Becoming a Certified Lymphedema Therapist (CLT) is more than just getting extra letters behind your name—it’s about addressing one of the biggest care gaps in oncology rehab.
In Part 1 of this two-part conversation, Dr. Kelly Martin, PT, CLT, shares a behind-the-scenes look at her recent CLT training: what she learned, what surprised her, and how it transformed the way she treats patients with cancer.
We talk about:
- Why so many patients are at risk for lymphedema (even those who don’t think they are)
- How the course builds your clinical confidence through reps, not just lectures
- Ways to have blunt but empowering conversations with your patients
- Why becoming a CLT can strengthen your referral network and clinical community
If you’ve been thinking about CLT training—or you’ve got questions about how it all actually works—this episode gives you a real, unfiltered look at what it takes and why it matters.
Listen now, then come back for Part 2 next week!
Catch Dr. Kelly Martin at The Cancer Rehab Community Conference 2025!
Save your seat today to learn from Dr. Kelly Martin & more amazing speakers at #TCRCC2025, happening November 7-8, 2025.
- Get your Professional Ticket (eligible for CEUs).
- Get your Student Ticket (NOT eligible for CEUs).
Want to watch the episode instead?
Watch this week’s episode of TheOncoPT Podcast on our YouTube channel!
About Dr. Kelly Martin, PT, CLT
Kelly Martin graduated from Campbell University with her Doctorate of Physical Therapy in 2022. She became lymphedema certified from the Norton School in 2025 and is an aspiring Board Certified Oncology Clinical Specialist. After spending 2 years of practice in orthopedic and sports in Greenville, NC. Kelly joined the Emily Couric Clinical Cancer Center and Breast Center at the University of Virginia to expand care for patients with oncological needs across Virginia and surrounding states. Kelly has a special interest in applying her past experience to the oncology rehab space and facilitating return to sport in cancer survivors.
Transcript
@TheOncoPT – Elise (00:19)
Hey, Onco PT and welcome back to this episode of the Onco PT podcast. One of the things that we’re doing this year in 2025 on the podcast is we’re doing more of these kind of debriefs of, okay, one of our audience members or one of our amazing community people has gone through a course or a conference and we’re bringing them onto the podcast to talk about their experience. One of the things that I love about this series that we’re doing is it’s nice to know what you’re getting yourself into.
And I think this topic today is especially pertinent to that because when I tell you the importance of becoming a CLT was impressed upon me as I was finishing up PT school and as I was going through my clinical rotations, but the explanation behind why I should become a CLT was maybe a little lacking. And so I didn’t really know what I was getting myself into. It was a very positive experience, but I’m…
bringing someone on today who is going to talk all about her recent recent experience going through her certified lymphedema therapist training and kind of the behind the scenes of what what was her experience like and if ultimately you’re discerning if this is the right move for you then hopefully this will help you make a decision in the future. So Dr. Kelly Martin
You may know her, you may not know her though, because she is one of the amazing behind the scenes persons here at the OncoPT team that we so adore having on our team. She is the brains behind our research roundup that we do inside of the OncoPT specialization community and so, so much more. ⁓ Also is going to be a featured speaker at the cancer rehab community conference later this year, I’m just saying. Like if you don’t know Kelly yet, you’re gonna get to know her very, very well soon.
So Dr. Kelly Martin, welcome to the OncoPT podcast.
Kelly Martin (02:08)
Thank you. think it’s been a long time coming. ⁓ I think the last time I was even on the podcast was probably last fall. Late fall,
@TheOncoPT – Elise (02:11)
It has been a
I think so. I think we did like a little research roundup. Yeah. Yeah.
It was overdue, my friend. So welcome back. Would you mind reintroducing yourself to the audience, please?
Kelly Martin (02:26)
Yeah, absolutely. So my name is Kelly Martin. I am a physical therapist and I am currently now located in Virginia. Originally when I was last on the podcast, I was in North Carolina practicing and have made a move in the new year to join at UVA at their cancer center as well as their breast care center. And so I’m really excited to kind of fully delve into the oncology rehab world.
And so I’ve been working now for six now coming up on surpassing six months, which is even wild and then kind of pertinent to the podcast episode is coming up on now three months as a CLT or certified lymphedema therapist.
@TheOncoPT – Elise (03:10)
So exciting. many new things over the past like six months plus with you on our team. So let’s take a step back real quick. So if you are maybe brand spanking new to oncology rehab, what the heck is even a CLT, which we defined previously, but let’s kind of set the stage for like, what is a certified lymphedema?
therapist, at least in your experience and now as a CLT Kelly.
Kelly Martin (03:41)
Yeah, certified lymphedema therapist, feel like it got thrown around maybe once or twice as a PT student. I always joke with, I joke with some of my patients that I treat for lymphedema specifically in that when I was a PT student, I knew.
maybe two things about lymphedema. One, that we had a lymphatic system and two, that we needed when we did CDT or complete decongestive therapy, which is one of the mainstays of lymphedema treatment, that you needed to use short stretch bandaging that had a high working pressure and a low resting pressure. That’s what you needed to know to answer a question related to lymphedema on your board exam as a PT student. So that’s what I memorized and then you enter this interest into
@TheOncoPT – Elise (04:12)
Mm-hmm.
Excellent. Excellent.
Kelly Martin (04:30)
oncology PT and you hear that word thrown around a lot more and you’re like oh lymphedema how do you treat it when is it prevalent how do you monitor for it what do you even do is exercise helpful is it not helpful
@TheOncoPT – Elise (04:34)
Mm-hmm.
Kelly Martin (04:45)
I think sometimes there’s a little bit of a scare tactic about like, what if lymphedema is not managed and they show scary pictures of really big limbs and all this stuff. And so there’s some scare tactics in it you’re like, what the heck? Well, how do I even, what do I do? And then.
@TheOncoPT – Elise (04:55)
Mm-hmm.
Right. Right.
Kelly Martin (05:01)
you get into oncology and you’re like, okay, this is definitely a considerable diagnosis for people and it’s not just breast cancer. It’s a lot of other cancer diagnoses that people who may not be as familiar with oncology and lymphedema, they don’t realize, you know, prostate cancer, any of your abdominal GI cancers, your gynecological cancers, the gambit. If it affects the lymphatic system and they have lymph nodes removed, they have
radiation in an area where lymph nodes are there, there’s an opportunity for lymphedema to be, for someone to be at risk or for someone to develop it. And so then we kind of have to remember to screen for that.
@TheOncoPT – Elise (05:43)
Bingo.
Kelly Martin (05:47)
ask the right questions to make sure that it’s not something to be considered or if it is let’s intervene right now because the quicker we intervene like many things the quicker we intervene recognize it the the better off a patient does their outcomes are way better the prognosis is way better and a lot of times their management strategies can be way better as well and so I think then was it kind of falls in nicely was like okay well if I’m gonna kind of come into the onco PT world now in 2025 like really be
in it? Okay, I need to really consider getting my CLT.
@TheOncoPT – Elise (06:23)
before you decided, before you started your new position, before you really started, you know, considering, I think I need to go through and get my CLT, what was kind of your understanding or your attitude towards CLT school?
Kelly Martin (06:42)
I think originally I knew that it was a part of oncology rehab. I almost felt like it was like one of the most unglamorous things in rehab. I think some of that comes from the scare tactic of like, ⁓ like I almost equated it to like wound care.
@TheOncoPT – Elise (06:57)
understandable.
Kelly Martin (07:01)
And that’s not what it is. I mean, yes, wounds could be involved, but it’s not the end all be all of what lymphedema management is. And I think I was kind of like, well, I don’t want to do that. Like, that’s not why I came here. That’s not what my interest is in. Do I really need this? So I wasn’t really on my radar. And then when I was transitioning into my job,
@TheOncoPT – Elise (07:02)
Yeah. Right.
Kelly Martin (07:26)
funny enough originally I thought I was going to go into acute care in the position to start and then they asked me you know like a week before was like hey what if we onboard you in the out we’re going to do this differently what if we onboard you an outpatient and that would start with outpatient oncology which we know you really really like and you’re very interested in
@TheOncoPT – Elise (07:49)
Mm-hmm.
Kelly Martin (07:50)
because I had applied for an outpatient oncology position with them and I did not get it, but they enjoyed my interview that they wanted to offer me another position and potentially work into oncology as their program grew. And so for me it was like…
@TheOncoPT – Elise (08:06)
Mm-hmm.
Kelly Martin (08:08)
All right, this may mean my original, I guess, brain was saying, I’m gonna be in acute care and I’m gonna work my way to oncology. And then it was like, no, thrust it upon me, hey, you’re gonna start in it. And I’m like, all right, well, I’m fine with that. And then my role kind of completely transitioned to all outpatient oncology. So I think it was more so that transition in what I expected my job to be that I was like, okay.
@TheOncoPT – Elise (08:26)
Mm-hmm.
Kelly Martin (08:33)
maybe this lymphedema thing is really important. And if I’m going to split my time between our cancer center, which we see our stem cell transplants, we do see some head and neck cancer. ⁓ We also see some of our ⁓ prostate and gynecological cancers.
and we’re expanding, which is exciting to be a part of, but then half of my practice is then in our breast center, where I think lymphenine is the most common, most well-known ⁓ diagnosis that comes with breast cancer. The risk is there, people know about it more. And so that’s really where it was like, okay, I need to really consider this. And then my job actually partners with the school that I did my training, my CLT training at. And so they were like,
@TheOncoPT – Elise (08:55)
Very cool.
Right.
Kelly Martin (09:22)
for if you want to do it and I was like okay well I wouldn’t mind. It’s not cheap so if you’re going out to do the course on your own and not through your job or if you’re in terms of considering your continuing education allotment it is big investment I think it’s about.
@TheOncoPT – Elise (09:24)
you
Mm-hmm.
Mm-hmm.
Kelly Martin (09:45)
$1,200, $1,300 to do the course as well and I think that’s pretty standard across other all of the of the mainstay programs like Norton which is where I did my training or Close and some of the other ones that are out there.
@TheOncoPT – Elise (09:48)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Mm-hmm. Mm-hmm. Yeah, I think price-wise, they’re about the same generally. Now, I haven’t, you know, I don’t have a spreadsheet where I have all the numbers in my head. So my next question, Kelly, is at what point was there a tipping point where you said, okay, I’m going to do it now? But it sounds like the, we’ll pay for it was quite a great motivator to be like, okay, it’s time to get this done. But was there anything else that made you say, it’s time? Like, it’s time for me to do this.
I’m gonna go all in on
Kelly Martin (10:34)
Yeah, I think that’s a great question. I think what really flipped for me, I don’t know, when I think about that in my head, I’m like, well, what made me decide to do it? One being, okay, a lot of my patients that I’m gonna see are gonna be dealing with this or are at risk for this. So it’s like, okay, I need to be knowledgeable of it and I should be able to intervene for it. And…
@TheOncoPT – Elise (10:53)
Mm-hmm.
Kelly Martin (11:03)
I also think that it’s just me and another therapist. So if we think about lymphedema management and when I was starting and being trained, the other counterpart for me, she’s this lymphedema therapist and she’s like, yeah, like people drive hours, the gaps in care for people to have access to this treatment.
is few and far between. People may wait months to years to be seen for this. And I was like, okay, I think a lot in my heart when it comes to rehab and also kind of stems in like, go where you’re, go where you’re needed to. ⁓ Even if it’s not your, your favorite thing or even, even then I think my opinions of what does it mean to be a lymphedema therapist? We’re still like thinking about wounds and not wanting to be with wounds and, like thinking about every person
@TheOncoPT – Elise (11:39)
Mm-hmm.
Kelly Martin (11:54)
that
I interact with would be very complex and have lots of comorbidities and there are patients that are that and they’re fun to work through too and it’s really sometimes rewarding to get them what they need but majority of who I treat and especially like at the breast center that I’m at majority of the people I treat are probably surprisingly enough you know they’re in their 30s 40s 50s 60s maybe
and they are, they’re very active and which is, I mean, my bias. I want people to be physically active after their diagnosis. There’s no reason that they can’t get back to what they love. I want to be a facilitator of that. And sometimes lymphedema can get in the way of that. And so I think for me, that’s where my mind really shifted and was like, okay, this, this skill set will help me bridge. is for some people, it is helping me bridge the gap between
@TheOncoPT – Elise (12:29)
Right.
Right.
Kelly Martin (12:50)
What I really want to do with these people would just get them back to exercise and training and activities and hobbies that they enjoy. This is a barrier for some people. Sometimes it’s even the fear of being at risk for lymphedema alone. That’s a barrier for them to be active. And it’s like, no, no, no, no, no, no, no.
@TheOncoPT – Elise (13:07)
Mm-hmm.
Kelly Martin (13:08)
We can break that barrier very quickly,
@TheOncoPT – Elise (13:10)
Right.
Kelly Martin (13:11)
which is very rewarding because I think they’re afraid. Again, the scare tactics that got me thinking, don’t really want to do this, are the same scare tactics sometimes that are used to be like, well, if you don’t manage this, this is what your arm’s going to look like. And it just is.
@TheOncoPT – Elise (13:29)
Yeah.
Yeah.
Kelly Martin (13:32)
can be traumatizing and then there’s a time and a place to be blunt with someone and say, that can happen. But, you know, I would say 95, and I tell my patients, I’m like 95 % of the patients I see don’t look like that at all. They don’t, they don’t. It’s just, that’s when it goes completely uncontrolled and tell them like, you’re in the right place. It’s going to be controlled, so that’s not gonna be you.
@TheOncoPT – Elise (13:38)
Totally. Totally.
Right. Right.
Mm-hmm.
Mm-hmm. Mm-hmm.
Kelly Martin (14:01)
So think
that’s really where my mind shift shifted and was like, okay, like this is a barrier to what I really wanna do with people and so I need to have the skill set to break that barrier or I can’t get to what I really wanna do anyways. So let’s tackle it.
@TheOncoPT – Elise (14:09)
Mm-hmm.
Nice. So you mentioned previously, your workplace has partnered with Norton, which is the program that you went through. That’s also what I went through way back when I got my CLT in 2018. So came out of school, I mean, like fresh, was June after I graduated in May. And so I’m giving this context to the listener because I went through my CLT program pre-COVID.
Kelly Martin (14:24)
Thank
@TheOncoPT – Elise (14:46)
And I understand that in light of COVID and like all the stuff that was happening with that, some programs have changed kind of the approach that they do. And so I want to know, Kelly, my program we did, so it was 135 hours total, and we did 35 hours of ahead of time, like video modules before you actually went to the 10 day, 10 like,
10 hour days, that’s where the 100 hours comes from, ⁓ that we did for our program. So what did your program look like when you took it in, what, spring of 2025?
Kelly Martin (15:28)
Yeah, I took, I started it in February of this year and finished, it was like the end of February through the first weekend of March. And so they didn’t have any offerings near Virginia. So I actually ended up going to Charlotte to drive to, I drove down there and took the course there.
@TheOncoPT – Elise (15:42)
Mm-hmm.
Kelly Martin (15:49)
in terms of getting it done sooner rather than later. And so I kind of, was kind of nice how I thought in hindsight, like it was kind of nice. I started in January and so I was already kind of, I was being trained by the PT that I work alongside. And so I was seeing patients that have lymphedema and we were talking a lot about, know, what does that look like? And, you know, monitoring limb volumes and how we have the, our, our lymphedema surveillance clinic has the bio.
@TheOncoPT – Elise (15:52)
Mm-hmm.
Kelly Martin (16:19)
impedance and long-term garments and how do you select those, how do you measure for those and so I was already getting some practical experience with understanding lymphedema and you know reading the clinical practice guidelines that the APTA puts out and kind of being in the literature a little bit so it’s like little exposures and then the the course prep itself it honestly sounds exactly how you did it ⁓ is we had
@TheOncoPT – Elise (16:20)
Mm-hmm.
Mm-hmm.
Kelly Martin (16:45)
35, 40 hours of module work that went through the anatomy, physiology, types of garments, CDT, exercise, all the elements that involve complete decongestive therapy and then long-term the maintenance phase of lymphedema management and
@TheOncoPT – Elise (17:08)
Mm-hmm.
Kelly Martin (17:12)
I have to say, I wish they would update these things. I know that costs money, but I swear the videos I was watching are from the 1980s. They’re so old. They’re so old. They are there. You can’t speed it up. It’s like off of VHS. I was like, what am I watching? I know lymphedema has come a long way and it has a long way to go, but it is has come a long way that from these videos from the
@TheOncoPT – Elise (17:15)
Yeah
Kelly Martin (17:42)
I just was, that always made me chuckle every time I was watching them. And so I kind of, the prep work as I was like, you know, working up to, you know, full time and I started, I didn’t start seeing people by myself in terms of seeing patients with lymphedema or at.
@TheOncoPT – Elise (17:46)
You
Kelly Martin (18:00)
I didn’t see them by myself until after I finished the course. I was completely partnered, but I was leading as I was learning I was kind of leading thing different parts of it whether it educating doing the circumference measures So I was getting to practice a little bit and kind of talk through things which I thought was really nice so then I was kind of you know going through the modules on my own after work ⁓ and And if any there was any downtime I would do a little bit of some of the prep work
@TheOncoPT – Elise (18:04)
Mm-hmm.
Mm-hmm.
Kelly Martin (18:29)
and so it was nice to be able to kind of, I tried to take the prep work while I was onboarding and like put it into practice, whether that was just educating or talking about it, and so that kind of made it kind of stick ⁓ a little bit better because then when you drive down there and you, the first day, of course they scare you and they’re like, it’s a pretest, it’s not graded, but just a pretest, we need to see how much you remember from doing the modules because you know when it comes to,
@TheOncoPT – Elise (18:37)
Mm-hmm.
Mm-hmm.
Right, how much you know? Mm-hmm.
Kelly Martin (18:58)
Continuing education, obviously, you pay money to be there and most people, unless it’s some very specific bad reason, everyone’s gonna pass it some way, whether it’s the first time or we had someone who got, they’re pretty good about extenuating circumstances, someone gets sick or an emergency happens and they jump into another course. And so we had someone come from another course offering for part of the program
@TheOncoPT – Elise (19:10)
Mm-hmm.
Mm-hmm.
Yeah!
Kelly Martin (19:29)
towards the end because they had gotten sick. And so you go down there, you take the pre-test, and then you start kind of reviewing some of the things that were in the modules and trying to build on them as well because it’s, I mean, we already did the prep, you should have done the prep work. So to kind of rehash all the lectures again would have been kind of overkill and a waste of time. So they were kind of starting to build on the foundational stuff we had.
@TheOncoPT – Elise (19:45)
Mm-hmm. Mm-hmm.
Kelly Martin (19:57)
already prepared for in the modules. And then a lot of it was really learning the practical skills like manual lymphatic drainage and compression wrapping and doing a whole, know, building all this, building through all the different techniques for manual lymphatic drainage, all the different ways we wrap the arm or the leg and
Practicing it was like, all right, you’re gonna do the sequence. It and then it was all kind of like lab It was like all right, you’re do the MLD sequence now You’re gonna wrap that one and you just rotate through everyone So you had people that were taller almost like PT school, honestly Yeah people that were taller than you shorter than you larger than you smaller than you long arms
@TheOncoPT – Elise (20:29)
Mm-hmm.
Mm-hmm.
Kelly Martin (20:40)
short legs and so you kind of got the chance to practice a lot of reps and critique yourself. That was like one of the mainstays in their course was like you should be able to your bandage is never gonna you always aspire for a perfect bandage but you’re you to be able to critique what ⁓ what you’ve done so that you can keep getting better because when you go out there at the at first you’re not going to be good at it. You’re going to struggle. ⁓
@TheOncoPT – Elise (20:54)
Mm-hmm.
Yeah.
Kelly Martin (21:07)
and different patient scenarios may cause you to struggle. So it’s never going to be perfect, but if you can continually critique yourself and make yourself better, it all works out. So it sounds really overall very similar to how you took it. And maybe I don’t know how they would have done it during the years of COVID. may have a lot of maybe Connette was on pause because I don’t really know how they would have done the in-person ⁓ portions or they did smaller groups. Who knows? ⁓
@TheOncoPT – Elise (21:12)
Mm-hmm.
Mm-hmm.
Yah.
Kelly Martin (21:37)
but this like hybrid model in terms of preparing and then going for a super long course. I don’t know any other continuing education course that’s 10 days long. That was probably the other thing that was big for me was that the course was a very long, it was a long 10 days and 10 hours. Like you just, you woke up.
@TheOncoPT – Elise (21:46)
right.
It was long.
Kelly Martin (21:56)
You went there, you went home, you ate dinner, and then I went to bed. Like, I didn’t have time to really… You had to be immersed while you were there because I didn’t have time to study. When I went home, I was exhausted.
@TheOncoPT – Elise (22:05)
Mm-hmm. Yeah.
Mm-hmm. Mm-hmm. No, I was, so I took my course in Nashville because that was kind of the closest, again, this is 2018, so it’s been a few years, but it was the best option for the time that I needed and like close-ish enough. And it really was like, I checked into the hotel every morning. I would drive to where the course was being held, would be there for 10 hours.
drive back to the hotel and eat dinner and then basically go to bed at that point. And I agree, like I kind of had to immerse myself in that and just know like, this is gonna be a grind while I’m here. But I really do feel like that was really beneficial for me to just be so absorbed in it. And I also really liked, I’m curious on this, Kelly. So I think my cohort was maybe about…
12 to 15 people. don’t remember the exact number. I could probably go back and look, but it was really cool because you’re in that course for so long with the same people. It was a really cool experience to then get to, know, like we’re practicing with each other and we’re, know, critique or constructively country, excuse me, critiquing each other and whatnot.
but really being able to just like get those repetitions in and to get the feedback from others so intensively so many times over that 10 day period, I feel like really sets the CLT experience apart from any other continuing education course that I’ve taken so far. Because I feel like in a lot of CEU courses, it’s very lecture heavy.
And then you might have a little lab where it’s like, ⁓ 30 minutes. here’s a couple of palpations or, know, like manual techniques, practice them. ⁓ okay, sit down. Now it’s time to move on to stuff. Whereas my program, and it sounds like your program too, it was like maybe a little lecture and then it was just manual. so again, reps on reps on wraps reps, excuse me, to really get the MLD down the bandaging down. ⁓
the foam application too, which I understand that’s like a really, I don’t know how big that is in some of the other programs. It seems like close and close in Norton. So close school and Norton school, very, very similar, like very, very similar components. They both stemmed from like the same lineage when it comes to lymphedema. I don’t know how much the foam plays into other schools, but like Norton, it’s foam, foam.
Kelly Martin (24:21)
you
@TheOncoPT – Elise (24:45)
I literally was cutting some foam for a patient earlier this morning. so getting to practice that again and again was a really transformational experience for me.
Kelly Martin (24:56)
Yeah, just, I’d laugh because cutting the phone was like so, it was always so hard. Initially, it’s like you were just struggling and then you put it on, you’re like, ⁓ I…
I think it sometimes just goes to show you, put the, you put the piece on them, you mark it like, and you look at the sheet and you’re like, okay, this is how I’m supposed to cut it. And then it just never, sometimes it just did not turn out that way at all. I was like that, I just butchered that, oopsies. And then like, you know, that was the one thing that the therapist I worked with, was like, you’re to have to get yourself a good pair of scissors. Like you need to go to the arts and crafts store and get a good pair of scissors. And I carry my good pair of scissors. I’ve never had to buy a good pair of scissors, but I carry them in my backpack.
@TheOncoPT – Elise (25:19)
Yeah, totes.
You
carry your good pair of scissors. Yeah. Yeah.
Kelly Martin (25:40)
all the now, all the time, and I
cut, and I cut from like a queen now, and I can bevel now, and all these little nuance things, but I swear I struggled in the course so much, and was like, this is, and then I always joke with my patients, like, yeah, this part of it’s kind of like arts and crafts. But it makes such a difference, and I think, I think in some ways, it’s, that’s where like, having some experience, and then going to the course, and learning it in one way, and.
@TheOncoPT – Elise (25:48)
my god.
Kelly Martin (26:09)
and thinking about it like this is the gold standard is interesting because you know where I currently practice we were kind of like okay if we’re gonna do if we’re gonna do you know CDT it’s like all right is this person experienced or not you know we’ve done the assessment what does their skin feel like how much has their limb volume changed if we have something to compare it to and
@TheOncoPT – Elise (26:13)
Mm-hmm.
Mm-hmm.
Kelly Martin (26:34)
There’s other courses that people will take on lymphedema management whether that’s you know other other CEU courses that I feel like a lot of times it’s come on like what’s the least amount of stuff we can do to get the best volume reduction? Whereas in this course and I see that in clinical practice, but then in this course
@TheOncoPT – Elise (26:48)
Interesting. ⁓
Mm-hmm.
Kelly Martin (26:56)
It’s like, okay, I’m here for 10 days. I need to learn it this way. One, because it’s important. And two, because this is how they’re gonna test me. Even if I disagree or I’m like, well.
@TheOncoPT – Elise (27:02)
Mm-hmm.
Mm-hmm.
Kelly Martin (27:08)
Do you need the foam? Do you really need it? If the patient, you, if you know, there’s different, there’s different models of how lymphedema gets covered and how bandaging supplies get covered. And, and so I think that is really based on what, what model each provider is in. Like I’m in a big health system model and it’s kind of all of our bandaging supplies is actually quite nice. All of our bandaging supplies are part of our just budget. So like the patient doesn’t, now even though Medicare covered
@TheOncoPT – Elise (27:10)
Mm-hmm.
Amazing.
Kelly Martin (27:38)
those things. Now,
@TheOncoPT – Elise (27:39)
Right.
Kelly Martin (27:40)
you know, the patient doesn’t ever have to worry about that. We have everything we need. We have phone, we have CompRex, we have the stockinette, we have all the different bandages sizes, we have all of the finger wrapping stuff, we have everything, which is great. I know that that’s not how it works in other models. ⁓ And so in some ways, this thought of like, kind of, I’ve seen it done where
@TheOncoPT – Elise (27:45)
love that.
Right, right.
Kelly Martin (28:07)
We don’t, we do all the other, you know, compression wrapping, but we don’t add foam at first. We see what happens with the first reduction. And then we say, okay, maybe we need a little bit, we need to be more aggressive. How does someone tolerate the compression, just the bandaging alone? ⁓ Because I think, you know, cutting foam and then having someone wrap.
@TheOncoPT – Elise (28:14)
Mm-hmm. Mm-hmm.
Kelly Martin (28:29)
caregiver wrap with foam, I mean it’s hard enough for us to do it and of course it’s gonna if you if you need your patient to self wrap a little bit then it’s going you’re adding another variable of challenge can are they able to do that do they have help to do it and so sometimes in practice you know I go without foam at first what’s the least amount we can do see what happens and then if I need to add foam I have it right there I’ll do it right away
@TheOncoPT – Elise (28:42)
Mm-hmm.
Mm-hmm.
Kelly Martin (28:58)
And so I think in some ways, kind of being, you know, critical of, okay, what are you learning? Here’s the gold standard. You’re in this immersion moment. You need to do it this way. But then also when you come out of it, okay, what’s, this is the standard. I need to aspire to that as much as possible. But then when all the other layers get put into, you know, patient care and this is the textbook, this is my patient. How do I?
@TheOncoPT – Elise (29:19)
Mm-hmm.
ring.
Kelly Martin (29:26)
divert sometimes because that’s what I have to do, but I can still do a great job and a limb can still get smaller and then we end, you all these things. ⁓ And so I think that’s really important. I think that’s something big that I kind of reflected a lot on after getting out of the course, coming back to, coming back to clinical reality and was like, okay, well, wait a minute.
@TheOncoPT – Elise (29:43)
Mm-hmm.
Right.
Okay, first of all, I love the coming back to clinical reality after the immersion in this course. Let’s take a step back, Kelly, because this is a really, really important aspect of, think, you know, when we go to conferences, when we go to courses, conferences and courses are based on the evidence as they should be, right? And hopefully it’s the latest and greatest so that we can
learn and better implement care to help our patients.
We all know also here at the Onco PT that it takes approximately on average 17 years for research to come out before it’s actually put into implementation. And some of this is based on, you know, just the barriers that be when it comes to, you know, publishing research and whatnot. But a lot of times in the research, especially in cancer rehab, it is very much best case scenario of the patient was able to come in, ⁓ you know,
They, the services, the PT was covered by the academic hospital that we’re in, et cetera. And so it’s taking out some of the barriers or the maybe obstacles that patients have to deal with in the real world. As far as like, this is how PT, this is how onco PT works in the real world. And dear listener, please know it’s, probably looks different for you than it does look for me. Right. I’m in Fort Worth, Texas. Kelly is in Charlottesville, Virginia. There are all kinds of.
individual barriers, but also systemic barriers that we face in oncology rehab that we have to consider. It may not work that way for our patient. And so what Kelly is talking about when she’s talking about gold standard, if you’re not familiar with this, is that when you go and you become a certified lymphedema therapist in your CLT course, you learn the gold standard of a patient comes if we are doing the intensive phase of
lymphedema therapy, complete decongestive therapy, they are coming to the clinic five days a week, or maybe four if you really have to swing it, four to five days a week. And we are doing MLD and we are doing bandaging. it’s, understandably, I understand the reason why they have it set up this way of, you you come in for this intensive period, it’s a few weeks long at the most.
and then you transition to more of the maintenance phase where the patient isn’t coming in as often and whatnot. And they’re doing more of this on their own. Amazing, great.
Kelly Martin (32:28)
you
@TheOncoPT – Elise (32:29)
that is gold standard, the actuality of how it works often does not look like that. And I think a lot of clinicians when they first get out of the CLT program are really are grappling with what you’ve just talked about, Kelly, of the clinical reality versus the gold standard. And I know that it exists in other areas. I don’t know that it exists as starkly like in stark difference as it does in lymphedema world.
Kelly Martin (32:57)
Yeah,
absolutely, 100%. I couldn’t agree more on that. And I think I even grappled with that having, I was like, wait a minute, like, if I’m gonna go back and do this work, like…
I need to be seeing my patients five days a week. And I think it pushed me to think deeper of like, well, how do I make that feasible for someone? I I’ve got patients that come from, some of them come from 10, 15 minutes away, some of them come from like three, four hours away. And I’m the only lymphedema therapist, we’re the only two that they can see. And it’s like, okay, well, am I gonna make you, okay.
@TheOncoPT – Elise (33:29)
Yeah. Yeah.
Kelly Martin (33:38)
When I think about that and I break that down, like, all right, if I’m going to tell them five days a week, that’s the gold standard. That’s five days a week. Okay. Well, are they working? Do they have to take off for work? They have to travel. They have to pay for gas. They might have to pay for lodging. ⁓ Are they a caregiver? Are they going to have pay for child care? You you could start the gambit and it’s like, okay, well, how are we, you know, this was also kind of, I grappled with this and literally I texted the
@TheOncoPT – Elise (33:49)
Yeah.
Mm-hmm.
Right, right.
Kelly Martin (34:08)
I worked with and I said at some point we need to like sit down and have a debrief about this course because I’m just feeling some type of way of like I feel kind of conflicted but I’m also like challenging the fact that like yes there’s a gold standard but can we be more efficient with what we have like do we really need five days a week could we get away do we get the same like let’s compare like treatment like if I treat you three days a week versus five days a week the same interventions
@TheOncoPT – Elise (34:13)
yeah.
Mmm. Mm-hmm.
Mm-hmm.
Kelly Martin (34:37)
Can I get the same outcomes? You know, those kinds of questions that think a lot of research also goes into with other physical therapy interventions. And so immediately it was like, we need to sit down and talk about this. And I think another layer for me grappling with it is the…
@TheOncoPT – Elise (34:39)
Mm-hmm.
Right. Right.
Kelly Martin (34:56)
medical center that I’m with is there’s there’s other see there’s other therapists who are CLT trained and there’s there was a lot I kind of came into talks about being a ⁓ lymphedema center of excellence and so really really wonderful awesome like I’m I’m in a really great ⁓
@TheOncoPT – Elise (35:10)
That’s right. We were talking about this off air. Yeah. Yeah.
Kelly Martin (35:16)
spot in an environment, the cancer center that I’m at is a comprehensive cancer center. We do it all. And now all of a sudden we want to be this lymphedema center of excellence. And I’m kind of coming into this learning about it and being a part of it and understanding where are we at in this process. And then I go to this course and I’m like, oh wow, I think we’re really far from that because…
@TheOncoPT – Elise (35:29)
Mm-hmm. Mm-hmm.
Kelly Martin (35:42)
I don’t see the gold standard that’s what’s been claiming right now that often. And then it’s like, well, no, that’s just clinical reality. I’m like, well, OK, if I’m highlighting these barriers as why someone can’t come into the gold standard, what can we do to facilitate that? Can social work be involved if they need to? Can we get them gas cards? Does social work need to work with them about going on
@TheOncoPT – Elise (35:47)
Mm-hmm.
Kelly Martin (36:11)
short-term disability? how can we, you know, all these other layers of like how do we make this possible? How do we, it’s not that we can’t do the gold standard. We know the gold standard. We all know it.
@TheOncoPT – Elise (36:15)
Interesting. ⁓ yes. Right. Right.
Kelly Martin (36:23)
and it would be great to do it. like, okay, how do we, we know, we also know the clinical reality and how do we, is there ways for us to meet in the middle? ⁓ You know, we treat our stem cell transplants at our cancer center and you know, lot of, it’s a long, long process. so they have social work very actively involved because it’s already known to be a long process. And if they need gas cards, if they need help with lodging, you know, some of those resources are available and I’m like, okay, well, can we take that same,
@TheOncoPT – Elise (36:40)
Mm-hmm. Mm-hmm.
Kelly Martin (36:53)
model and apply that to our lymphedema population. If we’ve got someone coming from three hours away and I could do this treatment intensively in three weeks, five days a week, can we can is there a way to do short-term disability? Is there a way to have lodging for them?
Is there a way to get gas cards for them so that they can make this happen? Because it’s not that people don’t do that because they’re not motivated to do it. People come, that’s one thing about the oncology rehab population I have really discovered, like they are so grateful for the care they get and they want, they will do it, they will do it. If I tell them it’s really five days a week, they’ll figure it out.
@TheOncoPT – Elise (37:25)
Exactly.
Mm-hmm. Mm-hmm. Right. Right.
Kelly Martin (37:41)
⁓ If they need to, they will do it. It’s just,
it’s really remarkable. So it’s like, it got my wheels turning about.
you know, okay, well, what are we doing in terms of being a center of excellence? What does the center of excellence even mean? So then I start going, it just opened up a lot of doors of like, what does that even mean? Because I didn’t know, I was just kind of coming into it new. And so then going into the literature of like, what makes the center of excellence? What are the, what are the qualifications of that? And there’s lots of lots of layers into that. But one of them, you know, management, conservative management involves lymphedema treatment, and that’s us. And so it’s like,
@TheOncoPT – Elise (37:58)
Right.
Mm-hmm.
Right.
Kelly Martin (38:20)
okay, well how do we optimize us? And so what does it take? Do we need other resources? If we need those, we need to advocate for those.
@TheOncoPT – Elise (38:23)
Mm-hmm. Mm-hmm.
Well, and I
think it’s not a, we need other resources, it’s what other resources do we need? And I think it’s, really, because again, we’ve had this conversation before off air, but I really appreciate, you know, because, so for the audience member who maybe is not familiar, the Fuldy Clinic, which is in Germany, is like the lymphedema clinic in the world. Like so much of what we know has come out of, or at least, you know, directly or indirectly.
Kelly Martin (38:34)
do we ⁓
@TheOncoPT – Elise (38:58)
And so how they structure the Foley Clinic, understanding is, know, patients are there, like Kelly is talking about, where they are there, like living in their institution for that period of time when they’re undergoing intensive decongestive therapy, et cetera. But they have things set up to do that. Like they are living there and it’s a complete whole body, whole health intervention that they’re working with as far as yes, they’re doing the lymphedema treatment, but I think they’re also working with
exercise and nutrition and all these other things. And so even in that model of like, this is the gold standard, there are other services that are having to be incorporated because we know, again, I say we know, I’m looking at Kelly, we know that lymphedema, there is an inflammatory component to this. And so of course it makes sense that we bring in nutrition and making sure that our diet is good and then we’re exercising and so much more.
I don’t know, and I say this like I believe we can accomplish anything. I really do. We cannot do that on our own as lymphedema therapists on our own in the wild. It’s not if we need other services, it’s whatever other services do we need. And I think the best model that we have for this is something that Kelly has already brought up, which is when a patient goes in for a stem cell transplant,
They’re there. And in my area, when patients are going to get a stem cell transplant, most commonly they are going inpatient in the hospital and they’re there for a few weeks and then they leave. But a lot of them, especially if they’re like really far out of town, they have to stay in the area or like be close to a major medical center that can handle that acuity for like a hundred days or something after they finish. And so that kind of support
Again, I think we have a model we can look to in the United States. It’s going to take some creativity to make it happen and it’s going to take that inclusion of other services like Kelly is talking about. Gas, do we need to pursue? Maybe, I love the idea of short-term disability. ⁓ know, managing care, are they a caregiver? Are they caring for a child or another family member or whatever that is? Housing during this time.
There’s so much that I think we are not equipped and we are not implementing here in the United States to make the gold standard we learn about feasible in clinical reality. And I love all of the ideas that you have mentioned and more Kelly about like, can we, I mean, truthfully, how do we bridge gold standard textbook with clinical reality? It’s through that that Kelly is talking about here.
Kelly Martin (41:49)
Yeah, it’s so got my, you know, I think it’s a it’s a double edge or it’s so great to have, you know, a different experience than take a course and then then grapple like even though in the moment it’s like, I am having this crisis and what am I doing? And you think it I always say a lot of times learning experiences as a clinician, whether that’s a continuing education course, or being a CI, a clinical instructor for for a student, I always say like sometimes
@TheOncoPT – Elise (42:01)
Mm-hmm.
Yeah!
Kelly Martin (42:19)
experiences are like mirrors. They tell you good things like, okay, I’m really doing the work. I’ve got the knowledge base about lymphedema and all the elements of lymphedema and how I can intervene with lymphedema or whatever.
But then sometimes it gives you the, it can also give you like a gut check of like, what have I been doing for the last, at least in relation to this podcast topic for the last month? What have I been observing? What have I been doing? How have I been formulating my own thoughts, my own decisions as a clinician? And that can be challenging and be like, I was.
@TheOncoPT – Elise (42:42)
Absolutely, absolutely.
Kelly Martin (42:56)
doing that all wrong. And it wasn’t, that’s not how I felt, but I was like, hmm, there’s a lot of work to be done. And how is my clinical practice knowing the information I know now going to change? How does it need to change?
how do I need to come to this lymphedema coalition meeting and talk about, if we’re gonna be a center of excellence, here’s the gold standard, how do we get the resources to make that more often than not what the patient can do? And there’s still gonna be situations where it’s not possible. Maybe we need to get a little bit more creative, telehealth, or even the networks that you create in your lymphedema certification courses also. We had a
@TheOncoPT – Elise (43:30)
Mm-hmm.
Good point. Good point.
Kelly Martin (43:39)
We did a spreadsheet and everyone filled out their information, their email, their contact information, even other areas that they like to treat. ⁓ So for me, I’m like, yes, I’m a lymphedema therapist, but I really love oncology and return to sport. everyone in my class knows that. And like we had a ⁓ PT who was doing a residency program. So was already, two of them were doing residency programs. It was already intertwined into their curriculum and their residencies. And so…
@TheOncoPT – Elise (44:06)
Very cool.
Kelly Martin (44:08)
We got that experience from them and connected with them and then we had other therapists from other states and some of them were across the country and you know, so then it was like, okay, if I have a patient that’s closer to West Virginia than they are Charlottesville, Virginia, I could refer to these two people that are in those locations and maybe they instead of driving three hours to see me, they can drive an hour to see someone else who’s just as capable as me and that’s a way to break a barrier and so
@TheOncoPT – Elise (44:30)
Right.
Excellent. Excellent.
Mm-hmm.
Kelly Martin (44:38)
It’s also
about the networking piece, I think, is really huge about the program. So then we can create this web of where are all the CLTs, because that’s another barrier is access to people, access to trained therapists. That’s why people have to drive so long.
@TheOncoPT – Elise (44:57)
Right? Right.
Kelly Martin (44:57)
to be seen. And
so it’s like learning, you know, where are your resources, who are they? And I think that’s another key piece of what the course really offers is that you practice with these people, they critique you in positive ways, and then you stay connected with them. And if they have a patient that moves or they have a client family member that lives in the area and now has breast cancer and needs lymphedema treatment, you know, it’s like, heck yeah, send my contact information. I’m happy to talk to them about getting
@TheOncoPT – Elise (45:07)
Mm-hmm.
Mm-hmm.
Kelly Martin (45:27)
them connected. So you also get to start connecting the dots. And that’s a really creative way sometimes to, to break those barriers when it comes to specifically lymphedema management. But I definitely think we’ve got a long way to go across the board. And a lot of therapists are doing such good work with so little, which I think is just an applaud to, to them out there, like just keep doing what you’re doing, get in getting in getting creative.
@TheOncoPT – Elise (45:33)
Yeah.
Right.
Yeah.
Mm-hmm.
Kelly Martin (45:57)
and
meeting those patients where they’re at because we don’t want to turn them away from a treatment that can really, really help them and make a difference in their life and get them to the things that really matter to them.
@TheOncoPT – Elise (46:05)
Mm-hmm.
Kelly Martin (46:12)
through this treatment. And it may not have to take five days a week to do it. We may be able to accomplish it in shorter amounts of time. And I’ve seen that possible. So I think it also challenges what courses present. So I think that back and forth between what we go in knowing and what the course present to us and what do we know now, that dialogue within ourselves and with other clinicians should never stop.
@TheOncoPT – Elise (46:16)
Mm-hmm.
Right.
Mm-hmm.
Mm-hmm.
Kelly Martin (46:37)
I think it’s super helpful and I think even it brings up, you know, great conversations in the cancer rehab community. I remember, I don’t know, maybe a month after I finished the course, there was a PT on there was talking about, you know, oh, like.
@TheOncoPT – Elise (46:44)
Yeah.
Kelly Martin (46:55)
something with like lymphovenous bypass surgery which is another you know form of lymphedema management a lot of times it’s happened after someone’s failed conservative management but now current practice is starting to say what if we do it at the time of surgery to affect someone’s risk of development which is you know great heck yeah let’s do it you’re already there ⁓ let’s make it happen and and so well okay they still have to i’ve actually gotten to see one of those surgeries which is pretty
@TheOncoPT – Elise (46:59)
Mm-hmm.
Mm-hmm.
Right.
Exciting!
Kelly Martin (47:25)
freaking awesome.
It’s a microscopic level. It’s wild. It was really, really cool. I actually did that before I took the CLT course. Like literally the Friday before I left work to drive down there, I got to see that surgery. You got to observe it and then went to the course, which was freaking awesome. And I think, you know, someone at their hospital system was like, hey, they’re starting to do this and we’re starting, they’re asking us to develop a protocol of like wrapping and how
@TheOncoPT – Elise (47:35)
Nice.
my God.
That is so cool.
Mm-hmm.
Kelly Martin (47:55)
much wrapping should we do? Kind of go full circle back to you know the least amount we need to do at the right time to get the right results ⁓ and they were like you know do I even teach them the the herringbone pattern or is the simple spiral suffice and how many different bandages do I need to do if this person’s just at risk and we’re just kind of prophylactically doing this to manage one post-operative swelling but to just manage their risk and I’m like and so I got to comment on that and be like well
@TheOncoPT – Elise (48:04)
Right.
Mm-hmm. Mm-hmm.
See
Kelly Martin (48:24)
This is what my course told me. This is kind of what we’re doing in our hospital system as we’re potentially moving in that route and just having dialogue in the rehab community about, know, what are you guys doing? well, let me know when you have that published. Like, I want to read it. And so I think just sharing that stuff is so cool too. And now I have a knowledge base to have even more meaningful conversations with clinicians, which I think is really incredible.
@TheOncoPT – Elise (48:28)
Mm-hmm.
Yeah.
Mm-hmm.
I think that’s one of the things I’ve really appreciated about being a certified lymphedema therapist and having that knowledge of, you know, having gone through a really intensive course to learn this information and to be able to walk out and treat patients. I’ve shared this previously, but there might be some new listeners. I took my CLT course in June of 2018, and then I sat for my licensure exam in July and I started working in
August of 2018. So I didn’t practice doing those skills for about a month and a half to maybe like two months. I still week one of when I started working with patients, I was extremely confident in my MLD and my bandaging skills to at least get the basics done. And I think that says a lot to the level of preparation that you will come out of that course with.
And I cannot say that I cannot speak enough praise for the level of intensity and how it, how I came out of that course. And so I just like commend those programs on that.
@TheOncoPT – Elise (50:04)
Hey y’all, this is Elise. Sorry to interrupt your podcast, but Kelly and I had so much to talk about in this interview that we actually split up the episode into two because we literally kept going for an hour and 45 minutes and we had to draw the line somewhere. So just know that the second part of this episode is releasing next Tuesday on the dot. It will be dropped into your inboxes. It will be.
delivered to your podcast players. Side note, if you’re not already subscribed to the Onco PT podcast, please make sure you do because that is the best fastest way to get all of your episodes in one convenient place. So know that part two is coming, but I’m going to make you wait until next week to listen to it. So thank you so much for listening and until next time, this is Elise with the Onco PT. And remember you are exactly the physical therapist that your patients with cancer need. So let’s get to work.