Ep. 58 – The Essentials of an OncoPT Lymphedema Clinic

Last week, I covered my favorite must-haves for a general oncology clinic. Today’s episode covers my favorite, essential items for an onco-lymphedema clinic. The idea with these two episodes is to pare down all the excess “toys” & “gadgets that tend to clutter our clinics – or to give those starting a clinic an idea of what they really need at the heart of all the “stuff.”

Disclaimer here before we get started: in my clinic, I usually only treat upper extremity lymphedema related to cancer. I rarely treat lower extremity lymphedema related to cancer, & I do not treat patients who have lymphedema caused by other conditions due to my typical patient population & my particular clinic set-up (I refer these patients to another practitioner). For more information on lymphedema & its treatment, I highly recommend my good friend Betty Westbrook’s Lymphedema Podcast.

Many of the things I’ll discuss in today’s episode are similar to last week’s essentials. Good news for us who treat both general oncology & lymphedema!

The Essentials

Treatment table – A treatment table is essential for an oncoPT lymphedema clinic. Traditional MLD protocols call for a patient to lay supine & prone during sessions, so a treatment table obviously makes sense here. Beyond MLD, a treatment table is useful for performing different soft tissue mobilizations, stretches/ROM/flexibility exercises & manual interventions, & even some strengthening exercises – as we know, many patients have other functional mobility issues on top of their lymphedema.

Bandages – I firmly believe that lymphedema treatment is not complete without bandaging or some form of reducing compression. Short-stretch compression bandages are the gold standard for lymphedema reduction, but some patients cannot tolerate them for a variety of reasons. With that said, I usually try to start my patients in compression bandaging, then switch to an alternative if they can’t tolerate them.

Linens & pillows – While these were on my “nice, but not essential list” last week, they’ve moved up in the rankings this week. One of the benefits of MLD is relaxation for the patient, so linens & pillows are a must to make patients comfortable during your treatments. Not to mention, my treatment rooms are usually freezing, so covers are critical.

You – Once again, at the heart of your clinic is you. You know how to treat your patients & without you, your clinic is just a collection of walls & stuff. Only you have the education & skills to help this patient, not the bandages, not the clinic toys & tools, not the treatment table. On that note: it’s critical that if you want to wholly treat lymphedema, you need to get your CLT. While there are weekend crash-courses in lymphedema treatment, I believe these provide only the bare-bones of what a clinician truly requires to effectively & efficiently treat lymphedema. In order to understand what is happening with the patient in front of you & truly treat their lymphedema, you must have the appropriate (& complete!) training.

Nice, but not essential

Chair – every once in a while, I’ll have a patient who can’t tolerate laying down, whether it’s due to pain (hello, spinal mets), difficulty breathing (hello, any number of CA & non-CA conditions), or various other issues. In this case, I can do a variant of MLD with the patient sitting in a chair, sometimes leaning onto a table so I can reach their back.

Emollient creams & STM tools – These are great for my patients who have scar tissue or other soft tissue restrictions limiting lymphatic flow.

Dumbbells &/or resistance bands – We know that exercise, especially resistance training, is beneficial for patients with lymphedema (see literally every major research publication on the topic for the last few years). It’s critical to ensure our patients transition to a community oncology exercise program or an independent exercise program, & it’s definitely appropriate to start the teaching in the clinic. One word of advice I’ll pass on: never wrap a resistance band around a body part with lymphedema. It can create a tourniquet & worsen distal swelling – attaching the bands to a handle to use is a better alternative!

To listen to last week’s episode on The Essentials of an OncoPT Clinic, click here.