodic "tune-ups" with my therapist. And I certainly wasn't prepared for the emotional toll that living under the cloud of this chronic condition would take on me or my family. The fact of the matter is: I am a breast cancer survivor and I have lymphedema.  Believe me, I'm thrilled to BE a survivor, grateful for the wonderful medical care that I received, and thankful to the dedicated professionals; the doctors, therapists and fitters who have successfully treated and continue to help me manage my condition.   But what I most wanted, after I had battled and beat the breast cancer beast, was to look and feel like my old self.  Needless to say, wrapping my arm in multiple layers of cumbersome bandages and wearing bland compression garments not only served as a constant reminder of my cancer battle, my self-esteem was assaulted on a daily basis!  Facing endless questions from well-meaning strangers asking, "How did you hurt yourself?" or, "Why are you wearing a bandage?" made me feel less like a "survivor" and more like a casualty.  Discouraging? Yep!  Depressing? You bet! And that would have been the end of my story had it not been for a timely gift in the form of some pirate tattoos (full disclosure: I'm a huge Johnny Depp fan!). The novelty of imagining my affected arm covered entirely in bold tattoos not only made me laugh, it gave me the courage to envision turning a negative into something positive. I thought, why not create something stylish and fun to wear over the dreaded "bandage"?  Since wearing a compression sleeve draws attention anyway, why not do it in a way that attracts smiles instead of sympathy? Instead of feeling self-conscious, why not sassy? Thus inspired, my sister and I created a line of vibrant, tattoo-like coverlets called "MySassySleeve." Our goal is to provide an affordable and fashionable coverlet to help women regain a positive self-image and to change how others interact with us.  While lymphedema wasn't on my radar back in '04, it is now. My sister and I have joined our efforts with those in the medical community to actively raise awareness about lymphedema. We've helped advocate to get more comprehensive coverage for patients with lymphedema. And, most gratifyingly, we've raised funds through our business to aid those in need to purchase medical compression wear. Along with the talented artists, local manufacturers and others who help to create our product, our shared goal is to make a difference in the lives of those with lymphedema... one sleeve at a time. MySassySleeve  Therapist Review: by: Guenter Klose, MLD/CDT Certified Instructor, CLT, founder of Klose Lymphedema Care in Lafayette, CO., Executive Director of Klose Training and Consulting. When Monica (co-founder of MySassySleeve) introduced me to her decorative coverlets and brought several samples in to our office, I was happy to see such a fresh and innovative product offered for people with lymphedema. It is exciting that patients who wear compression garments to manage their lymphedema now have a design choice with these interchangeable, non-medical sleeves.  Instead of feeling like they need to hide their compression sleeve under a jacket or long-sleeved shirt, they can wear these light-weight, stretchable coverlets over their garment to add a bit of light-hearted fun. I often hear from many of my patients that having to wear a medical garment is not only unattractive but makes them feel self-conscious. We immediately saw emotional benefits in patients who wear the MySassySleeve coverlets. By drawing attention to the colorful, tattoo designs and away from the medical looking therapeutic compression sleeve, my patients have rediscovered their self-esteem and self-confidence. They feel good about themselves and that has empowered them. While MySassySleeve is only decorative and does not manage lymphedema, it certainly provides an emotional, feel-good benefit that medical garments alone cannot provide. Congratulations on a wonderful and beneficial product. Fitter Review:  "The best part of having MySassySleeves for my customers is the spontaneous moment of surprise and joy they create. The bright colors and bold designs immediately transform a medical product into a fashion statement, and in the same moment transform a patient's experience from 'a little bit awful' to 'a little bit fun'. The tattoo patterns ARE sassy and we've watched so many women change their thinking from 'Not for me.' to 'Why NOT me!?' And you have to love the smile that goes along with trying something just a little outside their comfort zone. We have spent many years providing our customers with outstanding therapeutic garments- We are now delighted to provide them with the opportunity to see their compression sleeve as a blank canvas for their newest accessory!" Claudia Boyle Van Driel's Medical Support Wear  Patient Reviews: "What MySassySleeve is doing is so wonderful! It will make wearing my dull and boring compression sleeve so much fun to wear. It will also make me want to wear it more often which will benefit my condition. I will wear it proudly...thanks again!" Emmie B. "I am very excited about the MySassySleeve. Great idea- the fact that you are not trying to compete with medical grade sleeves but compliment them is perfect! I brought them to two breast cancer care education nurses and they loved them!" Syndi S., CMF, BOC, ABC Wilmette, IL This Product Review is a paid advertisement.    Marilyn Westbrook Garment Fund   The Marilyn Westbrook Garment Fund (MWGF) holds a special place in the hearts of the NLN staff. It gives us the opportunity to not only help our patients, but connect with them on a personal level and see firsthand the profound impact the fund has on their lives. Because of this, we have decided to share their stories with you. In every issue of Lymph e-Channel, we will feature the story of a MWGF patient. We hope you find them as inspiring and courageous as we do.      Ms. Gray is a breast cancer survivor who developed lymphedema shortly after her surgery in 2007. Initially, she was able to afford a sleeve and gauntlet, but the cost of replacing these garments was a burden for her. Instead, Ms. Gray continued wearing the same sleeve and gauntlet for the next two years. No longer providing adequate compression, her sleeve started rolling down, cutting off the circulation in her arm. Ms. Gray's swelling progressively worsened as a result. Fortunately, Ms. Gray's therapist told her about the MWGF and she quickly contacted us. With Juzo's generosity, we were able to supply Ms. Gray with a new set of garments.    "I wish to take this opportunity to thank you for all your efforts on my behalf and to thank the organization for financially supporting my need. At the time of the initial application I did not know what to do about getting a new sleeve and gauntlet. And everyday the old one was getting more and more uncomfortable. It is very comforting to know that there are people and organizations that help when you need it and with what you need. I can only say thank you again, though that seems to be very little for the great thing you have done for me! Sincerely yours, G. Gray" Ms. Gray's case is not unique. Across the country, there are many patients that need lymphedema garments. For many of us, the benefit of proper garments is clear - they are crucial to the success of lymphedema therapy. You can help! This year we plan to raise at least $25,000 to continue the work of the MWGF. As part of our Sponsor-A-Patient Campaign, a $50 pledge will support one patient by: Sponsoring a patient's application including a yearly membership to the NLN Covering program costs to administer and continue to grow the fund.   Click Here to make a donation to the MWGF.   For only $50 you can positively affect someone's life. But don't feel limited by one amount; you can make a contribution in any amount. Large or small, every dollar supports a patient. Check back frequently to track our progress on the thermometer! (Donors can also choose to have their name and/or logo listed) On behalf of the many patients, therapists, affiliated clinics, and the NLN staff, we thank you from the bottom of our hearts. Federal Health Policy Staffers Visit Sister Kenny Rehabilitation Institute to Learn About Lymphedema   April 26, 2011 On Tuesday, April 26, leaders from Allina and the Sister Kenny Rehabilitation Institute in Minneapolis, MN met with the health policy staffers from the offices of Senator Amy Klobuchar, Senator Al Franken and Congressman Keith Ellison to talk about lymphedema.    Erika Nelson, Sen. Klobuchar's office, Bethany Snyder, Sen. Franken's office and Mike Siebenaler, Congressman Ellison's office learned about lymphedema, proper treatment of the disease, innovative work being led by the Sister Kenny Rehabilitation Institute, and the challenges faced by providers and patients due to the lack of Medicare and some private insurance coverage. Nancy Hutchison, MD, Medical Director of the Sister Kenny Lymphedema and Cancer Rehabilitation Program and chair of the Medical Advisory Committee of the National Lymphedema Network, gave a presentation about lymphedema, the gaps in coverage for lymphedema and the need for federal legislation.    The group heard the facts and read the statistics but what really drove the message home was the presence and story of Kris Maser, a Sister Kenny Rehabilitation Institute patient with lymphedema. Maser, a wife, mother, attorney and cancer survivor, has been a patient of Dr. Hutchison's for several years and wanted to help educate our officials on this disease. She told them her personal story, showed them what lymphedema looks like and demonstrated how she has to wear several types of garments, compression bandages and home lymphatic drainage to control her lymphedema. It is Allina's hope that The Lymphedema Diagnosis and Treatment Cost Savings Act will once again be introduced at a federal level that starts to address some of the many concerns around this disease. The Health Policy staffers for the Minnesota Senators Klobuchar and Franken and Congressman Ellison stated that the information was very helpful. They recommended that other lymphedema providers and patients around the country hold similar meetings with their legislators and staff.   Learn more about lymphedema and the care provided by certified professionals at Sister Kenny Rehabilitation Institute on Allina.com. The Sister Kenny Rehabilitation Institute at Allina Hospitals & Clinics is a national leader in lymphedema treatment. It has one of the largest lymphedema programs in the United States and is the only physician- directed multisite, multi-hospital lymphedema program in Minnesota with programs at eight Allina hospitals and nine Sister Kenny outpatient centers, with over 30 Certified Lymphedema Therapists on staff. References from Painful Cording of the Arm:   Moskovitz AH, Anderson BO, Yeung RS, Byrd DR, Lawton TH, Moe RE. Axillary web syndrome after axillary dissection. Am J Surg. 2001; 181:434-439. Leidenius M, Leppanen E, Krogerus L, von Smitten K. Motion restriction and axillary web syndrome after sentiniel node biopsy and axillary clearance in breast cancer. Am J Surg. 2003;185(2):127-130. Lacomba MT, Orlando M, Coperias Zazo J et al. Axillary Web Syndrome after axillary dissection in breast cancer: a prospective study. Breast Cancer Res Treat 2009; 117: 625-630. Craythorne E. Axillary Web Syndrome or Cording, a Variant of Mondor Disease, Following Axillary Surgery. Arch Dermatol, 2009; 145(10):  1199-1200 Reedjik M, Boerner S, Ghazarian D et al. A case of axillary web syndrome with subcutaneous nodules following axillary surgery. The Breast. 2006; Vol. 15, 411-413. Lauridson MC, Christiansen P, Hessov I. The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer:  A randomized study. Acta Oncologies, 2005; 44:  449-457. Opie EL. Thrombosis and occlusion of lymphatics. Journal of Medical Research 1913; 29: 131-146. Kepics JM., 2004. Physical therapy treatment of axillary web syndrome[online]. Look Smart, Rehabilitation in Oncology. Available from:http://www.findarticles.com/p/articles/mi_qa3946/is_200401/ai_n9370189[Accessed 25 November 2005]. Mera K, Terasaki K, Kanzaki T, et al. Mondor's Disease of the Neck. Journal of Dermatology, 2009; 36: 179-180. Marcus RT, Pawade J, Vella EJ. Painful lymphatic occlusion following axillary lymph node surgery. Br. J. Surg. 1990; Vol 77, 683. Petrek JA, Senie RT, Peters M et al. Lymphedema in a Cohort of Breast Carcinoma Survivors 20 Years after Diagnosis. Cancer, 2001; 92, (6)  1368-1377. Sagen A, Karesen R, Risberg MA. Physical Activity for the Affected Limb and Arm Lymphedema after Breast Cancer Surgery. A Prospective, Randomized Controlled Trial with Two Years Follow-up. Acta Oncologica, 2009; 48:  1102-1110. Shaw C, Mortimer P, Judd PA. A Randomized Controlled Trial of Weight Reduction as a Treatment for Breast Cancer-related Lymphedema. Cancer, 2007; 110 (8) 1868-1874. Boneti C, Korourian S, Diaz Z et al. Scientific Impact Award:  Axillary Reverse Mapping (ARM) to Identify and Protect Lymphatics Draining the Arm During Axillary Lymphadenectomy. The American Journal of Surgery, 2009; 198, 482-487.
National Lymphedema Network, Inc. 116 New Montgomery Street, Suite 235 San Francisco, CA 94105 Hotline: 1.800.541.3259 Tel: 415.908.3681

Certification program info 2012

Lymphatic Care Specialists, LLC

Carmen Thompson, B.S., LPTA, CMT, CLT

P.O. Box 1411

Christiansburg, VA 24068

540-357-2084

www.lymphedemahope.com

Carmen@lymphedemahope.com

Thank you for your interest in our IMLD/CDP certification program.  We are happy to present our program as there is tremendous need for lymphatic drainage and lymphedema therapists in all areas of the country.

Courses are 8-5, Thurs, Fri, and Sat, and 8-2 on Sunday.

Certification includes all workbooks, hardback text, upper extremity and lower extremity bandaging kits, lab fees, certification exam and 140 ceu’s.  Cost is $2495 for all four modules.

Advantages of our program:  Our certification class is unique in that we offer perspectives on the varying treatment techniques and hand techniques taught by the different schools of thought in MLD.  Another advantage is that our course is offered in sections and there is ample time between modules to practice techniques, study and to come to the next module prepared with applicable questions.  If you take the course in Blacksburg, you also have the advantage of hands-on practice with actual in/outpatients in our clinics.  There is no substitute for practice and feedback from actual clients! Lastly, we also study manual lymphatic drainage applications for many other indications than just lymphedema.  We study lymphatic organ drainage and full body MLD to stimulate the immune system and bring relief  to many suffering with auto-immune conditions such as lupus, chronic fatigue and fibromyalgia.  We are recognized as an approved provider of MLD/CDP training programs by the National Lymphedema Network, www.lymphnet.org.

Basic MLD certification is available with modules I-III this will qualify practitioners to work extensively with conditions of the lymphatic system excluding disorders where there is a direct lymphatic pathology, i.e. cancer treatment of the lymph nodes, lymphnode removal, and types of edemas that require bandaging.   This is ideal for those who work outside of a direct medical setting, i.e. massage therapists, and aestheticians.

Conditions that you would be able to safely treat with the certification include:  Whole-body tissue detoxification, symptoms of lupus, arthritis, RA, osteoarthritis, Lime’s disease, chronic fatigue, fibromyalgia, aesthetics, cellulite, lymphatic facial detoxification, wrinkles, scarring, swelling due to surgical procedures and trauma and much more.

Complete MLD/CDP training is recommended if you want to treat more complex medical patients such as oncology patients, patients that have had lymph nodes removed or radiated, those with extensive vascular edema with skin deterioration/ulceration.  This is really key to seeing big reductions in you patients with visible swelling disorders. 

We will be teaching the full MLD/CDP 140 hour certification program in two or four modules, depending on your area. 

Modules   II, III, and IV will all be live seminars. 

The dates for all modules are as follows:  More courses being added!  Please email for details.

Module I:  This will include an extensive background/instruction in lymphatic anatomy/physiology, and all of the basic manual techniques.  This module is a home study that you may begin at any time. 

Module II:  This will be a live seminar that will move on from the general introduction of the lymphatic system and superficial treatment to lymphatic drainage of the deeper tissues.  These techniques can give you profound results with your complex clients. Next date is October 15^th weekend, 2011.

Module III:  This will be a live seminar that will include specific treatment techniques of lymphatic disorders.  We will also spend time on marketing your services, documentation and building your program.

CDP Module IV:  This module will cover all of the basic compression bandaging principles as well as a certified garment fitter training program.  Some complex bandaging techniques will be covered as well.  This is especially helpful when limbs are not uniform shape and helps relate techniques to real-life applications.

This course will be specifically designed for those who want extensive training on compression bandaging techniques that have been proved to be so beneficial for swelling disorders.  We will learn how to properly and safely wrap upper and lower extremities, as well as compression techniques for the trunk, genitalia and face.   Each therapist will have the opportunity to complete a certification as a compression “fitter” for one of the major garment retailers at no extra cost. 

We will also include a review of the previous three modules in preparation for the certification exam and discuss what the national LANA exam certification entails.

The cost of the MLD/CDP program is $2495 and includes three DVD’s, two texts a handbook for each module, MLD/CDP testing and certification, and the certified fitter program.  A non-refundable $50 deposit is required to hold your spot in the course, along with the registration form.  An additional $500 is due sixty days before the time of each module, with the balance of $945 due before the last module.  Please see the registration form for more details.

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Lymphedema is just one of many disorders that you will be taught how to treat and manage in our program.  It is an accumulation of lymph fluid between the tissue layers. This presents as swelling, or edema.  Lymphedema can be present anywhere in the body.

Lymph fluid is rich in protein making the edematous area very thick and heavy feeling.

Treatment is necessary to not only move the fluid out of the area, but also the protein. If it is not treated, over time, the lymphatic vessels will stretch out permanently and external compression and treatment will be necessary for a lifetime to maintain proper pressure in the valves to move fluid more normally.

Secondly, when the vessels are full of this protein-rich fluid, there is less oxygen in the vessels, decreasing the rate at which wounds, surgery sites and skin ulcerations heal. This also puts the patient at risk of cellulitis, or infection of the bloodstream.

Many people report the first signs and symptoms of lymphedema as a feeling of tightness, or heavy feeling, decreased flexibility in the joints, and clothing or jewelry fitting tightly.  Some patients only report strange sensations such as tingling or a crawling feeling on the skin.

What causes it?

There are two primary types of lymphedema.  The first is primary lymphedema, or from birth.  This is a congenital form of lymphedema caused by a malformation of thelymph vessels or nodes.  It may present itself at birth, or later in life.  Often it occurs when there are other cognitive impairments at birth as well, i.e. Down’s syndrome.

Secondary lymphedema is caused secondary to lymph vessel destruction, or lymphnode removal secondary to a disease process or a surgery.  Oncology care including radiation, chemotherapy, surgery, tumors, infection, compromise of the vascular and immune systems, burns, liposuction and general trauma can all be contributing factors of lymphedema. 

Lymphedema does not necessarily develop right after surgery.  It can develop decades later!

Lipidema is a condition that is often confused with lymphedema.  The patient presents with symmetrical excess size and fat from the hips to the ankles.  The patient often looks disproportionately thin on the top half of the body and at the ankles.  The lymphatic present in a corkscrew pattern in a lipidema patient trapping fat molecules, resulting in larger appearance and tenderness to touch.  Often there are also large lobules of fat on the inside of the knee. 

What does the lymphatic system do?

The lymph system is responsible for creating a homeostasis of fluid between the tissues and the general circulation of the body.  The system also has very important immune functions, acting to filter toxins from the body by removing bacteria, viruses, foreign objects, and mutant cells.

How is lymphedema treated?

Lymphedema is treated by one or more of the following:  Manual therapy, often called Manual Lymph Drainage, compression bandaging, compression garments, a specific self-massage protocol and impeccable skin care.  Treatment for lymphedema should be given only by a certified lymphatic therapist who has graduated from a 135 hour certification program.

The nationally recognized standard of care for lymphedema consists of manual lymphatic drainage, or MLD, compression therapy including a multilayered bandage and/or compression garments, and a self-care program consisting of skin care, self-massage and lymphedema exercises. 

The massage is extremely light in pressure, engaging the skin layer only to stretch the skin and cause a contraction of the lymphangion to move fluid and protein through the one-way valve system of the lymphatics.

The bandaging component to care is designed to get a good amount of volume reduction in a relatively short period of time.  A bandage is worn 24 hours a day and changed daily, or every other day depending on patient proximity to the clinic.  The patient’s day to day motions will not be restricted with the garment.

An intermittent pneumatic pump is not recognized as the standard of care for lymphedema, but is occasionally used when a patient does not respond to MLD and bandaging therapy.  The pump works to gradually move fluid from the limb in segments.  The downside of the pump is that is moves only the fluid component, not the protein component.  This sometimes creates a cyclical dependency on the pump for daily maintenance. 

After volume reduction has been met in the limb, the results will need to be maintained by use of self-massage, compression garments, exercise or a combination of these. 

Summary:  There is basically an untapped market in lymphatic therapy which is extremely beneficial and completely uninvasive for the patient while financially lucrative for rehabilitation facilities.   Swelling disorders of all types can be helped with MLD/CDP therapy as long as the patient does not have any of the contraindicated pathologies. 

Practical Applications of Manual Lymphatic Therapy

A cost effective way to increase patient outcomes

¨     Clinical applications of Manual Lymphatic Therapy-How does it work?

¨     Understand the anatomy and physiology of the lymphatic system and how it impacts a variety of diagnoses

¨     Learn the proper manual lymphatic techniques to increase and influence thelymph flow in the body

¨     How to assess and document for optimum reimbursement and identify proper audiences for marketing

If you’ve been a therapist for sometime, you have probably experienced “burnout” from time to time.  You see the same diagnoses and do the same type of treatment, day after day, with often moderate outcomes.  Have you ever had a patient whose pain level did not respond no matter what you did?  What about the total knee patient who’s swelling doesn’t leave the joint no matter how much E-stim, ice, and retrograde massage you do?  Do you see patients that are limited in gait or exercise due to swollen limbs?  Are there patients with wounds that won’t heal?  Are you often referred patients with Chronic Fatigues Syndrome, or Fibromyalgia that can not tolerate traditional therapies?  

Therapy specifically targeting the lymphatic system is cutting edge.  Only recently has lymphatic therapy been addressed in this country in conjunction with rehabilitation.  The results from this kind of work are so successful because they are significant, measurable, and very often, quickly achieved.   You will look at your patients with a new set of glasses upon your return to the clinic. 

Course Content:

I.  What is Manual Lymphatic Therapy?

A.    How does it work?

B.    Indications for MLT

C.    Contra-indications for MLT

D.    History of lymphatic therapy

    

             II. Overview of lymphatic anatomy             

                        Superficial Lymphatic

A.    Deep lymphatic system

B.    Plane barriers

C.    Microcirculation

III. Pathologies of the lymphatic system                  

A.    Primary  lymphatic conditions

      i. Congenital Malformations

B.    Secondary lymphatic conditions

ii.               Post breast cancer

iii.             Venous edema

iv.             Post prostate and other oncology care

v.               Post-trauma including orthopedic surgeries and conditions

vi.             Oral/Dental and Aesthetic applications including popular lypo-lymph drainage.

            IV. How is lymphedema diagnosed?            

                        Lymphscintigraphy

      Symptomatic diagnoses

            V. Clinical Applications in special populations

                        A.   Varicose veins

                        B.    Wounds              

VII. Manual Lymphatic Therapy-Strokes and techniques

A.    What strokes to use and when?

B.    Treatment sequences per diagnosis

           

           

VIII. Alternate forms of treatments for edema

A.    Bandaging                        

B.    Compression garments,

C.    Circ aid, Reid Sleeve

D.     Lymphedema pumps 

E.     Exercises with edema,

F.     Self massage                                            

IX. Marketing                                                            

            X.  Identifying when it is not lymphedema              

A.     Lipidema

B.    Chronic venous insufficiency

C.    Menstrual edema

D.    Ascites

E.     Arterial insufficiency

XI.       Documentation for optimum reimbursement           

XII.     Garment Problem Solving

XIII.        In-depth compression bandaging protocol.

Case Studies-Real Patient MLD/CDP observation/clinicals.  Our setting affords us the luxury of having you observe real patients in a clinical setting.                                                                                   

What you will learn

¨     An in depth knowledge of the anatomy of the lymphatic system

¨     Who will benefit from MLT/and or/CDP therapy

¨     Flow chart for deciding the plan of care

¨     How to treat certain types of lymphatic conditions and contraindications

¨     How to affect patient outcomes in general rehabilitation by adding MLT

¨     How to document for maximum reimbursement

¨     How to market to target audiences

Who May Attend:

            Physical Therapists

            Physical Therapist Assistants

            Occupational Therapists

            Certified Occupational Therapy Assistants

            Registered Nurses

            Massage Therapists

            Aestheticians

            Physicians

            Physician Assistants

            Nurse Practitioners

            Nursing Home Administrators

Course Director

           

            Carmen Thompson, BS, LPTA, CMT, CLT, is a Licensed Physical Therapist Assistant and Certified Massage Therapist with a specialty certification in Lymphatic Therapy.  She also has a Bachelor’s Degree in Health Care Management.  She has worked in a variety of health care settings over the last 14 years both clinically and in rehabilitation administration.  She has specialized in program development in long term care settings.  Currently, she teaches Lymphatic Pathology at the Blue Ridge School of Massage in Blacksburg, Virginia and works exclusively as a lymphatic therapist providing in and outpatient therapy to clients with a large varieties of diagnoses.  She has conducted local and state presentations on the necessity of education of breast cancer survivors and their health care workers in the prevention of lymphedema. 

           

FAQ’s for the Course

FAQ's For Module II

Where:  Place/Days Inn Blacksburg, VA 24  Conference Rate of $69 http://www.daysinn.com/DaysInn/control/Booking/property_info?propertyId=11245&as_srp=SP2&cid=carat_search-Days_Inn

There are a couple of people from the massage school willing to host students for low cost.  You would be driving about 20 mins in.  Please contact me for details.

We have people coming from Ohio, NC, TN, VA, FL, PA, and GA.  Please let me know if you are interested in a ride/share.  I will try to assist as able.

Airport:  The closest airport is Roanoke Regional.  You may take the SmartBus from Roanoke to Blacksburg.  Please check the schedule at http://www.smartwaybus.com/.

Meals:  Breakfast is provided if you stay at the hotel.  We break for lunch for one hour.  There are many reasonable lunch places close by.

What to bring:  A massage table, or yoga/exercise mat, blankets, pillows, lab clothes (sports bra), shorts, washable marker, masking tape,  and a 3 ring binder.

What you should have completed when you come to Module II:

A good foundation/knowledge of the “Foundations of Manual LymphDrainage” book.  We will review thursday morning, then be ready to start with new material after lunch. 

A good knowledge of the concepts from the “Foundations” questions/homework from Module I.

A good knowledge of the general hand strokes based on the “Manual LymphDrainage for Body and Face” DVD. 

You should have a START of recording your 10 manual practice sessions.  These do not have to be checked off on until the last module.  (Forms will follow with Module I registration).

You should have in your possession and bring:

               Practical Applications of Manual Lymphatic Drainage Workbook

               Zuther, Hardback text 

               Manual Lymph Drainage DVD

               National Lymphedema Network, info packet (white envelope)

               “Foundations of Manual Lymph Drainage”,  book and questions

               Lymph Evaluation Hours document.

Please let me know if you do not have any of these items.

Snow Policy:  If  I81/I77 are closed the night before class begins, the coursewill be cancelled and rescheduled.  If roads are otherwise hazardous, but passable there will be a judgement call by the course instructor.  Please call in if there is doubt.   My cell:  540-357-2084.  I will also leave a message at the front desk of the hotel.  Refunds will not be issued, but you will have credit to attend another course.

  We are going to have a great group!!

Notes from participants:

> Got it. Carmen, thanks again for an excellent learning experience. I did a
> basic MLD on R leg with my Oncology client who was experiencing swelling.
> her doc had given her diuretics but without results. Following the session
> we could see visual improvement and reduced swelling. I opened the neck
> area, taught her belly breathing and opened all axillary and inguinal nodes
>
>
> Got it. Thanks again for the wonderful learning experience. I had the
> chance to do a basic MLD sequence on the R leg on an oncology client today
> for swelling, arthritis and P! The results were visually noticeable by the
> end of session. Her doctor had given her diuretics ( low dosage) but they
> weren't helping. She seemed pleased with the results. After opening the
> neck I instructed her in deep belly breathing, opened all axillary and
> inguinal nodes (although I'm sure just R inguinal would have been
> sufficient), then drained her R leg (prox to dist and back). I got to use
> basic strokes, arc strokes and rotary strokes. I really enjoyed this and
> felt excited to have such a quick opportunity following class to reinforce
> the learnings and do something helpful. Carmen the clinical experience was
> invaluable to help me acquire the confidence to try these techniques with my
> clients. You work so hard for us to help get us adequately trained and I
> appreciate it beyond what my words can say. This class has been worth every
> penny and all the effort (including the car misadventure)!
>
> Andrea
>
> Carmen,
> Thanks for sharing this with us. Opportunities to gain this insight
> combined with the clinical hands on makes your course heads and tails above
> the others. My expectations are so exceeded! But by no means stop. I
> apologize if I should not have done a reply all on the first response - the
> hour was late ;-).
>
> One other question I would have for the client is which organs have been
> affect by the LYMF as it can be localized or widespread. Since the onset
> can be from childhood into adulthood I would want to know how long (she
> thinks) she has had it. If it is localized then perhaps rerouting might be
> an option - depending on what else she reveals.
>
> I hope you have time to share more on this person with us.
>
> > For His Glory,
>
> Joan
>

Lymphatic Care Specialists, LLC Course Registration

Please complete and return via fax to: 1-540-301-0750. 

Registration closes one month before course start with a maximum of 25 applicants for the first module. 

Cancellation policy:  Refunds can be received up to 30 days before the course start with the reduction of a $50 processing fee.  Within 30 days of course start, the amount can be credited toward a future course. 

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