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Lymphedema Reduction Program Occupational Therapy (OT)

Welcome to the URMC OT lymphedema reduction program.  The use of variable compression with short stretch bandages must be done with careful consideration to your body’s response due to risk of injury.  We have developed this program specifically to create successful lymphedema reduction. Success depends on your ability to attend appointments and follow the specific home instructions.

If at any time you feel you cannot follow the instructions, remove all bandages and we will move on to a containment program. We can always try again at a more convenient time when you can participate fully.

Before Starting the Compression Program

These tasks need to be completed before the compression program can start

  1. Schedule your first 2 weeks of appointments, then stay 2 weeks ahead by scheduling every week.  A gap in appointments can cause a loss of gains or failure of the program. 
  2. Obtain all supplies and bring to the first visit. Supplies can be found at a few local medical supplies stores and online.

Stores that usually carry these items:

  • Nu Life: 7300 Pittsford Palmyra Rd, Fairport
    Office hours at 990 South Ave
    (585) 672-5105
  • Fonte's Medical Supply
    1900 South Clinton, Brighton
    (585) 244-4747

Induction/Training Phase

 2 – 3 long OT visits each week for 2 weeks. Therefore the program does not start on a Thursday or Friday.

This includes the initial determination of the wrapping pattern that works for you. We train you or a helper to wrap at home. This is a complex task and usually takes 4 visits for training. Bandages are worn continuously during this period. Showers are not recommended. At the end of the period, the expectation is that you will be independent in the wrapping techniques.  If not, we may continue a clinic based program or stop the program.

CAUTION

If you have any symptoms of increased swelling, lasting change of skin color that is significant, tingling or numbness then you must remove the top bandage immediately.  It is also helpful to then stop doing whatever you are doing and elevate your extremity. Muscle pumping is also helpful.  If the symptoms do not resolve within 20 minutes then remove the next bandage.  If it any time ear pain or symptoms are significant then remove all bandages.  If you do not do not remove the bandages, then reduction does not occur as the body will not decrease lymphedema when there are stressful factors triggering a response.  By removing the bandages, your current status is likely preserved. Leave the bandages on under adverse conditions, and the symptoms are likely to worsen.  During the program, we are gaining knowledge on how your body tolerates compression or doesn’t, then we can make adjustments.

Ongoing Reduction Phase

 This program lasts as long as the size is going down. The average individual tolerates 2 to3 months. Wrapping must continue until the extremity is contained with a long-term garment or gains will very likely be lost.

Clinic Based Program

Following training, if you or your assistant are not able to apply the bandages at home, then an OT clinic based program can be done with 2-3 times per week visits with OT. There is no set timeframe for this phase, although usually people are “done” in one to two months, then continue to wrap until they have wearable containment.

Home Based Program

Once you have demonstrated independent donning of the supplies, then you can do the wrapping at home. The wraps are to be removed each night, washed overnight, and put back on in the morning. A second set may be helpful.

Each time the bandages are put on, there is an opportunity for reduction.

 Re-checks by OT are individually indicated, usually weekly.

** If there is no containment after reduction, then there is NO reason to do reduction, the fluid will come back. This program address the symptoms of lymphedema and does not change the cause.

Exercise

Muscle pumping is recommended. Light activity is usually tolerated.

Vigorous or new cardio exercise is not recommended as this places a greater demand on the lymphatic system. When reduction is indicted, then the system is not managing the current volume so additional demand during attempted reduction can be nonproductive.

Self-lymphatic Stimulation

This is a hands on self-administered technique to assist the lymphatic system to drain fluid and possibly find a new pathway.

Containment Program Lifelong

Compression

Your OT will recommend the appropriate amount of pressure at this time.

Off the shelf or Custom sleeve/glove/stocking – replace every 6 months is the standard.

A glove can be worn without a sleeve, but rarely can a sleeve be worn without a glove with active lymphedema as the pressure differential can lead to hand swelling.

Other Compression Options

Juxtafit/Readywrap: a one piece elastic garments with overlapping piece that built a sleeve. Lasts years

Compression pump- insurance usually may consider some coverage after failure of other options and only in certain diagnoses that are associated with lymphedema

Pumps are only considered when it is determined that the lymphatic system cannot be stimulated to manage without it. Pumps are not recommended as a substitution of other methods. Pumps are typically added to a program of compression garments.

Exercise

Is now highly recommended. Begin adding physical demand in a stepwise fashion. No sudden increases. Monitor for continued containment.

Weight Management

Obesity is the number one modifiable risk factor for primary and exacerbation of secondary lymphedema. Any weight loss is helpful!!!