Amanda Wilde (Host): There is a whole spectrum of rehabilitation services to help you get back where you were or to help you adjust to where you are when you're recovering from illness or injury. Today, we'll examine the uses and benefits of rehabilitation therapy with Katie Richardson, Senior Vice President, Operations and Long-Term Care Administrator, and Lisa Pignataro, occupational therapist and certified lymphedema therapist at Bergen New Bridge Medical Center.

Host: This is Wellness Waves, a Bergen New Bridge Medical Center podcast. I'm Amanda Wilde. Welcome to you both. Katie, Lisa, good to have you here.

Katie Richardson: Thank you for having us.

Lisa Pignataro: Yes. Thank you for having us. We're excited to be here.

Host: Katie, let's start off with just, me as a patient, how does someone needing treatment receive services at the medical center?

Katie Richardson: So, Bergen New Bridge Medical Center is a very unique medical center. We are 1,070-bed facility. We are the largest hospital in New Jersey. We are the fourth largest public hospital in the nation. We offer several service lines throughout our medical center. We have a behavioral health service line 323-bed facility, which sees patients from age five and up. We also offer a variety of outpatient services within behavioral health. We also have an acute care service line, which includes a med-surg, withdrawal management and a vast number of outpatient ambulatory care clinics with a variety of specialties that are offered there. We also offer a full service line for outpatient rehabilitation services, including physical therapy, occupational therapy and speech therapy.

We continue to be committed to providing healthcare throughout our communities. We've established a community health services team to ensure that all of our outreach includes the diverse populations, communities of color, LGBTQIA+ and other traditionally underserved populations.

One of our goals here at Bergen New Bridge is to be able to provide care, treatment and services to the majority of communities. We are constantly expanding our services to identify unique programs. One of the unique programs that we've brought to the medical center through our occupational therapy program is the lymphedema specialty.

Host: Which is Lisa's specialty.

Lisa Pignataro: Yes.

Host: So Lisa, what is lymphedema?

Lisa Pignataro: Lymphedema therapy focuses on relieving swelling, typically in an individual's arms, legs. It can be in the head and the neck, essentially all over the body. And we aim to move lymphatic fluid. And lymphatic fluid is just a protein-rich fluid that causes an immense buildup of fluid in the extremities. So, you can imagine it becomes quite heavy and quite painful. So, we move this fluid out of the limbs. Our goal is to prevent additional swelling and to reduce any swelling that's present. So, a lymphedema therapist should show you the lymphatic drainage during the sessions. And then, we also aim to educate our patients by using a compression sleeve. We show them how to do a multi-layer compression bandage. And this essentially helps to comfortably squeeze the fluid from the arm or the leg towards the center of the body so that it can drain. So, it's a very special treatment.

Host: Who are the people you're working with mostly? I mean, who gets lymphedema?

Lisa Pignataro: A great question. So typically, I see a lot of cancer patients, most frequently any individuals that are post-mastectomy. I also will work with a lot of athletes that have had a trauma or an injury to the upper extremity or lower extremity. We'll have people who go in for a simple surgery on the knee, for example and, during surgery, a lymph node will accidentally get hit and then that can cause lymphedema as well. So, that's called secondary lymphedema and that's due to a cause of an injury or an illness. But there's also lymphedema that's called primary. And these individuals are born with this for reasons that we don't know at this time, so research is still being done. But we see primary lymphedema more frequently in young children, they're typically born with it or they develop it around the puberty age as well.

Host: So, almost anybody can get lymphedema?

Lisa Pignataro: Yes.

Host: And why is there a special certification to be able to treat lymphedema? This is a sub-area of physical therapy, right?

Lisa Pignataro: Yes. So, it's very specific and there's an extensive amount of training to be done because what we are doing is moving fluid within the body, and you have to be very well trained in understanding where that fluid is accumulating and why. And then, you have to take that fluid to other "healthy areas" of the body in order for the body to be able to handle it. But since you are moving so much fluid internally, you have to ensure that the patient doesn't have any other comorbidities such as, you know, a heart condition, a condition in their lungs. You have to be extensively trained to know how much they can take.

Host: What do you see in your patients that make you know the therapy is successful?

Lisa Pignataro: So almost instantly, I will see someone feel so much relief. They usually will fall asleep during the drainage massage. It's very relaxing and comforting or they'll tell me that they're feeling a lot better, they're feeling a lot lighter. Another way that we know it's been effective is nine out of 10 times. Someone will have to use the restroom right away to urinate, that means that the fluid is draining. And then that day or the next day, within the next few days to weeks, we'll start to see the extremity shrink and get smaller in size.

Host: It sounds like lymphedema is so common. Is it among the most common of the rehabilitation services that patients and residents receive at Bergen New Bridge?

Lisa Pignataro: It's actually not amongst the most common, but that's a great question because there will be times in cases where we're treating an individual, let's say, they had a shoulder surgery or a knee replacement. And initially after surgery, swelling is quite common. But sometimes over time, this persistent swelling doesn't go away. Myself and the other therapists that I work very closely with will look into it more to determine, you know, why isn't this going away. And then through process of elimination, we realize that they're dealing with lymphedema and then we know how to handle that. So, sometimes it gets undiagnosed because it is such a new specialty in the medical and healthcare field. So, we're learning more as we go.

Katie Richardson: And traditionally, you know, this was not a service line that we provided. While we provided occupational therapy, being able to have a specialist who can identify lymphedema was not something that we had. So, the uniqueness of having this service available to our patients at this point is really something that we're excited about and it's really growing our services.

Lisa Pignataro: Absolutely.

Host: Katie, how much of an impact does this rehabilitation therapy have on quality of life?

Katie Richardson: A tremendous amount. Individuals can't live with pain. They can't live with discomfort. So being able to provide rehabilitation services, whether it's physical therapy, occupational therapy and, quite honestly, even speech therapy too, it's so important to overall wellness and health. Not everybody needs occupational therapy, physical therapy and speech therapy. It is prescribed by a physician. And a lot of times it is post-injury, post-surgery, but there are chronic conditions where living in pain is just not an option for individuals. And therapy a lot of times is the only way somebody will feel better.

Host: Lisa, do you see the greatest impact coming from physical therapy when someone's recovering?

Lisa Pignataro: Absolutely. I even had a great example of a patient today who has been in chronic pain for months on end. And today, we did one very small, simple thing together in therapy and she felt so happy and so amazing and she was ready to go live out the rest of her day just a little more pain-free. And you would've thought that we handed her a million dollars, but she was so happy with just feeling that little relief.

I completely agree. I think I receive wonderful outcomes along with my patients. I like to keep the sessions about their goals and what they want as well, while I just provide my clinical expertise and opinion.

Host: Well, thank you both for your work in the area of rehabilitation. It sounds like we're discovering new things all the time, so it's sort of a growing field.

Katie Richardson: It definitely is. And there's so much cutting edge opportunity within rehabilitation services and we're just happy that Bergen New Bridge is able to provide those services to the patient population out there.

Host: That was Katie Richardson, Senior Vice President, Operations and Long-Term Care Administrator and Lisa Pignataro, occupational therapist and certified lymphedema therapist at Bergen New Bridge Medical Center. For more information, visit newbridgehealth.org/healthservices. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

Thanks for tuning into this episode of Wellness Waves. I'm Amanda Wilde. Until we meet again, be well.