Reason 3 – Medical Staff or the Patient
In parts 1 & 2, we looked at two reasons CDT (complete decongestive therapy) may not work.
- Combined edema & lymphedema
- Inappropriate application of CDT (such as leaving one of the four components of treatment out, incorrectly applying technique or inadequate frequency).”
In part 3, we’ll look at the medical professionals & the patient’s role.
(photo by Pexels/Leeloo Thefirst)
Medical Doctors
A doctor may incorrectly diagnose a person with lymphedema, or they may overlook another condition causing swelling that is not lymphedema. And/or these other conditions causing swelling may not have been adequately treated. Additionally, compression garments recommended by a physician may not be the appropriate type or the right compression class.
Therapists
Therapists may also be a reason CDT doesn’t work. First, the therapist may not have actually gotten appropriate training (i.e. they may not have attended a 135-hour lymphedema training course in CDT yet say they “treat lymphedema”). Second, they may have attended an appropriate CDT program to treat lymphedema but may not have sufficient experience. According to Foldi,1 “Therapeutic success cannot be expected if errors are made in administering the treatment. The necessity of daily treatment has already been noted. Furthermore, we must again emphasize that a … therapist who has just received a certificate authorizing him or her to perform CDT is a novice & needs to get experience.” The text continues, “A “10-year rule” states that it takes approximately a decade of heavy labor to master any field!” The following are listed as the most common errors made by therapists.
- Gross technical errors (such as failing to remove a bra which causes constriction)
- Failure to treat the patient on a daily basis
- Failure to apply bandages properly
Patients
Surprisingly, some patients may cause “artificial lymphedema” through constriction of a tourniquet or other means (& in some cases, deny it for reasons such as disability income). But in most situations (in my experience), failure on the part of a patient is due to non-compliance. Non-compliance can be not showing up for appointments, removing bandages to shower, not performing exercises prescribed, or not wearing a compression garment (including separate daytime & nighttime garments which are typically needed for pure lymphedema).
References
1 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 281-282. Germany: Urban and Fisher. Foldi, M., & Foldi, E. (2012). Foldi’s Textbook of Lymphology (3rd ed.). Urban and Fisher.
