Managing Lymphedema

By Calli Carlson, OT/DOR, North Mountain Medical & Rehabilitation, Phoenix, AZ
In the fall of 2020, two of North Mountain Medical Center’s therapists, Tyler Lieberman, COTA/L, and Calli Carlson, OTR/L DOR, spent 145 hours over the course of three weekends to become certified lymphedema therapists. Calli received a brief introduction to lymphedema management in her occupational therapy graduate program but knew there was still a great deal to learn in order to provide the best possible care to residents. Tyler also expressed interest in becoming certified, particularly after observing many residents with edema/lymphedema and the subsequent joint stiffness and skin changes that resulted. North Mountain’s CEO, Jason Postl, and Director of Nursing, Jacque Green, were extremely supportive in providing the means for training and were equally as committed to providing the highest quality, holistic care for residents.

Lymphedema itself is historically ill-understood in clinical practice despite affecting 90 to 250 million people worldwide. Lymph node removals, trauma, surgeries, medications, genetics and obesity are just a few of the contributing factors to disruption of the lymphatic system, which can result in protein-rich fluid in the interstitium and cause a cascade of adverse reactions. Physically, patients may experience extreme heaviness in limbs, itchiness, skin infections, and, in later stages, dermal fibrosis, skin papillomas, and trophic skin changes. Psychologically, physical changes can create anxiety, depression, reduced quality of life, and impaired participation in functional tasks of choice.

Lymphedema management focuses on clearing edematous fluid from the interstitium via manual lymphatic drainage, compression, and/or decongestive exercises with additional focus on skin care and self-care management. Therapists use precise measurements to obtain the volume of the edematous limb and track over time to determine the effectiveness of treatment. At North Mountain, Tyler and Calli have noticed significant improvements in total limb reduction with the use of volumetric measurements, and patients also report that their limbs feel lighter and easier to move.

For patients with decreased alertness, staff members are trained for the continuation of techniques to ensure carryover from skilled therapy. The ultimate goal of lymphedema therapy is to improve patients’ overall skin integrity, movement, health, and quality of life by moving unwanted fluid from the interstitium back into the lymphatic system to be excreted by the body. It is an area of therapy that is not often explored in the realm of skilled nursing but has the potential to improve patients’ movement and tolerance to standing activities in physical therapy, reduce risk of developing decubiti by increasing blood flow, improve patient’s self-esteem and quality of life, prevent fibrotic changes that can occur from stagnant protein-rich fluid, and overall increase patients’ participation with self-care and functional tasks of choice. It requires interdisciplinary communication and engagement to create lasting results for the patient.

Though not often explored by therapists, Tyler and Calli would strongly encourage anyone interested in better identifying/managing lymphedema to become lymphedema certified to gain the valuable skills required for effective lymphedema management.