Lymphedema Case Study 1

I have a client who has given me permission to share her story with you all, but honestly it’s been a little while since I gathered the details. So in an effort to not just misquote her, I’m going to say that this is a fictitious story inspired by a client, but is a very real scenario and excellent learning experience.

Irene came to see me for Manual Lymphatic Drainage for her right arm.

17 years ago Irene had been diagnosed with breast cancer. With the combination of chemotherapy, radiation, and surgery (lumpectomy), she became cancer-free within two years. The lumpectomy resulted in the removal of four lymph nodes in her right armpit. Both her radiologist and surgeon told her that there was a chance that she could develop lymphedema in her right arm because of the trauma done to her lymphatic system. They told her that from now on, she should not have blood pressure taken on that arm, blood drawn from it, or vaccines in that arm either but that if she didn’t develop lymphedema within a couple years, she was probably in the clear.

When Irene came to see me it had been almost two decades since the radiation and surgery, she hadn’t developed lymphedema and had for the most part, forgotten that it was even a risk. And then last year she got a vaccine in her right arm. Over the next few weeks her arm started to feel heavy and tight and some of her shirts felt snug on her right arm only. After a few months it was clear that her right arm was bigger than her left and that she was likely developing lymphedema.

The vaccine in her right arm prompted a healthy response from her body, sending lymphatic fluid carrying white blood cells to the area that had been damaged by the needle and injected with a foreign substance. This is how our bodies protect us. But because Irene had radiation damage to the lymphatic vessels as well as lymph nodes removed (either one would be enough to be the trigger for lymphedema, so she won’t necessarily know which was responsible), that influx of lymphatic fluid to her arm was not able to drain and leave the area the way it normally would have (by the lymph nodes in her right armpit).

During Irene’s first session we worked on re-routing the lymph fluid to other lymph nodes so that the swelling in her arm could go down, this is done by manual lymphatic drainage, a process where the practitioner uses bare hands to gently stretch the skin in specific sequences and directions to guide and create movement. This process takes patience and dedication.

Manual lymphatic drainage is great for everyone, even those who don’t have compromised lymphatic systems. Because Irene does have a compromised lymphatic system and indeed does have lymphedema, she will possibly also be partaking in Complete Decongestive Therapy. This includes Manual Lymphatic Drainage, but is also then followed up with wrapping the right arm with several wraps (not ace bandages though they look similar), a compression garment for daytime and one for nighttime, as well as certain exercises.

Anyone who has had significant recent or previous damage to the lymphatic system is at risk for developing lymphedema. Once a person develops lymphedema they have it for life. It can be managed and maintained with manual lymphatic drainage and compression wraps/garments. These require the help of a Certified Lymphedema Therapist at first, but eventually can be done by the client at home.

Nurses, Massage Therapists, Physical Therapists, and Occupational Therapists can all become Certified Lymphedema Therapists. There are many advantages to going to a Physical or Occupational Therapist for lymphedema therapy including resources, support, insurance coverage, access to technology, and budgets for things like wraps and compression garments. One main advantage to seeing a Massage Therapist who is also a Certified Lymphedema Therapist is that we don’t require a doctor referral, so we are a little more accessible. I can’t speak for all LMT’s when I say this, but I can also promise you that your session will be heavily focused on relaxation and feeling nurtured. Our bodies heal when we are resting, this fact guides my practice.

If you are seeking Manual Lymphatic Drainage, here is some guidance to help you find the practitioner for you:

-A Licensed Massage Therapist who is trained in Manual Lymphatic Drainage can offer this modality to people with uncompromised lymphatic systems (people who do not have and are not at risk for lymphedema).

-If those same LMT’s take continuing education for post-op recovery they can work with plastic surgery clients.

-LMT’s that go on to become Certified Lymphedema Therapists can work with people who are at risk of developing or have lymphedema.

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