Lymphedema Therapy

before and after Complete Decongestive Therapy (CDT)

Symptoms of Lymphedema:

• fullness, heaviness and achiness sensation in the limb
• skin feeling tight
• decreased flexibility
• swelling in a specific area
• redness- the appearance of redness, rashes or heat in the at-risk
• limb thickening of the skin
• hardening of the limb
• leakage of lymph through the skin
• excessive swelling

Lymphedema most commonly follows a surgical procedure in which there has been a removal or disruption of the lymph nodes or vessels.

If you have been exposed to any of the following procedures or situations, you may be at risk for developing Lymphedema.

• biopsy of Inguinal (groin) or Axillary (armpit) Lymph Nodes
• breast surgery or Prostate surgery
• radiation or Chemotherapy treatment
• other surgery involving lymph nodes
• broken limbs from trauma
• hernia repair
• venous Insufficiency
• severe infections
• other medical procedure involving the lymphatic system.

Following breast cancer treatment, localized swelling is normal and should resolve with time.  However, you may also be at risk for developing lymphedema, which is a more serious form of swelling that affects the arm and truck on the same side of your body as your breast cancer.  It is important to realize that the symptoms of lymphedema may begin months or even years after your breast cancer treatment.  When diagnosed early, resolving lymphedema with treatment is much more successful.  Studies show that there is a 30% chance of developing lymphedema after breast cancer treatment.

Lymphedema is a disease, not a symptom, of an underlying malresponsive lymphatic system that is unable to clear protein fluids from the space that suspends all the cells. There are numerous causes of lower extremity lymphedema.

• Primary Lymphedema: These are individuals who are born with the disease of lymphedema. Often people with hereditary conditions are born with impaired lymphatic systems and thus born with lymphedema, such as: Millroy’s disease, Meige’s disease, Turner’s syndrome and Noonan’s syndrome. They often exhibit lower limb bilateral swelling.
• Secondary Lymphedema: This is when a symptom of edema causes the disease of lymphedema and/or is manufactured due to poor health conditions or through treatment of cancer. This over time with no intervention can become an irreversible failure of the lymphatic system. Below, in order, are the leading causes of lymphedema.
  1. Obesity: Due to fatty-tissue proliferation with increased inflammation triggers a cascading effect of lymphatic uptake failure and increasing hardening of soft tissues and skin that immobilizes the lymph fluid.
  2. Chronic Venous Insufficiency: Due to the vein’s valves inability to contain fluid a pooling of blood occurs and creates a retrograde flow (fluid back-up) in the surrounding tissues; thus, creating swelling.
  3. Congestive Heart Failure: Due to the heart’s inability to effectively pump or fill the chambers a pooling of fluid begins to occur. Often this can be seen in the feet and ankles first. These patients might also experience orthopnea, hard time breathing laying down, due to the pooling of fluid in the lungs. These patients often like to sleep on recliners.
  4. Treatment of Cancer/Iatrogenic (dissection/node removal, radiation): Surgical intervention of cancer can sometimes mean lymph nodes are to be removed as the cancer spreads. This mechanically dampens the lymphatic systems ability to drain protein fluids, thus creating lymphedema. Radiation treatment to cancer can also have lymphatic impairment causing blockage and thus inhibiting regular drainage of the lymph.
  5. Lipedema: Is a disorder of fatty metabolism that almost exclusively occurs in women. This is not lymphedema but lipedema and lymphedema are often found to co-exist in a patient. These patients do not exhibit swelling of the legs, unless they have lymphedema, but show disproportionate fatty deposition at the hips, thighs and legs while the feet remain unaffected.

The treatment protocol for lower extremity lymphedema is to provide Complete Decongestive Therapy (CDT) involving a phase of decongestion and a phase of maintenance. This includes Manual Lymphatic Drainage (MLD) of affected regions, thereby manually moving the fluid back into circulation and decreasing volume of the affected regions. Once manually drained, compression bandaging/therapy is applied to maintain the reduced size in order to continue the decongestive work.

Who are Certified Lymphedema Therapists-LANA?

CLT-LANA therapists are healthcare professionals who have successfully passed a comprehensive examination by demonstrating knowledge about the lymphatic system and Lymphedema management.  CLT-LANA credentials confirm for patients and referring medical providers that the therapist has the highest level of competency in the profession and has remained current with advancements in the field.

The Assistive Devices Program (ADP) of the Ministry of Health and Long-Term Care provides funding assistance for Pressure Modification Devices (PMD)—compression garments and sleeves—for chronic lymphedema management as well as sequential extremity pumps for primary lymphedema management. Any resident of Ontario with a valid Ontario health card is eligible to apply. The ADP pays 75% of the approved cost. Those receiving benefits from certain social assistance programs may be eligible for 100% funding of the approved cost. An Application for Funding Pressure Modification Devices form can be obtained from an ADP registered authorizer or vendor or downloaded and printed from the ADP website.

Funding for Pressure Modification Devices – Information Sheet (PDF)

For more information on the ADP, you can visit the following page at: www.ontario.ca/page/assistive-devices-program

You can email ADP directly at adp@ontario.ca
Alternately, you may call the ADP at 416-327-8804, toll free at 1-800-268-6021 or TTY at 1-800-387-5559.

The ADP Authorization assessment is 30 minute appointment at a cost of $75.00

Comprehensive lymphedema treatment is not covered by Ontario Healthcare. However, government support is only one source of funding patients should explore.

Insurance Providers

The coverage provided by specific employee-based health benefits and private insurance programs varies greatly. Manual lymph drainage is usually reimbursed under the categories of physiotherapy, occupational therapy, registered massage therapy or sometimes nursing care. If submitted expenses are refused by your insurance provider, it is prudent to challenge the decision by speaking with a program administrator and sending them information about lymphedema. A letter of support from your therapist or physician may also help your claim.

Income Tax Deductions

Certain medical expenses can be itemized as deductions on your income tax return to help reduce the amount of income tax you pay. Examples of eligible costs are:

• Unpaid balance of expenses for treatment/supplies not covered by ADP or insurance
• Travel expenses related to MLD treatment
• Purchase of compression short stretch bandaging supplies

For more information on allowable expenses, refer to the Canada Customs and Revenue website (www.crs-arc.gc.ca) under forms and publications.

Community Support

Some community groups provide financial assistance for cancer related expenses to low income individuals. Check www.cancer.ca for an extensive database on local community services available. You can also check with the Canadian Red Cross, Hope Air, Easter Seals Ontario, March of Dimes Canada, The War Amps, your local parish, Kiwanis, Lions or Rotary Club in your neighbourhood.