Many people are tempted to shortcut the therapy process in lymphedema. Instead of bandaging, they only want manual lymph drainage (MLD). Or instead of MLD, they only want to bandage. Or they may stop treatment early (or skip therapy & go right to a compression garment). Is it possible to “cheat” in therapy? Yes, it is. But just like shortcutting or changing a recipe, the outcome will be affected.
Protocol
The recommended protocol for lymphedema treatment (according to Foldi) is to bandage daily during the decongestion phase.1 Once volume plateaus & a patient is not expected to make further progress, they are fit with a custom, flat-knit, daytime sleeve/glove & they are to bandage at night for the maintenance phase.2 (Or, alternatively, a special nighttime garment like a foam sleeve might be used.)
A patient with left arm lymphedema due to breast cancer was tiring of bandaging & driving to appointments after ~10 sessions of daily treatment. Her arm fibrosis hadn’t maximized in reduction nor had the swelling, but she had made decent progress.
(evaluation – visit 1: total left arm volume 27.9 cm)
(after 10 sessions: total left arm volume 26.9 cm)
She wanted to proceed with getting fit for her custom, flat-knit sleeve & glove in a class 2 (23-32 mmHg). She would continue working on her arm fibrosis herself. In addition, she didn’t want to bandage at night (or get an alternative night garment like a foam sleeve which looked hot & bulky). She wanted to try using a daytime sleeve and glove at night in less compression instead – a class 1 (18-21 mmHg). I wasn’t wholly supportive of this idea, but I agreed to try it.
Waiting for the custom sleeve & glove
Custom garments can take 2-3 weeks to receive. During the waiting period, a person should remain bandaged. However, therapy sessions can usually reduce in frequency. In this case, the pt remained bandaged 3x/week until the daytime garments arrived.
What was the outcome? Find out next month.
References
1 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 272. Germany: Urban and Fisher.
2 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 273, 574-581. Germany: Urban and Fisher.
