At CHPT we have four therapists certified in the treatment of lymphedema and the treatment of other breast cancer related conditions including range of motion and myofascial restricitons.
Sevices include:
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One-hour evaluations for edema of the arms, legs, trunk and breast.
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Complex decongestive therapy programs created based on individual needs.
Each treatment session lasts up to one hour and consists of massage techniques, the use of compression and therapeutic exercise. The goal in all cases is to promote independence in the self management of lymphedema.
Callan-Harris Physical Therapy is recognized in the Rochester/Western New York region as a leader in the treatment of lymphedema, physical therapy pre- and post-radiation treatments, and soft tissue release before and after reconstructive surgeries. Our caring therapists treat you as an individual and understand the nature of cancer treatment and its effect on both the body and mind.
We offer an on-site, certified fitter to help you with compression garments, prosthestics and other needs. Working directly with your therapist, Mary Jo Provenzano, RN, will find the most appropriate garment for you.
Recent studies show that regular exercise is an important component of lymphedema management. Cardiovascular and weight training can lessen edema and decrease chances of flare ups. Fluid Motion is our movement class designed for people with lymphedema. Taught by Tracey Boccia, PTA/CLT, the class incorporates light weights and bands for upper body strengthening, stretches to improve range of motion, breathing and balance exercises, core strengthening and light cardio--all set to upbeat music. Click here for class offerings and more information.
Frequently Asked Questions:
Q: What is lymphedema?
A: Lymphedema is chronic swelling of an area due to permanent obstructions of the lymphatic pathways that carry fluid, which contains proteins and waste products, from tissues throughout the body.
Q: What is the lymphatic system?
A: The lymphatic system is a series of net-like structures that cover every part of the body, located right beneath the skin. Their function is to collect and carry the waste products from cells to any of the approximately 600 lymph nodes located through out the body. Lymph nodes then filter out the impurities and return the fluid back to the cells via the bloodstream.
Q: What causes lymphedema?
A: While some cases are congenital (primary lymphedema) most cases are caused by removal of the lymph nodes after surgery or damage from radiation treatments (secondary lymphedema). Secondary lymphedema can develop immediately post-operatively or weeks, months or even years later. It can be triggered by trauma to the lymphatic system, air travel (due to sudden change is cabin pressure), sunburn, bug bites or skin infections.
Q: Is there a cure for lymphedema?
A: Lymphedema cannot be cured, but it can be managed. Exercise, proper skin care, frequent massage and wearing compression garments can help you maintain and manage lymphedema independently.
Q: What does the treatment consist of?
A: Treatments begin with a full evaluation, including girth measurements of the limb(s) and the creation of goals for you to meet. Subsequent visits will include Complete Decongestive Therapy consisting of manual lymph drainage (MLD), exercise, skin care and compression. MLD is a light massage that facilitates the lymph nodes and establishes new pathways for lymph to flow through. For lymphedema of a limb, girth measurements will be taken on a regular basis to chart your progress. At the conclusion of the MLD, compression bandages will be applied (except for trunk or breast lymphedema) which should be worn 23 of 24 hours per day. These bandages will be replaced by compression garments at a certain point in the reduction process of your limb, although you may need to wear bandages at night. For trunk or breast lymphedema, your therapist will discuss with you a special bra that provides needed compression. Equally important to the treatment is the home management and exercise program you will be given.
Q: What will my home management program consist of?
A: Your therapist will instruct you in specific self-massage techniques and exercises to do daily. You will also be instructed on bandaging, so you and/or a caregiver can apply your bandages properly at home.
Q: Should I exercise with lymphedema?
A: Lymph is moved through the system by muscle and skin action, not by the heart or circulatory system. Exercise encourages skeletal muscle contractions to provide the primary pumping mechanism for lymphatic and venous drainage and therefore stimulate the contraction of lymph vessels and is believed to increase the lymph flow by 15 times its resting rate. Studies show that upper-body exercise may assist in the long-term management of lymphedema. The use of compression bandaging in combination with exercise may improve venous and lymphatic return and minimize fluid from leaking into the interstitial space. Heavy, repetitious or rigorous weight training should be begun gradually, under the guidance of your PT.
Q: What are the bandages for?
A: Compression bandages are applied initially at the end of each treatment session to encourage further lymphedema reduction. They should be worn 23 of 24 hours per day, even while sleeping, and changed daily. Bandages are not covered by insurance companies and should be an anticipated out-of-pocket expense.
Q: What are compression garments?
A: Once the reduction of edema has stabilized, you fill be fitted for a compression garment, such as a sleeve or stocking. Garments maintain the edema level but do not reduce it further. They are usually worn daily, for an indefinite period of time. Most health insurance providers cover a good portion of the cost of the garments.
Q: How long do garments last?
A: The average compression garment lasts about six months. Since skin oils and lotions break down the spandex, garments must be laundered frequently. Two garments should be purchased so that one can be worn while the other is being laundered.
Q: How often will I have to come for treatments?
A: Initially, your therapist may want to see you two or more times per week, until the reduction stabilizes. Since lymphedema is a lifelong condition, your therapist will teach you self-massage, exercise and bandaging so you may manage your lymphedema at home. You may need to come in for occasional MLD as needed.
Q: Do I need a pneumatic pump?
A: While pneumatic pumps can successfully treat venous edema, they are not recommended for lymphedema. The pressure can actually further damage lymphatics, causing the swelling to worsen.
Q: Will my health insurance cover lymphedema treatment?
A: Treatments are covered by most insurance providers, however bandages are not. You will be expected to pay for these as an out-of-pocket, non-reimbursable expense. Compression garments however, are covered in part, by most insurance. Contact your provider for details.
Q: If I do not have lymphedema, how can I avoid getting it? If I have it, what should I do to make sure it doesn’t worsen?
A: No one can predict whether or not lymphedema will occur, however there are precautions you can take to improve your odds:
- Avoid injuries to the skin. Wear gloves for gardening and use caution when playing with your pets or doing housework. Avoid the use of scissors to cut nails and don’t cut your cuticles. Injuries, even small ones, can cause infections. If you do have a cut or burn, consult your physician for an antibiotic immediately.
- Avoid mosquito bites. Wear insect repellent when outdoors.
- Use caution when exercising. Avoid movements that overstrain.
- Take frequent breaks when scrubbing, mopping or vigorously cleaning.
- Avoid heat. Very hot showers, hot packs, sunbathing and the use of saunas could have a negative effect on your lymphedema, pulling fuid into the already swollen area. Avoid extreme changes in temperature and massages on your effected extremity.
- Inform all health care personnel that you have lymphedema. Blood pressure should be taken on the extremity free of lymphedema.
- Nutrition is important. There is no special diet for lymphedema, but nutritionists recommend a low salt, low fat diet. Obesity may have a negative effect on your swelling.
- Travel. When traveling by airplane apply an additional bandage on top of your garment. Avoid mosquito-infested areas.
- Clothing that is too tight may restrict proper flow of lymph. Avoid restrictive undergarments and socks.
- Don't carry a heavy purse or handbag on the affected side.
- Don't drink much alcohol; alcohol causes blood vessels to expand and leak extra fluid into the tissues.
- Don't smoke. Smoking narrows small blood vessels, lessening the flow of fluids in the arm.
- See your doctor if you have any signs of infection fever, chills, red and hot skin or fungal infections.
- General tips: Always wear your compression garments during the day and if necessary your bandages at night; perform your exercises daily and always consult your doctor or therapist should you have any questions about your lymphedema.
For more information:
National Lymphedema Network
Lymph Notes
Mayo Clinic
Breast Cancer Support
National Cancer Institute
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