Dr. Kelly Martin, PT, CLT is back for part 2 of her honest debrief on becoming a Certified Lymphedema Therapist and what it means to truly step into your role as a CLT.
From gaining the depth of education that changes how you communicate with patients, to confidently admitting when you’re still learning—it’s all part of becoming the clinician your patients actually need.
We talk about why crash courses just don’t cut it, what sets CLTs apart from generalists, and how certification transformed her ability to treat lymphedema at the level her patients deserve.
If you’ve ever thought, “Do I really need the CLT to treat lymphedema?” — this episode answers that question loud and clear.
🎧 Hit play and hear why Kelly says certification isn’t just about the title—it’s about showing up for your patients fully prepared.
{P.S. Listen to Part 1 of my interview with Dr. Kelly Martin, PT, CLT here}
Interested in becoming a CLT?
Check out these courses:
- Norton School of Lymphatic Therapy – Full CDT Lymphedema Certification Course
- Klose Training Lymphedema Certification
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, we are back this week on the Onco PT podcast with part two of my interview with Dr. Kelly Martin on her recent experience with her certified lymphedema therapy course. Now, if you haven’t listened to part one yet, you are going to want to go back and listen to that first. I have linked that episode in today’s show notes as well as within your podcast player description. So make sure to go back and listen to that episode first and then come back and hit play on this one.
Cause we get into some really juicy stuff and you’re going to want the context first. enjoy part one. Let’s get into part two.
@TheOncoPT – Elise (00:55)
But I think it’s also really interesting kind of pivoting here every year. So I’ve been a CLT for I think seven years now, give or take, give or take some change. And it’s interesting to reflect on.
Every year I feel like I kind of go through a little bit of identity crisis when it comes to how I treat my patients with lymphedema and like how I implement CDT and all these things. And it’s really cool to see some of the new literature that’s coming out when it really comes to researching the effectiveness of lymphedema therapy and what are we doing? When are we choosing to implement it? How are we choosing to implement it?
And so having, I have some friends who recently went to the Földi Clinic, like conference that they did, and then also hearing about some of the research that’s coming out of Australia through the ALERT team. It’s really maybe changing some things on how we manage. And so I’m, I’ll be curious to see over the next few years, like how CDT might change.
how we implement it, but also maybe how it’s gonna stay the same. Like there’s the basics I think are still very much there for me when I treat my patients with lymphedema, but maybe the like the approaches or the strategies or maybe the finesse that I’m using has evolved over the years of practicing, which like, I don’t know.
I’m still, think a new PT in all of this. So I’m sure there’s a, there’s a Goldie out there who’s like, yeah, that’s how it works. But like, Hey, I’m learning this as I go. ⁓
Kelly Martin (02:33)
Well, if you consider yourself still a newbie, then I’m like an infant when it comes. I am a baby when it comes to all of this. And I would totally agree with that. I think one thing is that we just haven’t, we haven’t yet talked about, but it’s one of my funny moments when it comes to being a lymphedema therapist is how ill prepared I felt to go into the clinic and measure someone for maintenance garments, long-term compression garments, whether that’s day
@TheOncoPT – Elise (02:48)
Let’s do it.
Let’s go.
⁓
Kelly Martin (03:03)
or nighttime garments.
@TheOncoPT – Elise (03:04)
mm-hmm, mm-hmm.
Kelly Martin (03:06)
That was probably of the entire course that was maybe six hours worth of content and it was over lunch with the different manufacturers which is all wonderful. Again it adds a lot of networking but this was literally I always I will never forget
@TheOncoPT – Elise (03:16)
Mm-hmm.
Totally, totally.
Kelly Martin (03:25)
Anytime I talk to people about lymphedema and lymphedema management and the course and how I felt very well prepared in some areas, but where I felt ill prepared in others was I had a patient who the other therapist I work with was evaluated and she had had an exacerbation of her lymphedema and her limb volumes are elevated. So wanted to undergo CDT to reduce limb volumes and get her into new compression, daytime compression. And I was like, okay.
So of course, know, Tuesday morning, she’s my very first patient of the day. And I read, I’m like prepping and doing my chart review. And I’m like, all right, continue with CDT. And I’m like, yes, like, let’s go. Like I’m literally leaving the course on a Sunday and going in Tuesday morning into this clinic. And I’m about to just like wreck this person’s world with my MLD and my managing skills. I’m like, let’s go. This is great. This is exactly what the core prepared me to do. I’m going to do it. ⁓
@TheOncoPT – Elise (04:08)
Go! ⁓
Mm-hmm.
Exactly.
Kelly Martin (04:25)
walked in at 8 a.m. and I was like hey like how’s it going and I know you got started with CDT and she was like Kelly it’s so nice to meet you for the first time but I am NOT the candidate for this I am just I’ve been trying to do it and I’ve struggled over the last weekend like she she got started maybe on Thursday and then it was the weekend so maybe four days in
@TheOncoPT – Elise (04:48)
Mm-hmm.
Mm-hmm.
Kelly Martin (04:55)
She was like, I can’t do it, we’re traveling and there’s no way I can keep this up. And I’m like, she was like, I just want to be measured for my, and I have come to fruition that I’m okay with where my limb is at. I’m ready to get into daytime garments. And I’m like, okay.
Like we’re gonna do this. All right, and I was like go throw my entire plan out the window and I’m like, okay Well, let’s figure out how to measure for your daytime garments and not screw it up on my first patient of my very first day by myself and I was terrified and that literally put a lit a fire under me and was like I need to talk to every single representative for every single manufacturer in that services Charlottesville area because I don’t know what I’m doing. I’m scared and
@TheOncoPT – Elise (05:22)
Uh-huh. Uh-huh. Mm-hmm. Yep. Absolutely. Absolutely.
Yeah!
Kelly Martin (05:43)
And when I think about,
@TheOncoPT – Elise (05:43)
Yeah!
Kelly Martin (05:44)
you know, these garments are expensive and it’s custom and I, and then we have to submit for remake if it’s wrong and I’m perfectionist so I don’t want to be wrong. We’re best, we’re growing in that and getting better at that. And I was like, oh my gosh, like I, okay, well we’re, we gotta do this. So we’re doing it and.
@TheOncoPT – Elise (05:57)
Mm-hmm.
Kelly Martin (06:08)
long story short, her grammar’s turned out fine. I did a good job. I don’t believe we had to remake them.
So I did a good job on the first time, but it was terrifying and I was like, okay, you know I remember being so overloaded with all the things we learned in the course and then all when the manufacturers come in they just talk about all these garments and we’re eating lunch and free lunch is great and it’s like it’s just an hour and so it’s just an hour of our time and these 100 hours and there’s probably six maybe six hours of a hundred hours. We talked about like this other half of lymphedema management.
@TheOncoPT – Elise (06:15)
Good job. Good job.
Heck yeah.
Kelly Martin (06:45)
And after you reduce, the goal is to maintain and you’re gonna keep doing this skill set for a lot of your therapy. know, when they need new daytime garments, it’s every six months. ⁓ And so the skill set’s not going away. And I wish they had, I don’t know how you feel, but I wish that they had set us up better.
@TheOncoPT – Elise (06:51)
Mm-hmm. Mm-hmm.
Right.
Kelly Martin (07:06)
and being prepared to do those things because you get out there by yourself in the wild and you’re like my gosh I don’t know what I’m doing and I don’t want to mess this up because working with
Working with medical suppliers to get these garments can also be a headache. And so you do a lot of stuff with that. And it’s just, then you really feel like the pressure to not mess up is really high. Because someone could wait weeks and weeks and weeks and weeks and weeks to get these garments. Which is frustrating in and of itself. This episode could be two parts, but.
@TheOncoPT – Elise (07:24)
my gosh.
Yeah. Yeah.
Literally, I
mean, literally, like you just, you just kind of started off a whole like, totally even forgot the word of just what that was, like a tan, not, not a tangent, but like another, another aspect to this of I agree. I do. When I walked out of that course, not prepared to fit for garments. Like, and that’s maybe some of my classmates were, I don’t know. I know that I was not. And so for me,
Kelly Martin (07:45)
Yeah.
@TheOncoPT – Elise (08:08)
I identified really early on in my practice of there is so much other stuff that I am trying to get done within my very limited plan of care. Like the allotted time that I have with this patient, I connected with a really wonderful durable medical equipment company here in Fort Worth that I, and they have gone through the training to be fitters for the garments.
I actually send my patients to them and ooh, I know that might be controversial. There’s probably someone out there who is having a conniption right now listening to this, but I know my strengths. Fitting garments is not one of them. And same thing, I would feel horrific if I was the reason that a garment had to be remade. I could not handle that. Like I know myself, I know I cannot handle that. And I would beat myself up forever on that. And so I know
rather than me trying to fumble my way through it, I have a team that I can rely on who have excellent customer service. And if they have to remake a garment, they’re on it. And that’s what I do in my practice. Again, I know that might be like against the Bible of, know, CLT. That’s me and that’s how I have to do it. And I’m in agreement, Kelly, like me and garments.
I do not fit for garments, but I have a team who I can depend on for that and who I’ve been able to connect with in that way.
Kelly Martin (09:40)
Yeah, found the reps have been like me just sending them an email and was like, hey, I’m a new CLT. I took this course. I am finding myself more often than not need to do these skills. I really need help. They’re absolutely wonderful. Whether it’s Zoom or Teams or I’ve had some of them come to me in person and they go through it with me and they’ve, you know, it also kind of gets my ideas being, okay, how can we, we’re doing all this stuff. Is there a way to like,
@TheOncoPT – Elise (09:47)
Nice.
Excellent.
Yeah.
Kelly Martin (10:10)
have your system? Like is there a way for us to have that set up somehow? Is there a certain day that I could schedule you know six people that need to be measured? That’s a little bit of logistical stuff but six people that need to be measured and have someone come out and have a little room space to do all that. ⁓ And I’m like okay well is that possible so that there so that you know decrease the amount of time that you’re
@TheOncoPT – Elise (10:12)
Mm-hmm.
Right.
But if it works…
Right? Genius. Genius. Genius.
Kelly Martin (10:37)
doing remakes and things like that. And I think it’s terrifying to have to remake something and it’s gotten, I’m better at it now because I still do it. I’ll still do the whole CDT and then I will measure them for their garments and I’ve gotten way better at it. They’re good at, I mean, I had a patient two weeks ago now.
@TheOncoPT – Elise (10:40)
Right.
Kelly Martin (10:58)
She’s chronic management, been doing wonderfully and you know, some other things about her case and what would be the best garment for her. was kind of, had my brain was thinking one way and she’s kind of you know, our chronic patients who are just coming back for their new garments and they know their stuff. They’ve been around the circle so many times and so we’re talking about like all the different options and what I’m thinking as a new therapist and she’s like, well I’ve kind of already done that before and I’m like,
@TheOncoPT – Elise (11:01)
Mm-hmm.
Mm-hmm.
Kelly Martin (11:28)
know what we have the time why don’t I talk to these representatives at it happened to be Juzo I was like let me talk to the rep and see if he’s available and we can come talk us out and they were able to get on her team’s meeting with me and my patient while she was in the clinic and and it worked out and we I had already done all the measurements for what I thought was I thought would be the best thing and
@TheOncoPT – Elise (11:39)
Right, right.
Mm-hmm. Mm-hmm.
Kelly Martin (11:55)
then they were like, okay, well, if there’s no other measurements you need, then send it off. I’m like, all right, cool. So we did that. But it was like, just, it took one more visit, but the patient felt, you know, very, she was like, this is, this is elite level care. I’ve never had someone consulted on my behalf from a manufacturer. And I’m like, this is your garment. Like you have to wear it. And I’ve, I’ve kind of, this is like my slogan when it comes to, that I educate a lot on, is the three C’s.
@TheOncoPT – Elise (12:00)
No room.
outstanding.
Kelly Martin (12:25)
Comfort, compliance, and containment. If we can balance comfort of the garment and containment of their edema so that the reduction, the great work that we do in CDT, the intensive phase stays that way long-term, containing it.
@TheOncoPT – Elise (12:28)
Mm-hmm.
Mm-hmm.
Right.
Kelly Martin (12:43)
So is the fabric type gonna do that? ⁓ Do they need certain accessories to maintain the compression gradient so that it’s containing the lymphenema? Is it comfortable? Are there accessories or the things we need to consider to make sure that it’s comfortable for the patient to wear it every day like they’re supposed to? And if we can get those two things pretty balanced, we’ve got compliance. The person’s gonna wear it. And so they’re spending all this money to have these things, whether it’s their insurance is sometimes picking it up or they’re paying somewhat out of pocket.
@TheOncoPT – Elise (13:12)
Mm-hmm.
Kelly Martin (13:13)
for it.
@TheOncoPT – Elise (13:13)
Mm-hmm.
Kelly Martin (13:14)
Those are my three C’s. I’m like if you can nail that the best you can, then there’s no perfect scenario, but the best you can you get you get the great results we achieve long term and they’re happy and even if it takes one extra visit talking it through with the manufacturer you’re thinking that
@TheOncoPT – Elise (13:20)
Mm-hmm.
Mm-hmm.
Yeah.
Kelly Martin (13:34)
does a world of difference and the patient feels, you know, the buy-in and the rapport that you build with your patient by saying, I want to talk about this with some more experts, someone who’s been a lymphedema PT for 20 years and has seen the gamut of different complex situations. I want to get their thoughts and their expertise before I go get something to bill your insurance for this garment. And they’re great. So if you’re, if you don’t have a world where
you have a DME nearby that can do all the measurements, leaning on the representatives. It’s in their job description to communicate with you, to potentially travel around and see you, talk about new products, help you with measuring. They’ve even given me other DME companies that I can send orders to. They’re in the midst of that.
@TheOncoPT – Elise (14:05)
Mm-hmm.
Mm-hmm.
Nice. ⁓
Kelly Martin (14:30)
and they know all
the ins and outs of that. So leaning on them, meeting them somehow, whether it’s phone, virtual, in person, they’re absolutely wonderful. And it was kind of the, I think if I hadn’t had that experience on day one, patient number one, by myself.
I think I would have, you know, the lunchtime talking about garments and the cards we got from people who are the reps. I think that would have just stayed in the bag they gave me and I probably wouldn’t have potentially done anything with it so that it really opened that like.
@TheOncoPT – Elise (14:59)
Yeah. Mm-hmm.
Kelly Martin (15:03)
scary moment really opened up a door for me to be like, no, I need to communicate with these people. They’re a part of this lymphedema management that’s, you know, it’s very holistic and all encompassing. And so these are people I need to have on my side. They need to know me by name. They need to know what I do. And then I’m working for patients that use their products. ⁓ So that’s like kind of the…
@TheOncoPT – Elise (15:08)
Mm-hmm.
Kelly Martin (15:27)
The business-esque side of PT that’s not really, yeah, it’s somewhat intervention, but it’s like the art of being really successful in this world, in the world of lymphedema, I think, is a community of other PTs and the people that these patients are gonna work with, the DME reps and the manufacturer reps that are making these products that they’re using, I think are.
@TheOncoPT – Elise (15:30)
Mm-hmm.
Mmm.
That’s a really good point.
Mm-hmm.
Kelly Martin (15:53)
They’re huge. They can be huge, huge resources. And so leaning on them anytime you need them, that is their job. That’s what they get paid for. And so use it 110 % because I do. And it’s probably the best decision I’ve made.
@TheOncoPT – Elise (16:00)
Right.
Yeah.
And I wonder too, you know, having listened to you talk about that and reflecting on it, maybe that’s also part of the intent or the structure. Listen, I don’t know what they think when they structure these courses, but I almost wonder if that’s part of the intent of like, you get a tasting when you’re in the program during lunch, as you’re like snarping down lunch, cause you’re hungry after filling your brain for like five hours or whatever.
Kelly Martin (16:22)
Yeah.
@TheOncoPT – Elise (16:33)
I feel like this is then the opportunity to say, you know, here’s the tasting of what you’re getting. And then you get out into the field and then you at least, maybe you don’t have the answer on like, how do I fit this garment? One thing that I really like having conversations with when it comes to garment representatives, the features of garments. ⁓ Because that just blows my mind as far as like a lot of my patients, you know, it’s
post breast cancer lymphedema we’re working with. So it’s like pretty straightforward. They don’t need anything too crazy when it comes to their garments, but sometimes they do. And so learning like, okay, which of these options is really going to be best for them? Like within this garment line that we’re talking about, do I want, you know, an elbow, you know, I don’t even know what they’re called, but like a flexi zone where they’re going to move better or something like that. Or, you know, like, ⁓
Kelly Martin (17:27)
Yeah, yeah, yeah.
@TheOncoPT – Elise (17:31)
That’s just one example, but like some of those features that you can start tweaking to make a garment so that it better addresses the issues that the patient is having. I really like pulling the reps for that because they have such a wealth of information on like, this is the purpose. This is worth your time. This one is not worth your time. Don’t even worry about that. Here’s what I would maybe recommend instead. That has been a tremendous value for me as a clinician because frankly, I don’t have the
bandwidth to be able to memorize all of those different features and their functions and benefits in all the different garments out there.
Kelly Martin (18:09)
Yeah, no, I agree. And that’s like, okay, you start thinking about, know, again, this could be a whole another part two, I think, when it comes to the maintenance phase and garments and how you select a good garment and are the different brands and how is this one how is a how is a Medi flat knit different than a Juzo flat knit, like, you know, in the different lines and ⁓
@TheOncoPT – Elise (18:34)
Mm-hmm.
Kelly Martin (18:39)
Medi texture feel versus a Juzo Expert, which the reason why I say that is that for me it comes down to, which one’s more comfortable and which one’s better containing? They’re both flat knits, but if you feel two different manufacturers flat knits, sometimes they’re a little different in feel. And so if you’ve got someone who’s
@TheOncoPT – Elise (19:00)
Mm-hmm. Mm-hmm.
Kelly Martin (19:05)
I always, they’re like on the bridge. They really probably need a flat knit.
they don’t really want to do a flat knit because people think it’s really hot and it’s thicker fabric so it feels heavier and yada yada yada. They’d rather stay with a circular knit. But that’s really not, if I feel strongly that that’s not what they need, they really need a flat knit, then it’s like, okay, which brand of flat knit is maybe a little bit more comfortable that’s a bridge? And I find different manufacturers that have that. Little tweaks, almost like some of the different
@TheOncoPT – Elise (19:14)
Mm-hmm.
Mm-hmm.
Kelly Martin (19:41)
things you can add to a garment. It’s like, okay, think in your head which ones, which ones feel a little bit more aggressive, which ones feel a little less regressive when it comes to the world of flat knit. Let me start them with this flat knit and then you know you can reevaluate in six months.
You can say, okay, is this comfortable for you? Is this containing? You’re going to do your reassessment. You’re going to measure the volume volumes. They’re going to, if you have access to it, we do, they’re going to go to the lymphedema surveillance clinic and do the bioimpedance. So you’re going to see the numbers and the numbers don’t lie. ⁓ And so then you can have the next conversation of, okay, I think we need something a little bit more aggressive or okay, yes, this is doing the job. Like we’re just going to measure you up and send you on your way. Boop, boop, done. ⁓
@TheOncoPT – Elise (20:12)
Amazing. Amazing.
Boom boom.
Kelly Martin (20:28)
But I really, think also, and I tell, I educate my patients a lot on this, you know, you’re gonna try something for six months. And this may be great for you for the next six months for all eternity, but ⁓ we may find six months that this ain’t it, and that’s okay.
let’s we get to reevaluate. get an opportunity to optimize your management plan, whether that’s the garment, whether that’s helping you get into exercise, whether that’s about talking of getting you connected with nutritionists or dietician, whether that’s, you know, making sure you’re taking care of your skin. You’re not having repeat infections. If you are, can we consider something add into your garment to reduce that risk? You know, there’s more education, there’s more layers, and you get to do that every six months and a lot of
@TheOncoPT – Elise (21:03)
Mmm.
Kelly Martin (21:13)
are really easy. A lot of people are like boom boom boom, I do myself MLD, I got all this, we just need my garments, great, they’re working great, just measure for them and move on. But for some it’s like you almost have to add a layer at a time and say okay we’re gonna do, we’re gonna measure for your garments, we’re talking about this, we’re gonna do the CDT, we’re then gonna get you for your daytime garments and your nighttime garment and then while we’re reducing we’re talking about manual lymphatic drainage and we’re doing it and then we’re saying well here’s ways you can
@TheOncoPT – Elise (21:28)
Yeah.
Kelly Martin (21:43)
do it at home and there are massage therapists that are trained in it you can also utilize them and so giving these people all these resources to manage and then we’re talking about exercise because you know a part of the intensive phase is exercise and why because I think it gives you like five for the price of one I’m a huge proponent of that I think that’s another thing in the course I didn’t feel like was talked about enough especially when
@TheOncoPT – Elise (21:49)
Mm-hmm.
Bye.
Kelly Martin (22:10)
not all of the providers in my course were rehab providers, PTOT. So I think that was another layer that, you know, we kind of glossed over exercise and I think in some ways you can be general, but…
@TheOncoPT – Elise (22:16)
Right, right, remember you talking about this.
Mm-hmm.
Kelly Martin (22:28)
is that person, you know, when you’re doing an evaluation, you’re also determining is this person safe to do exercise? Do they need further medical testing? Do they need further clearance based on their comorbidities? You know, are there, are there, you know, other things to consider? And some other, some people that aren’t rehab providers aren’t.
they’re not able to do that. And sometimes because we glossed over it, I felt like I didn’t want them thinking that they needed to take this upon their shoulders. And I’m like, and I like even, I even said, I like said it in the class. I was like, if you’re not trained in this, if you’re not a PT, OT, whatever, rehab professional trained in exercise prescription, don’t feel like you need to do that, you know?
@TheOncoPT – Elise (22:52)
Mm-hmm.
Mm-hmm.
Kelly Martin (23:18)
you don’t need to do that. There are people that will do that and make sure the patient’s safe doing it. ⁓ And they were all like, heck yeah, I will surely pass off that skill. But just like the thought of knowing, I think also being in a course, it’s like, I need to know all these things and I need to apply them perfectly when I get back into reality. ⁓
@TheOncoPT – Elise (23:28)
Ha!
Kelly Martin (23:42)
when you can’t do that and you struggle you feel bad and you think you’re being a bad clinician and it’s like no you’re not you’re learning it’s hard to do ⁓ and I was very very first to be like no do not feel like you that’s not that’s not your skill set you don’t feel like you need to do that ⁓ and they were very appreciative and I was like no no no
@TheOncoPT – Elise (23:50)
Mm-hmm.
Hmm
Kelly Martin (24:03)
You don’t need to do this. can’t be part of me was territorial and was like, we can’t give this away. This is our skill. This is what we go to be trained to do from the get go outside of becoming a CLT. But, you know, this is our this is our, you know, wheelhouse. We do this training. Don’t feel like you need to harbor this new responsibility of exercise to.
@TheOncoPT – Elise (24:11)
Right.
Right.
I think that also brings up a really interesting… ⁓
perspective, but also because so many different professionals can take the CLT course, at least through Norton and Close and I’m sure the others from what I understand, like PT, PTA, OT, CODA, speech therapists, licensed massage therapists, chiropractors, physicians, nurses, and maybe a couple others that I’m totally forgetting, which like no shade, I just don’t remember them off the top of my head.
that encompasses a lot of different professional scopes and professional practices. And when you look at the difference between, like you said, a rehab professional, a PTOT is trained in exercise prescription and whatnot. And a licensed massage therapist, for example, probably doesn’t have that same kind of experience unless they’ve done something outside of massage therapy, right? And so I’m curious, like,
Kelly Martin (25:26)
Earth. Yeah.
@TheOncoPT – Elise (25:31)
Yes, I get the benefit of being vague or more general in that aspect, but I also think, I think that could be a place where there could be more discussion, honestly, around like, hey, if this is outside your scope of practice, if you’re not comfortable doing this, then okay, but maybe draw that to attention more instead of, because I felt like even,
When I got back from my course, I was asking other CLTs, was like, what decongestive exercises do you even do? Like, what does that count? And so I had a colleague at a clinic down the road who shared with me ⁓ from her program way back in the day, her flow of decongestive exercises. And then I’ve adopted that and kind of adapted it over time for my patients. But I, and again,
This was me at the very beginning of my career, which like that’s, you know, I’ve grown as a person and as a therapist since then. I really needed that like explicit information because otherwise I was like, again, it ended up fine, but I was going and looking for some of that stuff later. ⁓ And I just, love having things all in one contained unit so I can go and find them. But again, I understand the generalizability aspect of it.
But maybe there’s an opportunity for like continuing conversation about that. And you know, maybe a little different approach as far as like how we address decongestive exercise within a CLT program. And again, I’m throwing things out there. I don’t run a CLT program, but this is my thought as a former student.
Kelly Martin (27:15)
Yeah, and so there’s
definitely, there’s definitely, I mean, the course could, you could make the course as long as you wanted, but you know, within the time constraints of 10 days, 10 hours every day, on top of prep work you did beforehand, which is, all of these things are way beyond the scope of any other clinical, continuing education course ever.
@TheOncoPT – Elise (27:21)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Kelly Martin (27:40)
And so at least to my knowledge and if that is if I stand correct in that please someone tell me but I’ve never heard of any other course that goes this long and apparently it was longer than this apparently was two weeks at some point I’m sure and they short and they shortened it and that’s where they kind of got the the mod the hybrid mod
@TheOncoPT – Elise (27:55)
I heard, okay, yeah, I did hear that. I did hear that, yeah.
Kelly Martin (28:01)
that you do prep time and then you come and just do all the really intensive stuff which is great but in some ways they have to cut things out and but I think some way you know where do they cut those things out and when do they update things going back to those videos from the 80s when do they update things how are they incorporating you know
@TheOncoPT – Elise (28:11)
So true.
Kelly Martin (28:24)
the new clinical practice guidelines that come out from the APTA. And obviously there’s other professions that are involved in these courses. It’s not to be like APTA, but also APTA says this and that, you know, that.
@TheOncoPT – Elise (28:27)
Yeah. Totally. Totally.
Considerations, right? Considerations for inclusion.
Kelly Martin (28:40)
consideration came out, well I think pretty sure it came out in 2020 and documents in my CLT binder are from like over 10 years old and I’m like, okay, well we need to update these things. you know, lymphedema research and lymphedema treatment research and all these things is progressing. It needs to progress because we are finding again, kind of coming full circle, is that it’s not just breast cancer.
@TheOncoPT – Elise (28:49)
Mm-hmm. Yeah.
Absolutely. Absolutely.
Kelly Martin (29:09)
that where people become at risk for lymphedema, it’s head and neck, it’s prostate, it’s abdominal. I I’ve treated patients with other cancer diagnoses. It’s also people that don’t have cancer. It’s people that had a, you know, primary lymphedema. Now, that’s not as common, but you know, there’s people out there that have issues with how their lymphatics develop. ⁓ And…
@TheOncoPT – Elise (29:12)
Mm-hmm.
Yep.
Mm-hmm.
It’s out there.
Kelly Martin (29:38)
they get the same treatment. It’s the same exact treatment, ⁓ even though the cause, the underlying cause is different. And so I think just people are more aware about it and I think education’s a huge piece because a lot of times I feel like, especially when we see it most often in cancer, it’s like basically a patient gets told they have cancer and then that’s literally all they hear.
@TheOncoPT – Elise (29:46)
Mm-hmm.
Kelly Martin (30:07)
that people can talk and talk and talk about, know, this is the treatment plan we’re gonna do, this is the surgeries we’re gonna decide between, this is how your chemo’s gonna go, this is how your radiation’s probably gonna go, ⁓ you’re also at risk for lymphedema, that’s a risk, with any of these above treatment options, it’s like, huh?
@TheOncoPT – Elise (30:07)
Yeah, yeah.
Kelly Martin (30:22)
They don’t even hear that. They only heard the first sentence. And they’re trying to grapple with what did I do wrong in my life? And now I feel like a lot of times this is one of the things that just keeps on giving, which sucks. And I feel like I say that a lot to my patients because I’m like, no one chooses to have cancer. No one chooses to be at risk or then develop lymphedema. But this is a modif- it’s something we can modify and move around. It’s not a we’re going to stop you from doing all these things.
@TheOncoPT – Elise (30:28)
Yeah.
Mm-hmm.
Kelly Martin (30:52)
in your life. ⁓ We’re going to show you how to do the workarounds and how to be mindful and how to be educated. ⁓ And so I think even that’s getting better.
as well. There’s so much work to be done in this area too, so it’s exciting to in some ways, you know, be a part of it and keep having conversations about it and keep looking in the literature. There are a couple articles coming up in the research roundup that involve, you know, lymphedema and discussions around that and hopefully as, you know, treatments evolve and having, you know,
@TheOncoPT – Elise (31:09)
Totally, totally.
Kelly Martin (31:30)
different bypass surgeries done at the time of surgical intervention. How does that change risk and risk reduction and management? I think there’s so much more to be done and there’s so much more that all the professions can learn about lymphedema that see these patients. A lot of them don’t know.
what they don’t know and I think that’s also a huge education piece too is for us to be able to go out of CLT’s and say hey this is where the literature is going and this is how we should be if we can do breast practice in clinical reality this is what it should probably look like and everyone in some way should be involved in that ⁓ for the patient so that the patient can get better, can get caught quicker and their life’s better because of it.
@TheOncoPT – Elise (31:57)
Absolutely.
Mm-hmm. Mm-hmm.
Mm-hmm. I think the role of a CLT course is really a foundation and a springboard. And I think early on in my practice, I didn’t really understand that. Like, there’s so much nuance when it comes to treating other human beings in this very, very dynamic patient population that we’re in. You know, it was really easy for me because I’m also very like…
If you tell me to do something, I’m going to implement it perfectly, not perfectly, but like I’m to do my darnedest. And there’s so much more space that I think you have to make when working with lymphedema that that black and white rigid approach is not always what’s really going to work. so knowing, and again, now this is having the…
Kelly Martin (32:55)
Yeah.
@TheOncoPT – Elise (33:15)
looking back on perspective of seven years practicing, of really kind of reevaluating, my CLT course was a foundation and a springboard that equipped me to start treating patients who have lymphedema. And then, much like we see in many other aspects of physical therapy and cancer rehab,
You then take that information and you apply it into your clinical practice. And then you like relearn it almost all over again over the next like months to years of, okay, I understand this is what I’m striving for or that this is what I’m really trying to do with this patient population. But I’m also weighing it against some of the individual circumstances that I’m having to deal with and then consider when developing my plan of care.
How can I marry them together? And I think that perspective, again, that hindsight is now what is leading to for so many clinicians, the continuing conversations that we’re having about this. Again, like we can recognize all of the incredible, amazing things about a CLT course and what we both took away from it, but also how can we make it better? How can we make it more accessible and
I don’t know, just like better in general for more patients. And that’s really exciting to me at this point in my career of like, I get the basics and there’s a place for the basics. How can we also maybe update those basics? How can we make them better? Is a return to basics what we need to be doing? And again, it’s exciting to see the research coming out about this because I think this is gonna help answer some of these questions that.
Kelly Martin (34:42)
Mm-hmm. Yeah.
@TheOncoPT – Elise (35:03)
that are starting these discussions that we’re having in these spaces.
Kelly Martin (35:06)
Yeah, absolutely. I couldn’t agree more.
@TheOncoPT – Elise (35:09)
now having gone through the course and looking back at who you were as a clinician before you went through your course, what would you tell yourself or maybe someone who’s considering taking a CLT course?
Kelly Martin (35:26)
I would tell myself or a person considering it, know, definitely do your research before you take a course or, you know, if you’re choosing between different programs. Like, I know I remember you and I talked about it when it was presented to me at my job of like, hey, do you want to do this? And I was like, yeah. And then I was kind of like,
That was kind of the question and then I didn’t get any other, I didn’t at first get any other information until I started and then I had the chance to ask questions about like, what course am I taking and how would this be funded and what gets covered when I travel or whatever. And all the logistical stuff that I was curious about. Like I remember asking you, okay, well, I don’t know if this is something that’s, you know.
@TheOncoPT – Elise (36:02)
Mm-hmm. Mm-hmm.
Mm-hmm.
Kelly Martin (36:17)
I think know your why. Why are you taking the course? Is it within your patient population that you’re treating? And percentage-wise, look at your population and say, hey, this is 60 % of my population. Yeah, this is worth my time to take this course and really understand on a deeper level, even if it’s not necessarily the…
@TheOncoPT – Elise (36:20)
Yeah. Yeah.
Kelly Martin (36:44)
thing you’re passionate about. I’m not passionate about being a CLT. I am passionate about mitigating that barrier so that my patients can exercise and return to sport and return to these things. Like it’s almost a means to an end to have this skill set because it breaks a barrier for someone to be afraid to go do those things. ⁓ Or they’re limited
@TheOncoPT – Elise (37:04)
Yeah.
Kelly Martin (37:10)
and doing those things and they have the desire to get back and I have the skills to get them what they need in that way. So I wouldn’t say that, I mean if you’re striving to become a stellar lymphedema therapist then absolutely take the course. But even if you’re not like, this isn’t my bread and butter but I see it 60 % of the time, absolutely take it because that was me and that still is me. I think asking the questions of what course
@TheOncoPT – Elise (37:32)
Definitely.
Kelly Martin (37:40)
⁓ How’s it getting covered? Do you have to travel for it? How’s that getting covered? You know?
@TheOncoPT – Elise (37:44)
Mm-hmm.
Kelly Martin (37:48)
all of those things, how does it elevate you as a provider in your clinical practice in terms of you’ve added three letters to your name and there obviously is a lot of conversation around like letters after your name doesn’t always equate to being a great therapist. It does a lot and a good chunk of times but sometimes it doesn’t. There’s lots of talk about that I feel like in the world of like you don’t need 20 different letters after your name to be a competent therapist.
@TheOncoPT – Elise (38:00)
Mm-hmm.
Mm-hmm. Mm-hmm.
Kelly Martin (38:18)
and I agree with that. I think that lymphedema is pretty specific so I feel like it is worth taking the course to be more of an expert in it because you can mess it up and it can be dangerous to mess it up if you initiate at the right or the wrong time. It could be a mess or what if it’s not lymphedema and you’re treating something and you’re wasting resources on something that it’s not and you have to know that.
@TheOncoPT – Elise (38:19)
Yeah. Yeah.
I agree. Yeah.
Mm-hmm. Mm-hmm.
Kelly Martin (38:47)
⁓ And so I think in that way, you know, I think it is a course that you kind of need those letters behind your name. You should have them.
@TheOncoPT – Elise (38:59)
I agree. I
agree.
Kelly Martin (39:01)
And I think there’s other letters that follow CLT, like the LANA certification, which you and I have talked about a lot. I’m not LANA certified. There are CLTs out there that aren’t. There ⁓ was some talk in our course about like, it worth being LANA certified or go join the NLN, the National Lymphedema Network. ⁓
@TheOncoPT – Elise (39:06)
Mm-hmm. Yep. Mm-hmm.
Mm-hmm.
Kelly Martin (39:25)
And so that’s a whole nother question set for you in terms of is it worth it to do those things? But I definitely think it’s worth doing the CLT if the demand is there, if it’s going to, if you identify the demand is there and it’s potentially a barrier for some of your patients getting to what you’re potentially more passionate about. ⁓ For me it was.
@TheOncoPT – Elise (39:28)
Right, right.
Mm-hmm.
Kelly Martin (39:50)
My job was gonna pay for it. It was a course that’s well known. It wasn’t something in house. It’s a well known, Norton’s a well known school, close is a well known school. I would have felt comfortable. I probably would have had to do more digging and be more evaluative if it wasn’t one of those two courses. To make sure that I’m getting the value out of what I’m taking.
@TheOncoPT – Elise (39:50)
Yeah. Thank you.
Mm-hmm.
Kelly Martin (40:16)
versus not getting it. if it wasn’t, I know we talked about this at one point, was like, if it’s not one of those two courses, how do I advocate that that’s the course I wanna take? And that’s the course I want them to pay for ⁓ versus what they’re offering. Because you don’t have to take what they offer. You can always negotiate.
@TheOncoPT – Elise (40:30)
Mm-hmm. Mm-hmm. Yeah.
Very true!
Kelly Martin (40:37)
So I think that’s
@TheOncoPT – Elise (40:37)
Very true!
Kelly Martin (40:37)
a really important thing that I had to think about and then I got my answer and it ended up being one of the courses that I was told like these are gold standard, this is going to give you the most handle and experience, this is what this is what’s really you’re going to walk away really prepared and I felt that way and I was like okay well I don’t have anything to worry about but if you’re if you’re considering that.
@TheOncoPT – Elise (40:45)
Mm-hmm.
Mm-hmm. Yeah.
Kelly Martin (40:56)
you know, considering where you’re getting your content from, just like anything else. Consider where you’re getting your research from. Consider where you’re getting these other courses from. And so I think definitely doing a thorough review of why you want to do it and what will it, where are you going to take it and what will it do for you when you come back? Does it involve, you know, more pay?
@TheOncoPT – Elise (41:01)
Of course, of course.
Mm-hmm. Mm-hmm.
Kelly Martin (41:18)
Does it involve extra, are you gonna be able to develop a program? We talked about better implementation of this skill set and does it allow you clinical time to develop that program and protocol in your clinic setting? Because now you’re the expert. Or are they making you do that outside of work? Or does extra pay come into the equation? ⁓
@TheOncoPT – Elise (41:24)
into it. Yeah, right.
Mm-hmm. Mm-hmm.
Mm-hmm.
Kelly Martin (41:45)
by knowing this new content and being a certified lymphedema therapist? Those are important questions that you have to think about. ⁓
@TheOncoPT – Elise (41:48)
Right.
Mm-hmm.
Kelly Martin (41:54)
before you go embark on this really expensive course. It’s definitely an expensive course and if you can get it fully covered or partially covered or if you’re doing it all on your own. There were some people in my course that paid for it out of their own pocket and I was like, what? What do you mean? This is like two grand. I wouldn’t be able to afford this out of my pocket. No way.
@TheOncoPT – Elise (41:58)
Right.
Mm-hmm. Mm-hmm. Yeah. Yeah.
It, you
know, again, it’s, we, you know, talked about this kind of at the top of the episode. It’s an expensive course. I mean, you’re paying for the content that you’re getting. ⁓ many programs also offer scholarships. So if you’re listening to this episode right now and you’re like, Whoa, cost is a huge issue. The only reason I was able to get it was through a scholarship that I received. And so.
They give them out all the time. Like look into the schools that you’re interested in and look into their scholarship availability because they’re out there. Like they want more people to be CLTs and that could be a really great option for you. Yeah. I mean, it’s an investment, Kelly, right? Like it’s an investment into you and your practice and your patients. Absolutely.
Kelly Martin (42:55)
Yeah, absolutely.
Yeah, and so I think that I’ve seen it pay off a lot now being three months out. ⁓ Pay off in actually practicing it and getting better at it every single time. But I also think one way that I feel like I’ve grown a lot is educating the patient. Because sometimes my patients walk in and I’m like, yeah, I got this referral. It kind of talked about being at risk for lymphedema. What does that mean to you? And.
You know, having a lot of discussions, especially when it comes to diagnosis of lymphedema and in the early stages where it kind of waxes and wanes, having those conversations of, know, this is what it will typically do. Sometimes you have your symptoms, sometimes you don’t. Sometimes you have no symptoms at all and it’s happening. I’ve caught people like that and then gotten them referrals to our surveillance clinic. Like, you’re going to catch things and it’s a great time to educate your patients because I think that they, they’re… ⁓
@TheOncoPT – Elise (43:29)
Mm-hmm. Mm-hmm.
Mm-hmm. Good. Good.
Kelly Martin (43:53)
afraid and so then you can bring them that ease of like no no no no no it’s not it’s not that it’s not it’s not all crazy like I feel your you know validate them and like no no what your fear you have is is valid but I am gonna help you feel
@TheOncoPT – Elise (43:56)
Yeah!
Kelly Martin (44:13)
more comfortable that you don’t have to be afraid. That’s my job is to reduce your fear, but your fear from the get-go is probably is completely true. And it’s because you don’t have, you have no idea what’s going on and what this all means. You’ve only seen a fraction of it. So I get to open this door for them as well. And I open the door for, I have some medical students that shadow with me in clinic. And so I get the chance to educate them. And you know, we work alongside other providers, physicians being ones that refer to us.
@TheOncoPT – Elise (44:22)
Mm-hmm. Mm-hmm.
Mm-hmm.
Kelly Martin (44:44)
And so being able to educate the next generation of physicians and saying, hey, this is a big deal. If you’re interested in oncology, you know, this is something you’re gonna deal with. You’re going to be potentially diagnosing. You’re gonna be working alongside CLTs in the world.
@TheOncoPT – Elise (44:56)
Yes.
Exactly, exactly.
Kelly Martin (45:05)
and these are you know when you’re patient and when you inherit a patient that comes in with a garment on or their whole limbs wrapped up you kind of have an idea of what’s going on and you’re like okay. ⁓
@TheOncoPT – Elise (45:15)
Absolutely.
Kelly Martin (45:17)
And so, and I think also having them think about, you sometimes those early stages, can’t see it. You sometimes, depending on, you can’t measure it, they’re just describing symptoms. Is it lymphedema? Is it not? Is it something else? Because I think that opens up another door of opportunity of education, which I’ve said before, education is intervention too. And so I think that’s super, super important as well, that it allows us to do with this new skill set.
@TheOncoPT – Elise (45:27)
Mm-hmm.
Right.
Absolutely. Absolutely.
Right. That might be for me, one of the actually most important aspects of becoming a certified lymphedema therapist that I think is the most important. Like, yes, MLD, yes, bandaging, but the education, the ability to have a conversation with a patient on their level to take this information and be able to connect with them and not only communicate your point, but have them understand.
and be able to implement that information into their own life. That I think is what really sets us apart from non-CLTs and just people who don’t work with lymphedema is you really have to be able to have these conversations. And if nothing else from the course, I feel so solid in that. like Kelly has said multiple times, not just in this episode, but in another episode she’s been on, education is intervention, 100%.
I’ll kind of wrap up with this. What Kelly mentioned, I would like to re-echo here. If you are going to treat lymphedema, a CLT, like having a CLT behind your name is a non-negotiable. And I feel this very deeply. Y’all know here on the Onco PT that we believe very fervently in board certification because we know it is the fastest way to get from, I’m interested in oncology. I think I know how to treat patients with oncology conditions to “I can do this
as a specialist in my community and deliver the best level of care possible.” But that’s optional. If you are going to treat a person who has lymphedema, you need to be a CLT. No weekend crash courses. ⁓ Because as Kelly mentioned, and as I have seen multiple times in my practice, it is not that hard to get something very wrong when it comes to lymphedema management. I have a patient who I am working with right now.
who went and got a massage. And it was just like a Swedish massage, know, relaxing situation. And when her therapist got to her arm where this person has lymphedema, my patient was like, hey, you know, I have lymphedema here. I’m working with it. You know, my PT, Elise on this, whatever. And this other person says, ⁓ I can help you with that. And proceeds to move all of the fluid distally.
towards her fingertips. And so then we had to undo that the next time that she came in to see me. And this is just, unfortunately, one of the stories, like multiple stories that I’ve experienced over my career, that like being a CLT is a non-negotiable because of how wrong like information is out there and how ill-prepared you can be if you don’t know what you’re doing and how harmful, frankly, you can be. And so at the Onco PT, we are
If you’re going to treat a person with lymphedema for their lymphedema, you need to be a CLT period. I will link the schools, some of the schools, because I know there’s multiple out there, within the show notes, as well as any scholarship information for these programs as well, would highly recommend it. And Kelly, just so we’re clear, is getting your CLT worth it?
Kelly Martin (49:08)
I think it’s 100 % worth it to do it. If you’re seeing that population, you’re an oncopet, you’re an aspiring oncopet, and you’re about to enter the realm of this world, it’s worth it to, it is inevitable. It’s almost like the tagline of, it’s not when you see a patient with cancer, it’s not if, it’s when you see a patient with cancer. It’s not if you’ll see someone with lymphedema, it’s when you’ll see them. So it’s super important to have the skill set and know.
@TheOncoPT – Elise (49:28)
Exactly. Exactly.
Absolutely, absolutely.
Kelly Martin (49:38)
what to do, when to do it, and know when not to do it so that the patient can get the resources they need first.
@TheOncoPT – Elise (49:46)
Absolutely. Kelly, thank you so much for coming on this episode. It was such a fabulous, like deep brief. And I know we’ve had some of these conversations off air, but to get to put it all together and to also reflect now that you’ve been practicing and using these skills and this knowledge for a few months now in your own patient care is really exciting. It’s always lovely to see how much you have grown as a therapist in the few years that I’ve known you and I’ve gotten to work with you. So I’m just like.
Kelly Martin (49:50)
Yes. ⁓
@TheOncoPT – Elise (50:14)
tickled beyond all belief at just the therapists that you are growing into and are only going to continue to grow into more. Where can people connect with you if they want to keep this conversation going after the podcast episode?
Kelly Martin (50:29)
So you can definitely connect with me on the cancer rehab community or the Onco PT oncology specialist community as well. I am occasionally on X or Twitter. I will say I’m not on there frequently, but my handle is at Kmart DPT.
@TheOncoPT – Elise (50:33)
Oop oop.
Yep. Yep.
Ha
Kelly Martin (50:55)
And I’m also on LinkedIn, so I definitely get on those pretty, I’ll check them periodically. I think the rehab, the communities through the OncopT, those are probably the ones I’m on most frequently. Yeah, just like tag me in a post and direct message me, whatever. I’m happy to help. love having these conversations, whether it’s lymphedema or if it’s other things regarding, you know, oncology PT.
@TheOncoPT – Elise (51:02)
Mm-hmm.
Yeah.
Yeah, you’re on there all the time. It’s awesome.
Kelly Martin (51:25)
I can go down a rabbit hole as you can see here and it’s fun. It’s so fun to talk about these things and be better because of it.
@TheOncoPT – Elise (51:34)
Yeah. And one last thing, I know we teased this way back at the beginning of the episode, but you are presenting at the Cancer Rehab Community Conference 2025 coming up this November 7th and 8th. Would you mind giving us just a little, a snippet or a tagline about what your presentation is going to be about?
Kelly Martin (51:55)
Yeah, so I it’s crazy. It’s like coming up very very quickly before we know it’s gonna be november so I am very very passionate about oncology rehab as well as returning to sport and high levels of exercise and training and so My topic is really gonna kind of dive into You know, what does that look like? What? What does the literature even say? Does it say it’s even possible? ⁓ do people even do it across?
@TheOncoPT – Elise (52:21)
Mm-hmm.
Kelly Martin (52:25)
different diagnoses and how we can really implement that into clinical practice. What kinds of tests and measures can we consider? Whether or not they’re validated, they should be. We should work. I should work on that. Validated in our oncology populations, that’s a whole other realm of research. But what is out there? And it’s really, think a lot of it is, it’s kind of a passion project for me. And so a lot of it’s like, what’s not out there? And why do we, we need to get it out there. And so people need to be aware.
@TheOncoPT – Elise (52:45)
Mm-hmm.
Kelly Martin (52:55)
So ⁓ I’m really excited to talk about, you know, where that passion came from, but also what’s out there. Do all the legwork for clinicians of like, I’ve got this patient coming into my clinic and they’re a marathon runner and they’re having, you know, they’re having a mastectomy and they’re going to have radiation and they’re going to be at risk for lymphedema and can they go back to running marathons?
And how do I modify training to do that? ⁓ Because it’s possible. It’s totally possible. I say it a lot. It’s not, it’s oftentimes not about if you can go do those things. It’s when and how you get there. And I think that’s one of our huge jobs with working with survivors is how do we get there? Because we can get there together. And so being skilled in that way is super, super beneficial.
@TheOncoPT – Elise (53:52)
outstanding. I will of course be dropping the link to register for the Cancer Rehab Community Conference 2025 in the show notes. We cannot wait to see Kelly there. And this is going to be a really, really wonderful and again, very timely presentation. This is not something that we talk about a lot. I feel like in cancer rehab or if we do, it’s very niche and it’s time to really bring this topic to the forefront. So we’re really excited that Kelly’s going to be doing this.
Kelly, thank you again so much for coming on this episode of the Onco PT podcast. I know there’s clinicians out there who have been contemplating if the CLT is right for them, what to expect, and this has answered a ton of questions. And I’m really, really excited to see what comes out of this. So thank you so, so very much once again.
Kelly Martin (54:19)
next.
Absolutely, thank you so much.