lymph drainage massage - how to do

Linjea, goodness yes -- brownies and a good lymphedema therapist!

Unfortunately, lymphedema massage (Manual Lymph Drainage, or MLD) and wrapping are not do-it-yourself. That's because learning the proper pressure, direction, and order of the massage is very critical and it depends on your own individual needs -- for instance, whether there is fibrosis or scarring present, what kind of surgery you've had, and the condition of the skin. Only a therapist can assess your particular needs and help you learn a technique that is workable for you.

The point of the wrapping (which must be done with the proper pressure throughout or it will do more harm than good) is to help reduce the swelling by promoting lymph vessel function. Exercising or even just the ordinary movements of daily living help the wrapping work, but it also works well at night. Like Manual Lymph Drainage, this can only be taught in person, one-on-one with a really good therapist.

The sleeves and gauntlet that you order are only for use AFTER the initial therapy (regular MLD and wrapping by a well-trained therapist). They don't reduce the swelling but only help maintain the reduction that happens with therapy.

When you already have swelling in your hand a gauntlet is a bad idea, because it will cause the lymph fluid to be trapped in your fingers, where it is very difficult to get it out. And any sleeve that does not fit well on ANY PART of your arm will make matters worse, as the compression needs to be greater farther from your axilla and less as it moves up the arm. If it's looser at your wrist and then tighter in your forearm that will trap fluid around your wrist. When the off-the-shelf garments don't fit, it's time to be fitted for custom garments. BUT, again, that is only after you've had the therapy by a well-qualified therapist.

Early stage lymphedema does sometimes reduce and then swell again. This is the stage where it is VERY IMPORTANT to begin therapy, because otherwise it will progress and produce fibrosis (hardening of the tissues inside) and more serious skin changes that may then be permanent. Please don't let that happen, as it's discouraging and disabling and will eventually affect your arm strength and range of motion.

The achiness and pain are early indications of a need to get help with draining the stagnant lymph fluid and keeping it reduced and healthy. This will not only feel better and be much easier to manage, but it will help prevent the cellulitis infections that are so common in lymphedema.

Here's a page of information about how to find a well-trained lymphedema therapist near you:
http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm

Hang in there -- there's help for this, and it makes a BIG difference. And please let us know how we can help.

Big, gentle hugs,
Binney 

Linjea, did either of those therapists actually do MLD on you? Just curious, as it's nearly impossible to learn without some hands-on, but there are a lot of therapists out there who are not making the time/effort to do that.

If you've had bilateral surgeries (don't know if you have or not), you don't want to move the fluid from the bc side to the "good" side, because both are at risk.

There are several good lymphedema therapist training schools, and they each have their own unique take on this, though they all do basically the same thing about clearing nodes, then massaging the chest, etc. The differences come in the kind of strokes used (though all have to be very gentle). There is even one very good school that recommends that their patients not do self-mld at all, because we so often get it wrong anyway -- whether we forget a step or two, or we go too fast (the lymph system has a very slow rhythm), or we press too hard when we get frustrated or hurried.

The issue really is, which works best for you? Two things to consider: which is more effective at reducing swelling, and which are you more likely to be able to pull off every day on an on-going basis. Keeping up this routine over time is a big part of the challenge, so we do need to be realistic about what we can actually do. There are a number of "short-cut" routines that help some women (and not others). For instance, using the first three sections of the Lebed exercise DVD is as effective for me as doing self-mld, but it may not be that way for others. For some, several short versions (that include node clearing and a few key massage strokes and/or some deep breathing or exercises) throughout the day work better than one (or two) whole self-mld routines.

And just as an aside, therapists call self-mld "Simple Manual Lymph Drainage" or SMLD, but I sorta resent the term -- nothing simple about it!

Others will no doubt be along with their own versions of mld coping. Be well!
Binney