Decongestive Therapy – Oedema 

Decongestive Lymphatic Therapy (DLT) also known as Combined Decongestive Therapy (CDT) is the treatment used to reduce stagnant, contaminated, thick and heavy fluid. Decongestive therapy is your ticket back to normal, and best done as soon as possible.

Some may require daily intensive treatment, and others may only need a few to get the lymph system pumping again. All efforts are made to consider all possibilities, especially your affordability and other alternatives when your budget has been stretched too far.

Firstly, please note – It’s very important to seek medical advice if you have developed any kind of new or abnormal swelling

There could be some serious underlying health implications that needs to be addressed urgently. Once all your health checks have come back clear, it’s time to look at your lymphatics.

Decongestive treatment will likely consist of a combination between manual lymph drainage (MLD), compression bandaging, pneumatic compression pump, skincare and specific lymph assisted exercises, then into compression garments when we find your baseline.

Manual Lymph Drainage 

The movement of the skin stimulates the lymph vessels to open, allowing for a larger volume capacity to pump and move out the metabolic waste, excess fluid and other components causing inflammation and disease. Also, improved function and drainage of the lymphatic system, means enhancing the overall function of the immune system

Compression Bandaging

Bandaging increases tissue pressure influencing both lymph and venous return whilst also softening any skin changes due to the accumulated protein in the tissues (known as fibrosis). Once a reasonable reduction in volume has occurred, compression garments are then prescribed to keep the volume down. Garments are best prescribed after this process for long term effect.

Pneumatic Compression Pump 

The compression pump is used while Sal is working elsewhere with her hands. This is to encourage continuous lymph flow and further softening whilst she chooses to work more proximal. This is an addition to your hands-on lymph drainage massage, so incurs additional costs. 

Skin Care 

your skin is the barrier between the inside and outside elements. Dry, flaky or broken skin is an open invitation for infection. Even more seceptible when living with a lymphatic condition. 

Exercises

Movement is extremely beneficial to your internal lymph pump. Muscle contraction increases pressure on your vessels, encouraging them to open right up and push through. It is also very effective to do while you have your bandages on with internal and external pressure working in sync.

  • Decongestive Treatment for Lymphoedema

    Treatment can vary considerably from person to person. The below treatment recommendations are all subject to change when combined with other complications and co-morbidities. No two people are the same, its evaluated on a case-by-case basis.

    It is also beneficial to have your treatments close together, not allowing the lymph system to slow down with too much time between appointments, kicking the system off to recovery quickly.

    Please note – the recommendations below are a conservative baseline, you may need more or need less, depending on how your system responds.

    Stage 0 – difficult to identify, let alone recognise whether it needs treating. But if you have felt a heaviness in a limb, skin tightening discomfort, or a size differential, then it’s best to get it checked out straight away.

    Treatment Est. 2-3 treatments + home care instructions, Plus check-in 3-6 months (then determine from there, compression garment may be recommended)

    Stage 1 – At this stage you will likely notice a little bit of pitting, whether it be a sock indentation or one limb swelling larger than the other, intermittently going up and back down. It would be advised to have a consult learn about prevention rather than waiting for it to get worse.

    Treatment Est. 1-3 treatments per week for 2-3 weeks + home care instructions, you may need more or less depending on your medical history. Plus check-in 1-2 months (garments will likely be recommended if medical history determines an irreversible cause)

    Stage 2 – At this stage, it’s likely becoming problematic, and proving harder to reverse with a short term intervention. As it starts to become complex, tissue is hardening and developing fibrosis, and the build up is very difficult to predict and quantify a treatment plan. A quick succession of multiple treatments is recommended to get the system moving. For e.g.  3-5 treatments per week for 1-2 weeks, review results and determine what’s needed from there (An adequate compression garment will be necessary to keep the tissue decongested)

    Stage 3 – You are in a fair bit of trouble at this stage. You will be incredibly uncomfortable, already immobile, have painful skin changes, and potentially worsening other symptoms. A concern for your overall health is now imminent.

    It can be very complex at this stage, and again very difficult to quantify any number of treatments, as there is so much to consider. Wound management, acute infections, co-morbidities and your daily activities.

     A quick succession of multiple treatments is all that will work at this stage to make any progress. Once we have it down to a manageable state we can opt for another treatment strategy.

    A great start – 2-4 weeks of intensives 5 x daily treatments per week + bandaging (to be evaluated at the end of each week.) Whilst it can be very costly, it’s necessary to get you on the road to recovery. The alternative means unfortunately your condition will get worse.

    Once settled, 3 treatments the following week spread out evenly while we wait for your garment/s to arrive  (adequate garments are a MUST for this stage, and you will likely need custom-made garments to precisely fit to your individual measurements)

    There is an option to use Wrap compression throughout the whole decongestive process, allowing for adjustable tension as your tissues decongest. But this option will depend on your budget and your activities during this time.

    See compression Garments page for more details…

  • Decongestive Treatment for Venous Insufficency turned Phleboedema

    Oedema in Venous Insufficiency is usually identified in the lower legs, caused by a disruption in blood flow back to the heart, due to malfunctioning valves within the vein vessel walls.

    In the early stages it can be reversed by simply elevating your legs, however if left untreated can progress into Phleboedema. See more information on Venous Insufficiency page under conditions on the main menu…

    Phleboedema is very similar in treatment style to Lymphoedema. We are addressing the same stagnant, thickening fluid. However, we need to assess your blood circulation and possible arterial flow concerns first, whether we need to deal with any open or closed wounds, and the conditions surrounding why they are hard to heal, plus any other skin conditions that are impacted by compression.

    Compression bandaging and garment selection is also very different. See Compression Garments page for more recommendations…

    But for the purpose of decongestion, treatment protocols are as per Lymphoedema above but with long stretch bandages and circular knit garments.

  • Decongestive Treatment for Mixed Aetiologies

    For other conditions, where lymphoedema is secondary, decongestive therapy is helpful. Treatment of Lipoedema has differing opinions on oedema, however from Sal’s experience, decongestive therapy can be helpful in the interim, especially for pain and immobility, but as an intensive, is often not necessary.

    Other health concerns that may cause oedema:

    • Heart conditions: Such as heart failure or cardiomyopathy 
    • Kidney disease: Can cause oedema 
    • Liver disease: Such as cirrhosis 
    • Lung disease: Chronic lung disease can cause oedema 
    • Thyroid disease: An underactive thyroid can cause oedema 
    • Malnutrition: Not having enough of the right foods can cause oedema e.g. inflammatory foods, or not enough protein
    • Medications: Some medications, such as some antibiotics, corticosteroids or high blood pressure (hypertension) medicine, can cause oedema 
    • Pregnancy: Oedema related to pregnancy, short term unless complicated by other co-morbidities
    • Menstrual cycles: Oedema related to menstrual cycles can be treated with manual lymph drainage
    • Injuries: Such as a strain or sprain 
    • Insect bites or stings: An insect bite or sting can cause oedema 
    • Allergic reactions: A large allergic reaction can cause oedema 
    • Head injuries: A blow to the head can result in an accumulation of fluid in the brain 
    • Strokes: A major stroke can result in brain swelling 
    • Brain tumors: A brain tumor will accumulate water around itself 

    See more information regarding specific conditions under the conditions Header on the main menu.