Hidden in Plain Sight: Understanding Lymphedema and Lymphatic Function in Wound and Tissue Healing

Hello, my name is Dr. Heather Barnhart. I am a physical therapist, a professor of physical therapy at Nova Southeastern University, and my background in clinical expertise is burns, wounds, and lymphedema. So I have a PhD in physical therapy. I'm a certified wound specialist, advanced wound care certified. I hold a credential as a certified lymphedema therapist, and I'm a LANA-accredited, as well as a certified lymphedema and wound therapist.
 
I think identifying risks for patients at lymphedema requires an understanding of what to be looking for. So knowing the right questions to ask, looking at the history and the physical, appreciating the quality of the skin, and really getting a sense of the contributing factors that have led potentially to the development of their edema, what other comorbidities do they have, and just really recognizing the signs and symptoms that are classic for lymphedema.
 
The most important things to include when looking to diagnose the disease of lymphedema is really going back again to that thorough history and physical. Very important, we feel the tissue texture of that skin.
 
How does the edema behave? What are the symptoms like? What is the personal experience of that patient living with that condition? If they know a contributing factor, how it started, when it started, what makes the symptoms worse, what may make the symptoms better?
 
Because it's really a diagnosis, a clinical diagnosis, and so understanding the contributing factors but the history and the physical will really make that lead to that differential diagnosis that much stronger.
 
The good news is, even though lymphedema is a chronic disease currently without a cure, it can be managed very well through complete decongestive therapy. Complete decongestive therapy is a two-phase therapy.
 
The first phase is really clinician-driven. What that involves is a lymphedema therapist working with that patient to do skin and wound hygiene, manual lymphatic drainage, followed by compression for treatment, so as we're actively reducing that patient, we want certain compression products to help support that reduction.
 
Of course, then followed up with exercise while wearing compression and lots of patient education. The second phase is after that limb has reduced is the maintenance phase.
 
Now that's patient-driven. They'll do all the same things we did in phase one, but they're going to be managing their disease condition now on their own in a redacted way. We need to educate them on those components so that they can manage that for the rest of their life.
 
During that maintenance phase, they would be in compression for maintenance. This is where the garments, the customer over the counter or the stockings would be recommended. For one, there are not many that are certified.
 
There's definitely a need for more people to become certified in lymphedema and particularly certified in lymphedema and wound care. That's critically important because these patients present with both problems oftentimes.
 
The best place to really go is either through the different credentialing schools, the certification schools that offer lymphedema certification because they can let you know in the area they're alumni that have gone through their programs.
 
One of the best sources is going to the Lymphology Association of North America, L-A-N-A or Lymphology Association of North America. You can search by zip code and they'll break it down within a 25-mile radius, 100-mile radius,
 
A lot of times there aren't or isn't direct access to therapists initially or if there is oftentimes the lymphedema therapists have quite an extensive wait list to get in. What providers can do at that time is just keep really good skin and wound hygiene.
 
Teach diaphragmatic breathing. It seems so simple, but belly breathing is a great way to just promote siphoning and suctioning of that lymphatic system to help promote flow. It can be also potentially getting them started on either an active or a pneumatic compression device until they can get in to see that therapist.
 
Some form of compression can be initiated at least to help start to contain some of that fluid, but really educating and establishing connections within the community for that patient can be really helpful as well to get started.