Selected Podcast

Preventing and Managing Lymphedema

Living with lymphedema is challenging. Without proper management, the condition progresses, limiting motion, strength, and stability. Because lymphedema is usually caused by bodily trauma such as lymph node removal, surgery, radiation, pr infection, patients may not be in the best of health when they first start treatment. They need hands on physical therapy, support, and encouragement to keep the condition under control.

Jennifer Fernandez and Michelle Haas are both certified lymphedema therapists at MarinHealth. In this podcast, they cover the difference between primary and secondary lymphedema, the types of therapies they provide, and the importance of personalizing treatment to the individual.
Michelle Haan, PT, CLT | Jennifer Fernandez, PTA, CLT
Michelle Haan, PT, CLT is a Physical Therapist and Certified Lymphedema Therapist at MarinHealth.

Jennifer Fernandez, PTA, CLT is a Physical Therapy Assistant and Certified Lymphedema Therapist at MarinHealth.

Bill Klaproth: So are you suffering from lymphedema?
And why is it so worrisome and exactly what is it and how do you treat it?
Well, let's find out with Jennifer Fernandez, a physical therapy assistant and
certified lymphedema therapist, and Michelle Haan, a physical therapist and
certified lymphedema therapist, both from MarinHealth.

This is The Healing Podcast brought to you by MarinHealth.
I'm Bill Klaproth. Jennifer and Michelle, thank you so much for your time. We
really appreciate this. Jen, let me start with you. Could you give us a brief
background on your professional experience?

Jennifer Fernandez: Sure. Hello. My name is Jennifer
Fernandez and I have been working as a physical therapy assistant for over 20
years. I am also a certified lymphedema therapist and have a specialty
certification in orthopedics. And I've been working here in the outpatient
department of MarinHealth Medical Center for the past seven years.

Bill Klaproth: All right. Great. And Michelle, can I
ask the same of you? If you could give us a brief background on yourself

Michelle Haan: Hi. Yes, of course. I am a physical
therapist. I've been a physical therapist for over 20 years and I'm also a
certified lymphedema therapist. I've been here at MarinHealth for about four
years. I currently specialize in oncology and lymphedema management, as well as
women's pelvic health..

Bill Klaproth: All right. Well, thank you both. And
again, it's a pleasure to talk with each of you. Jennifer, let me start with
you. Could you explain this to us just so we all are on the same page? What is

Jennifer Fernandez: So let's first start with a
little bit of information about the lymphatic system. So the lymphatic system
is an important part of your immune system, and it's made up of a network of
tissues and vessels and organs, and it has two main functions. The first one is
to fight infection and to rid the body of toxins, waste and other unwanted
materials. And the second main function is to help maintain a fluid balance in
the body's tissues.

So now that we know a little bit about the lymphatic system,
we can talk about lymphedema. And lymphedema occurs when the lymphatic system
is not able to adequately drain the lymphatic fluid from a certain area of the
body. And this leads to an accumulation of protein-rich fluid which causes
swelling and this swelling is what we call lymphedema.

Bill Klaproth: Okay. Got it. Well, thank you for
explaining that now that we have an idea of what that is. So Michelle, let me
ask you this. Are there different types of lymphedema?

Michelle Haan: Yes, there are two types of
lymphedema, primary and secondary. So with primary lymphedema, there's a
developmental abnormality of the lymphatic system, which is either congenital
or hereditary. In this case, lymphedema can develop any time during a course of
a lifetime. And it's rare. It affects one in a hundred thousand people in the
US. Diagnosis is often made by a physician after excluding any general, venous
or secondary node disease.

Secondary lymphedema is much more common. This affects one
in a thousand people in the US. The mechanical insufficiency present in
secondary lymphedema is caused by a known insult to the lymphatic system. The
most common causes we see for secondary lymphedema include surgeries, such as
removing lymph nodes or removal of breast tissue due to cancer, radiation,
trauma, infection, malignant tumors, and chronic venous insufficiency.

Bill Klaproth: So then, Jen, because of the nature of
lymphedema, the treatment must be very personalized based on the location of
the issue and the patient's situation. Is that true?

Jennifer Fernandez: Well, of course, we always
personalize treatments based on the individual needs of our patients and how
they present. And that could be different at every treatment. The treatment
components will vary on things like the time elapsed since surgery, any
precautions that are put into place by the surgeon, any restrictions in the
tissue or the joint, the functional requirements of the patients, what the
patient can tolerate and the goals of the patient.

Bill Klaproth: So then what are the treatment

Jennifer Fernandez: So there's tons of different
treatment options. And again, those are individualized based on the needs of
the patient, but some of the common components when we treat a patient with
lymphedema include manual lymphatic drainage, and this is a very specific light
skin stretching technique that was developed by Dr. Emil and Mrs. Estrid Vodder
in 1936. And this specific technique helps to move the lymphatic fluid out of
the area that has become swollen and direct that fluid to the functioning lymph
channels and collectors that were not damaged by the surgery or insult to the
area. We also use manual therapy to address tissue and joint restrictions,
therapeutic exercise to address range of motion, strength and stability
deficits. Sometimes compression bandaging and/or compression garments is
indicated. And probably most importantly, patient education, and this will be
on how they can reduce their risk of developing or progression of their
lymphedema, healthy habits, and also on the things that they need to do in
between treatments and then ultimately throughout their life once they're
discharged from physical therapy.

Bill Klaproth: Okay. And then Michelle, how is
physical therapy used in the treatment of lymphoma?

Michelle Haan: Well, education about the lymphatic
system is probably one of the major components of our PT. Many people come to
us with a fear of developing lymphedema or without any knowledge of how to
manage the lymphedema that they do have. So we teach the patient about the
lymphatic system and what signs and symptoms to look out for. Early detection
and treatment is very important. If lymphedema is caught in the earlier stages,
it can be reversed. But once lymphedema has progressed to stage II or further,
it's no longer reversible and it has to be managed so that it doesn't worsen.

So we evaluate for the presence of lymphedema by taking
circumferential measurements of the limbs. We assess skin and tissue texture,
and we listen to symptoms that the patient is describing. Then based on our
findings, we'd prescribe an individualized treatment plan based on the
patient's goals. This program may include multilayer bandaging, manual lymph
drainage, exercise, skincare, self manual lymph drainage, compression, and
possibly a pump for longer term management at home.

Bill Klaproth: So Michelle, you said when it's caught
early, it can be reversed. If not, it has to be managed. So then what are the
typical treatment outcomes? Do most patients see improvement?

Michelle Haan: They do. Compliance is very important.
So it's important that the patients do follow through with our recommendations.
Our recommendations, based on the patient, may include bandaging at home,
wearing compression, exercising. As long as they're following through with the
education that we've provided, they will see improvement in range of motion,
increased strength and stability, reduction in swelling, reduction in pain,
improved function and mobility, reduction in scar tissue and/or cording, and
also just an improvement in their knowledge of lymphedema and how to reduce
their risk of developing lymphedema in the future.

Bill Klaproth: So obviously, early detection is
important. If a patient is experiencing lymphedema, what steps should they take
to seek treatment?

Michelle Haan: Well, if you suspect you have
lymphedema or you have any edema that is of unknown origin, it's important that
you reach out to your doctor so that they can assess the etiology of your
edema. They may need to order tests to rule out other causes. If diagnosed with
lymphedema, then ask your doctor to refer you to a certified lymphedema
therapist in your area as soon as possible.

Bill Klaproth: Okay. Well, this has really been informative
talking about lymphedema. Jen, let's wrap it up with you and thank you both for
your time. Is there anything else you'd like to share about lymphedema?

Jennifer Fernandez: Yeah. Thank you, Bill, I just
wanted to say that MarinHealth Medical Center has been the primary resource for
the treatment of lymphedema and cancer-related dysfunction for more than 30
years. Our physical therapy staff of certified lymphedema therapists are highly
skilled. They're experienced and passionate about providing exceptional and
individualized care for all of our patients. We were fortunate to work closely
with all of the Marin Cancer Care Team of physicians, nurses, patient
navigators, and integrative wellness clinicians to maximize the care of the
whole person.

Bill Klaproth: Yeah, absolutely. And the good to know
that. Well, Jen and Michelle, thank you so much for your time. This has really
been informative. Thank you again.

Michelle Haan: Thank you, Bill.

Jennifer Fernandez: Thank you bill.

Bill Klaproth: And once again, that's Jennifer
Fernandez and Michelle Haan. And to learn more, please visit
And if you found this podcast helpful, please share it on your social channels
and check out the full podcast library for topics of interest to you. This is
The Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Thanks
for listening.