A primer on treatment.

I’m so incredibly grateful for Julie, the physical therapist who treated me. She has a very gentle and healing presence. In fact, I decided to be a physical therapist because she helped me.

Physical therapy really helped me. After wondering around for two years being told to keep my legs up, I was hungry for something to do to manage my body. What is really cool about physical therapy is the patient has an active part in the management of their condition. The physical therapist serves as a guide to allow the healing process to progress.

I also like how a good physical therapist creates space for enhancing self efficacy. Self efficacy: a person’s belief that they can be successful when carrying out a particular task. That would be pretty important if you needed to manage your lymphedema throughout your life right?

Lymphedema is not a curable disease. When I first heard this; it hit me in the gut. If someone who has an infection can be cured by medicine or someone who has an ankle sprain can be rehabbed, why couldn’t my leg swelling be “fixed”? Well, it turns out there are a lot of things in our medical system that need to be managed versus cured. Some of them include diabetes, autoimmune issues, etc.

The five components of current best practice for lymphedema treatment are: education, skin care, compression, exercise, and manual lymphatic drainage.

Education is the most important!!! In order to manage your condition, you need to understand your condition. If someone with diabetes didn’t understand how blood glucose was affected by food they ate, it would be very hard to manage your blood sugar. In many cases, the patient will become the advocate with our current medical model. More on this later.

Skin Care: To prevent infections, you want to maximize the barrier protecting you from the external enviroment. This means moisturizing your skin and taking care of your nails. For folks who have had lymphedema for awhile, it might mean addressing some other changes including ulcers, fungal infections, etc.

Compression: Because your lymphatic system isn’t working 100%, you need external support to keep fluid from accumulating throughout the day. Initially this looks like short stetch compression bandages and is transitioned into compression stockings/sleeves.

Exercise: Your muscles actually assist lymphatic reuptake. Long term, the more healthy you can make your body, the better your lymphatic system can work. I think this is the most underdosed component- more to come here.

Manual lymphatic drainage: This hands on technique has been shown via imaging to actually improve lymphatic function.

All of these components are addressed in treatment as all components need to be addressed after you complete treatment and transition to self management. They can look different during various stages of your life. Depending on the severity of lymphedema, different components may be emphasized.

Another word on management- consistency is key. An example, if you only brush your teeth once or twice a week, are you being helpful or efficacious? If you only take your blood pressure medicine when you remember, will your blood pressure be managed? Building habits are a very helpful way of acheiving consistency. More on habits later.

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