Skin changes, wounds, weeping infection risk. Socially people aren’t going out anymore. Clothes don’t fit, so there really is a big impact with their whole life.
This is FOXcast OT, a podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org
Jimmy McKay, PT, DPT: Alright, welcome to FOXcast OT. I’m your host. You’re in Mackay on the program, Callie Stoll. Callie, welcome to the show.
Callie Stoll, OT: Thank you.
Well, we bring you on the show to talk about lymphedema that’s a topic we haven’t covered yet on the program and why don’t we start with a brief overview for the audience?
Callie: Lymphedema is a progressive disease that’s caused by an insult to the lymphatic system. So…
Skin changes, wounds, weeping infection risk. Socially people aren’t going out anymore. Clothes don’t fit, so there really is a big impact with their whole life.
This is FOXcast OT, a podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org
Jimmy McKay, PT, DPT: Alright, welcome to FOXcast OT. I’m your host. You’re in Mackay on the program, Callie Stoll. Callie, welcome to the show.
Callie Stoll, OT: Thank you.
Well, we bring you on the show to talk about lymphedema that’s a topic we haven’t covered yet on the program and why don’t we start with a brief overview for the audience?
Callie: Lymphedema is a progressive disease that’s caused by an insult to the lymphatic system. So there’s either primary lymphedema which you’re born with that’s genetic. It’s in your family or also there’s secondary lymphedema which can be caused by surgery cancers, accidents, parasites actually and that leads to swelling generally in the extremities can be seen in other parts of the body as well.
Jimmy: We want to make sure we have some takeaway points for the audience I’m sure that individuals out there either they’re regularly working with with clients that have lymphedema and the symptoms from that or if they’re every once in a while working with clients who have lymphedema and those symptoms. What are some takeaway points about lymphoedema where do we start?
Callie: Well it really is with diagnosis and recognizing that you have it or that your clients will have it. So that comes with the symptoms. Generally it starts with like a sensational heaviness that your client is feeling heavy or fatigued in a limb. It can lead to just some minimal swelling which might resolve overnight but doesn’t have to. Joint tightness, asymmetry of the limb. Those are really kind of the start of lymphedema where you’ll start to see it. But then it moves into skin changes, wounds weeping, infection risk. Socially people aren’t going out anymore. Clothes don’t fit. So there really is a big impact on the whole life.
Jimmy: Yeah it’s going to affect the whole person and the things that person is going to be able to do or want to be able to do, right? Right. Let’s talk about staging for just a second. How is lymphedema staged?
Callie: There’s actually three main stages I guess four, because stage zero is really when you’ve had that initial impact. So the easiest way for me to talk about is with cancer. So somebody that’s had breast cancer and they had lymph nodes removed. Technically that person has lymphedema whether or not they get the swelling. It really depends on the person’s body. There’s no set that number of lymph nodes or vessels in somebody’s body so sometimes people can handle the load of the fluid in their body other times they can’t. And that’s where they get the swelling. Then it progresses into stage one which is that sensational heaviness that I was talking about. They start to feel gosh my limb is heavy. I feel waterlogged is generally how they describe it. There might be some swelling that starts generally. People say might my rings don’t fit my watch is tight and that moves into stage two. Stage two is that swelling is there and it’s not resolving overnight anymore. Stage 3 is where you can get into the elephantiasis. Skin changes wounds, weeping that’s a big problem. So early diagnosis and early treatment is key.
Jimmy: Alright we’ve got the diagnosis and the staging so now we know where a client might be and the progression of that lymphedema. What does treatment look like how do you start to describe that?
Callie: As far as treatment goes really kind of the main school of thought with that is complete decongestive therapy. So that starts with a particular type of lymph drainage is called manual lymph drainage which is a it’s a type of massage that helps to move the fluid around those areas and allow your body to get rid of it elsewhere. That also goes into compression with either bandaging or compression garments which can be custom or ready to wear and an exercise program and really the goal of treatment is to teach your patients how to manage their own symptoms since it is a lifelong disease.
Jimmy: Yeah I love that. Empowering the patient because they have to understand that im sure patient education even just explaining what lymphedema really is can sometimes be difficult because it’s kind of hard to picture it’s not something that gets talked about a lot.
Callie: Right exactly. That’s just it. It is being talked about a little bit more since Kathy Bates actually came out and she has lymphedema, and she’s kind of talking about more publicly about her journey. So people are starting to recognize that a little bit more.
Jimmy: What are some other considerations as a clinician treating individuals with lymphedema?
Callie: A lot of it is access. A lot of people that we see don’t have the funding that’s needed because it’s not cheap. Bandaging, compression garments and a lot of time with the advanced stages you have to have a custom garments that fit properly and allows for the best treatment. And those are expensive. Insurance generally doesn’t cover that specially for older generation or older population that we work with. So it really is a big out-of-pocket expense. So that’s one of the huge limitations that we work with.
Jimmy: Now there is the lymphedema act within government to change this what is that describe that very briefly.
Callie: Yes really trying to work toward getting funds for people who are underfunded or just coverage in general to get people to be able to have the supplies and the treatment that they need. It’s been in the works for several years still not there yet. So there is if you go to LymphedemaTreatmentAct.Org. They do have a list of the French government officials that are involved in kind of a brief overview about what that is and where it is in the process.
Jimmy: Now as a clinician working with FOX specifically within our practice. What are you able to do with individuals with lymphoedema?
Callie: We’re able to reach those client in our practice that a lot of people can’t. These people might not be homebound but they might not have access they might not qualify for home health. So they really do fall through the cracks and as that progesses it gets worse and worse and so that can lead to wounds and weeping. And so we’re really at a unique place to be able to access those clients. We can perform the manual lymph drainage. We can suggest for compression garments. I’m able to, if somebody does want garments I can measure for garments which also helps them to not have to make a trip out someplace. Not a typical outpatient setting and so it’s great to be able to access those patients.
Jimmy: We call the house call model or therapy on wheels and you mentioned at the top of the show. You know a lot of those individuals when it gets to a certain stage they might not be able to or they might not want to go out because they’re self-conscious and that’s what health care providers are there to do is to make sure you get the care no matter that limitation.
Callie: Exactly.
Jimmy: So now you mentioned that you are a certified lymphedema practitioner. Yes and also a certified and fitting talk really briefly about what those certifications really allowed you to do in kind of enhanced your practice.
Callie: There is different ways to become certified. I actually did mine through the Norton school of lymphatic therapy when I was still in occupational therapy school. That was a really comprehensive look at how to effectively treat. Actually a hundred thirty five hours total education with ninty in the classroom and 45 at home. So that is is a really comprehensive view because it can be dangerous to treat if you don’t know what you’re doing. And then also as far as the garments go, there’s different companies and different brands and so with the fittings and the garments you learn about different fabrics type was the best way to do it. And with custom garments that helps to, it’s really like an extra skin to be able to provide that appropriate compression especially with somebody who has lobe’s on the leg or needs just a little bit more custom fit than a traditional ready to wear garment.
Jimmy: Excellent. That’s a great insight into maybe someone who’s out there listening thinking of getting certified in lymphedema treatment. What can the clinician listening right now who might not be certified just yet like yourself do tomorrow with a client that they have suffering from lymphedema?
Callie: Really need of treatment is education, so encouraging that person to really understand what’s going on. Even as far as not having them get blood pressure checked in their arm or their leg, needle sticks in the arm and the leg because that can exacerbate their symptoms. Elevation is important. Recommending compression garments. Avoiding too hot or too cold temperature. So that’s hot tubs, that’s showering. And also a good thing that somebody can do is belly breathing. Because there’s a big trunk that runs from your lower extremities all the way up and when you belly breathe your diaphragm actually strokes that trunk to help more help move that would more efficiently. Also just encouraging a healthy diet and hydration. So that’s all very important for controlling that swelling.
Jimmy: Great overview and a great look inside of some treatment with clients with lymphedema, I appreciate. Callie. The last thing we do on the show is your FOXtale. Are you ready for that?
Callie: Sure.
Jimmy: Why did you decide to work with older adults. What about that patient population really drew you in?
Callie: You know that words just kind of a no brainer for me. I’ve always known I was a caregiver type and I worked in an assisted living facility for many years before and through occupational therapy school worked with people with special needs. And I really you know I really am passionate about the geriatric population. They really have insight and advice. And just a different way of looking at life than others do. And know being able to help them achieve things champion their lives is really meaningful for me. So that really is a no brainer to work worked with geriatrics.
Jimmy: Love that, Callie thanks for taking some time out to talk Lymphedema with us today and really appreciate your time and insight.
Thanks for listening to FOXcast OT. A clinically excellent podcast brought to you by FOX Rehabilitation. FOX clinician’s work hard love their work and get the respect they deserve. Sounds good? Then you’ll love the autonomy to work in your own style and the support you get to achieve excellence. Plus freedom and flexibility to have a personal life. Whether it’s your first day or you’ve been around for a while. Your contribution is acknowledged and rewarded. That’s what makes FOX a success. Happy well-trained clinicians make great health care. Are you a fit for FOX? Find out now at FOX Rehab.org.
