mastectomy and lymph drainage

[Pompal 09.]

Hello All, I am in serious need of an expert. I have a new client with multiple problems but one that bothers her most is lymphedema in her left arm. She had a complete mastectomy on the left side ten years ago. Her left breast was reconstructed with her left latissimus dorsi (sp? She has a lovely scar going from her spine to nearly her sternum from the operation. She says sometimes the "breast" gets very contracted and hard and gets numb. I did not respond to this letting her know I have little experience with this particular situation. Her main concern though is the edema in her left arm from her shoulder to her hand. She said it comes and goes and it was flared up today. She got a full body massage for an hour and I did some NMT work and a little swedish mixed with DT. Lol. Very integrated massage. On her left arm I did lymphatic drainage and felt immediate relief. She said it felt funny, like the opposite of swollen. *shrug* I could visibly see the edema in her arm lessen. the forearm and hand still were slightly swollen but she had a lot going on and wanted full body in an hour plus the drainage. Very sweet lady. Anyways... I want to find out if there is a specific way to do lymphatic drainage on a mastectomy patient. She is missing 21 lymph nodes she said and I don't know if that is only the ones in the breast tissue or if the axillary ones were removed also. She was not really knowledgeable about it. She could only tell me they took out the l-mus something in her back and 21 lymph nodes with the breast. I have had training in lymphatic drainage and I'm certified but I did not get in depth pathology information in my course. Just basic knowledge of the watersheds and technique basically for healthy people I guess. I appreaciate any feedback or good references. I have the Sean Reil video but it doesn't really go into this particularly if I remember. I am going to review it of course. I am sleepy and rambling and I apologise but I really want to help this woman and perhaps others like her. Thanks. Diana}]i[{

 

[Drew]

I don't have technique advice but I can tell you that if her scar is that big and they took nodes, they definitely took axillary nodes.

 

[Sarah A]

Hi DianaMarie,

There are multiple levels of lymphatic training. The first levels address working with healthy people, and the advanced levels go into specific detail on lymphedema and post-cancer techniques. It's not something you can learn from a video. Generally, all the lymphatic pathways on the arm & shoulder where she had the surgery are probably abnormal (moving in different directions than you learned in your classes). Also, if there is enough swelling to be visible, she needs compressive bandaging as well as lymph drainage, to keep the swelling down. Bandaging is complicated and definitely something you should avoid if you don't have specific training. (Poor bandaging can make the lymphedema worse.)

I've had 50 hours of LDT training through the Upledger Institute. I'm not yet qualified to do bandaging. I highly recommend referring her to a specialist. Here are two websites to help you find a qualified lymphatic practitioner:

http://www.iahp.com/pages/search/index.php
(On this website, type in OK in the state box, and on the modality menu, scroll down and highlight Lymph Drainage Therapy Certification. That means the practitioner has had 100 hours of training, including bandaging.)

http://www.clt-lana.org/therapists/default.asp
(On this website, any therapist listed has a minimum of 135 hours of training, including bandaging.)

Good luck. Sometimes the best service we can give our clients is a great referral.

 

[Caribou Lou]

Thank You Blisss! I appreciate the references for referrals. While I relish the opportunity to work with her I do want her to recieve the work she really needs. I would like to get more training for specific pathologies and do more "medical" oriented work. I would rather help people who really need it and recieve dramatic changes than the average person with aches and pains.

 

[Pompal 09.]

Thank You Blisss! I appreciate the references for referrals. While I relish the opportunity to work with her I do want her to recieve the work she really needs. I would like to get more training for specific pathologies and do more "medical" oriented work. I would rather help people who really need it and recieve dramatic changes than the average person with aches and pains.

Then I highly recommend Upledger's LDT course series. It's amazing how many applications the technique has -- for people with cancer & lymphedema, but also for pre & post-surgery, healing from injuries, autoimmune disorders such as fibromyalgia & chronic fatigue, and overall wellness.

 

[Dover_lino]

Then I highly recommend Upledger's LDT course series. It's amazing how many applications the technique has -- for people with cancer & lymphedema, but also for pre & post-surgery, healing from injuries, autoimmune disorders such as fibromyalgia & chronic fatigue, and overall wellness.

Ditto! I've taken LDT level 1. After having abdominal surgery I went to a therapist who had completed advanced training - she had done Vodder and another type before taking Bruno Chikley's method (taught through the Upledger Institute). She really felt that Chikley's teachings were far superior to any of the other methods she had studied. I was amazed what a difference it made in the contour of my abdomen as well as the texture of my scar. Good stuff!

I second Bliss' recommendation about the bandaging. A friend of mind works with a lot of post-mastectomy patients using LDT. She's had wonderful results and it's not unusual for bandaging to be needed in those situations.

Lisa

 

[Pompal 09.]

update

Thank you guys for your input. I have since learned from my first post that the client does have several of her axillary nodes left and she felt "500% better" after her first session! I am very excited about her because her insurance is going to pay for massage therapy. Since the work I did before worked really well for her I feel that it would be appropriate to continue working on her. Her edema was not severe just noticable when she pointed it out. She also has TMJ and said the pain completely went away after our session. I think much of her physical condition had to do with the mental and emotional stress in her life and the massage helped her to release that stress and therefore the pain. I did do several techniques to help her physical and I am sure she is feeling that too but I think the combination is what made this particular woman feel so much better than she was. I have not seen her again but she should be in this week when she finds out her schedule so I am excited to find out how she is now.

 

[NHK]

Hello everyone-

I'm new to the board and I was scrolling through and reading when I came upon this topic.
I totally agree with Bliss. I also came across quite a few other MLD questions and posts.
I've been certified in Decongestive Therapy and worked in a Lymphedema treatment center full time bandaging, doing MLD, and garment fitting. With a patient like the one in this topic, they need to be referred immediately to a therapist -whether it be a PT or MT-to be evaluated and treated. This patient was describing Seforum.xxxe 1 Lymphedema, this is where they need to be fully educated and sometimes fit for a compression garment to control the condition. As far as massage goes, she could greatly benefit from a full 60-90 min MLD Tx. The unfortunate thing is most people don't find out everything related to their condition until it's too progressed.
Anyway, I guess my point is to be careful even if you have some experience with MLD. It's a lot different working with a patient like this. It doesn't matter how many lymph nodes they have left, they're still at risk.

With all that preaching, I hope I don't sound like a jerk

 

[VFKNerd]

No fixedgear, I think you sound concerned and helpful and we're glad to have your input on this matter. Welcome to the board.