Lymphedema Treatment Frequency?
My oncologist said she was sending a referral for a Lymphedema evaluation and recommendations to the clinic in her medical building (which, in turn, is in a hospital near my home). I need to follow up since they haven't called as expected, but I saw that the program outlined at another area hospital is five days a week for four weeks. Is that typical?
I'll be having my 7th weekly Taxol tomorrow after a very tough time with AC. Add in four surgeries (two lumpectomies, port implantation & replacement of that port due to looping / retraction / poor performance) and two infections, one requiring a PICC line and two weeks of daily IV antibiotics. The idea of getting dressed, battling for a parking place and doing such frequent therapy with weeks of daily radiation therapy on the horizon makes me want to cry or scream, not to mention the cost since I haven't met my catestrophic out-of-pocket yet this year. I have severe Fibromyalgia, which adds to the fatigue factor. Was your treatment schedule that demanding? Thanks!
Lyn
Comments
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I had lymphedema treatment in an NCI center that has multiple certified LE therapists. I did not have appointments that frequently, and my therapy consisted of discussion, supervised light exercise, and lymphatic drainage by the therapist. Toward the end of my active lymphedema treatment I was also taught to do MLD on myself. Others at appointments were wrapped (I have a friend who required this and went to the same center), and then were taught to wrap themselves. I attended therapy initially twice weekly for about a month, then once weekly for another month, then was discharged to care for myself. I can go back at any time if I feel the need to. My therapists did not fit sleeves and hand protection, but rather wrote the order for compression level and I was sent to a specialty medical device company, that also does custom prosthetics, and they measured me and ordered my garments (I have bi-lat LE) and billed my insurance. I don't know what the experience is for others, but there are a number of BCO members here in Tampa and I believe their appointment frequency is consistent with mine. Wishing you luck as you navigate this.
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my treatments consisted of the lymphedema rubs done at a physical therapist, who also taught my kids to do the wrap. I mostly use the sleeve and glove, but the wrap seems to work better. I now do my own lymph rub, from neck to shoulder to hand. fortunately nothing on back where I could not reach.
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That sounds more doable, Special K. I have huge upper arms so will definitely need a custom sleeve if that's recommended. I can't image wearing it in the Texas summer. I can barely stand to wear clothes! ;-). Thanks for responding.
How often did you go to the PT, Cliff?
Lyn
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Lyn, the routine you described in your original post is considered the desirable standard. However, there are a couple of factors that change that.
The first is the lymphedema stage. For instance, it's now considered acceptable to treat pre-clinical (or Stage 0, with early symptoms of discomfort and occasional mild swelling) with nothing more than a well-fitted sleeve and glove or gauntlet to be used for exercise and travel; and early Stage 1 (with more consistent mild swelling) is sometimes managed with just a few sessions with the therapist.
The second consideration of how rigorously to treat is what's actually possible for an individual patient. If their insurance doesn't cover PT or (like you) their treatment exhaustion makes it unthinkable, there are modifications that can be made to suit your own situation. During your first visit, be up-front about the things you've mentioned here and work with your therapist to set up a schedule that works FOR YOU. That may mean, for instance, taking remedial measures now and putting off "the full whammy" until you're up for it, or making an effort to teach you self-care quickly so you can handle Manual Lymph Drainage (massage) and (if necessary) wrapping at home yourself. A lot of LE care is up to us, so speak up and expect some flexibility that fits your own needs.
Let us know how it goes!
Gentle hugs,
Binney -
3 times a week. actually the sleeves aren't too bad in the summer or winter, the ones I have anyway. the material is like the best girdles are made of. the problem I came up with was that gloves (regular kind) don't fit my left hand anymore. I use an xl on the right and 4xl on the left. had to go to an army navy store to find one big enough for the left hand. we had some days below zero this winter, and without a warm glove, that's uncomfortable.
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Thanks, Binney! That's encouraging.
Sub-Zero temperatures without a glove sounds miserable. Good luck with your search, Cliff.
Lyn
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I have been going once weekly
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I went twice a week for a month, then dropped back to once a week. After a couple of months, I was released. Now I am back in therapy since I've obviously done something to cause a flare. I will continue to to MLD at home & see the therapist once a week for awhile.
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Thanks for the input, ladies!
Lyn
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VLH oh dear you have had a whole whack of harsh treatment. If your feet lose feeling from taxol gabapentin worked like a charm for me. My nueropathy was so painful in fingers that I couldn't touch the fly on my jeans to pull up. Switched to pull up joggers. It took about 6 months to fully recover.
I go for once a month tune ups for my le. That way the therapist can keep a eye on me. If I get a problem I schedule more. Been doing this for years. Costly....,,yes out of my pocket as insurance only pays out a couple hundred bucks but worth it in the end.
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I'm sorry you have LE on top of everything. You deserve a break.
My LE treatment was eight or ten sessions plus an initial evaluation. They wanted them ideally twice a week, but I too was fitting them in around active treatment and radiation, so it was challenging. I did several in the afternoon after radiation in the morning. But at the height of the radiation, I was badly burned and didn't want any MLD, so we stopped for a few weeks to let me heal.
I think a lot depends on the therapist. Mine was lovely, and I always felt that I got a lot out of the sessions. In retrospect, though, it might have been better not to have done them while in radiation. It was just a bit too much, and I was too distracted to ask the right questions of the therapist. My LE therapist was scheduled to have a baby right after my treatment ended, though, so that was an incentive to finish up quickly!
But the LE treatment is very educational, and I did come out of it feeling that I could manage the condition on my own, for the most part. I'd go back if I had a bad flare and do call occasionally with questions.
Good luck to you!
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Thanks for sharing your experiences, all. My oncology nurse called. First, she was waiting for signed notes from the MO. Second, she said the scheduler at rehab had a death in the family so it may be a few days before I get a call. I'm glad the 5x per week format isn't mandatory, even if ideal. I'd like to complete the chemo and LE treatment at the same time if possible to give myself a couple of weeks off before starting radiation. I haven't seen my family for three years so plan to visit them during my treatment vacation.
Lyn
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There is the ideal, then reality of patients' lives! Ideally, a patient would go to a clinic (or have someone come to their home) daily for 2-6 weeks for measuring, MLD, bandaging. The patient would wear the thick bandages at home for 23 hours, come back the next day for more MLD and bandaging. After several weeks, after the volume of the limb has stopped decreasing, the patient is "discharged" and put on "maintenance", meaning they and their therapist select daytime/nighttime home garments, and the patient learns self-care/donning, and doesn't have to be seen again for 6-12 mos until it's time for a checkup. Because the daily visits are so hard to get in, patients discuss with the therapist what they can manage, perhaps MWF, for example.
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Thanks, Julia! I'm disappointed that the therapist can't see me until 3/6. First, the nurse didn't forward the referral because she needed some documentation, then another week's delay since the scheduler unfortunately had a death in the family. It's frustrating to have a five week delay and I still find myself so angry at the ER nurse who inserted an IV line after I told her that arm was a lymphedema risk. Would the LE have progressed anyway? No way of knowing, but I have to think that the timing of going from mild seeking to "sausagy" was no coincidence and now I literally have to pay the price. :-(
Lyn
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