Planning the treatment program depends on the cause of the lymphedema. For example: If the lymphedema is caused by infection (redness, rash, heat, blister, or pain may indicate an infection), your doctor will prescribe appropriate antibiotics.
If the lymphedema is NOT caused by infection, depending on the severity of the lymphedema, a treatment plan will be determined using an approach based on complex decongestive physiotherapy methods which consist of:
Manual lymphatic drainage is performed by specially trained therapists. This therapy focuses on gently massaging connective tissue, rather than muscle tissue, with a pumping motion. This stimulates the weakened lymphatic system by pushing the stagnant fluid through the vessels, allowing the venous system to reabsorb the fluid and supporting the development of new collateral channels through which the lymph can begin to flow. Self-manual lymphatic drainage is taught in order for patients to perform at home in their own some of the basic massage strokes.
A number of treatment centers now use a special bandaging technique for both upper and lower extremity lymphedema. This method has been used for decades in Europe in conjunction with manual lymphatic drainage. It is an ideal alternative for patients who travel as self-bandaging can be done anywhere at any time once the technique is mastered and has been proved to be one of the more effective modalities.
A sequential gradient pump may be used. Pressure is sequentially distributed through overlapping air compartments constructed in a customized appliance that envelops the affected limb. The compartments inflate sequentially, causing the lymphatic fluid to circulate out of the affected limb. IMPORTANT: A patient using a pump needs to be monitored by a clinician to ensure that a proper and safe pressure is applied and, ideally, have manual lymphatic drainage before and after treatment.
Antibiotics are widely used to treat local infections or prevent recurrent chronic infections. Diuretics continue to be recommended by some practitioners, but they should be used cautiously. They demonstrate little effect on reducing lymphedema and there is evidence that long-term use can be harmful.
Patients who have congestive heart failure must be monitored closely. Patients with venous or arterial obstruction (deep-vein thrombosis) or acute infection should not be treated until the obstruction or infection has been resolved. Patients who are receiving anticoagulant therapy should have a venous screening to rule-out deep-venous thrombosis before being treated.
When these procedures, therapies, and diagnostic studies are medically necessary, many insurance companies will provide reimbursement. You should discuss your insurance coverage with your insurance carrier once the required treatment has been determined.
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