5 Key Questions to Ask When Choosing a Lymphedema Therapist
Finding a Lymphedema Therapist
Finding a qualified lymphedema therapist can be challenging! Lymphedema is not always easy to recognize or well understood by healthcare professionals. Also, there are limited numbers of qualified and experienced therapists available to treat lymphedema. Because of this, patients with lymphedema need to equip themselves with the right questions to ask to make sure they get the help they need.
Treatment of Lymphedema
Lymphedema occurs when fluids accumulate in the tissues because the lymphatic system is not working correctly. Fluid accumulates in the space between the skin and muscle fascia and results in swelling. This fluid is rich in proteins and fat cells and as a result, can put a person at risk for infection. Lymphedema can occur for numerous reasons and cannot be "cured," but requires ongoing management. It is critical to find a therapist who understands the complexities of lymphedema and who can partner with you for long-term management of your condition.
Complete Decongestive Therapy (CDT) is the most effective way to treat lymphedema and includes four components: skin care; manual lymph drainage - a light massage that stimulates the lymphatic system and results in increased fluid uptake; compression - external pressure on the tissues through compression wraps or garments; and exercise. Unfortunately, not all clinics provide a comprehensive treatment of lymphedema. Currently, there are no mandatory training standards for lymphedema therapists, and some therapists who see patients with lymphedema have not actually completed a nationally recognized lymphedema training program. So how do you know if you are receiving high-quality therapy? Here are 5 questions to consider when choosing where to get treatment of your lymphedema:
- Is your therapist a Certified Lymphedema Therapist?
According to Lymphedema Specialist Joachim Zuther, certified lymphedema therapists receive a minimum of 135 hours of specific lymphedema training ("How to Locate a Certified Lymphedema Therapist..." 2010). Training consists of one-third of classroom lectures and two-thirds of lab instruction and focuses on the skills necessary to effectively treat lymphedema. Upon successful completion of the course, therapists take a written and hands-on examination. With successful completion of the course and the exam, the participants graduate as certified lymphedema therapists (CLT).
Therapists who have completed the 135-hour certification process are then eligible to take the Lymphology Association of North America (LANA) exam. Passing the exam provides a distinction that therapists have not only completed the certification requirements but also follow best practices and complete on-going advanced training established by LANA standards of care for treatment of individuals with lymphedema.
- How does your clinic bill for therapy and supplies?
Physical, occupational, and speech therapy services are considered "reimbursable" services by health insurers and lymphedema is a "covered" diagnosis. As such, physical, occupational and speech therapy can be billed to your health insurance. Often times massage therapy cannot be billed to health insurance companies. Billing lymphedema services to your health insurance can significantly reduce the amount that you will pay out-of-pocket so ask if your clinic is set up to bill health insurance and if so, ask if they are in-network with your insurance.
Compression supplies required in CDT can include short stretch wraps, padding, foam, compression garments, and more. Supplies are not typically covered by health insurance and are most often an out-of-pocket expense. Ask if your clinic sells the supplies you will need or if you have to go elsewhere to get them. You should also ask if they can give you an estimate of what the cost of your supplies will be and what payment methods they accept.
- How much experience does your clinic have?
Experience and consistency are important when treating lymphedema and you will want to make sure your clinic is set up to provide both. Ask how many lymphedema therapists work at your clinic and how many of them are certified lymphedema therapists. If there is only one certified lymphedema therapist, how will your needs be covered when the therapist is out? If there is more than one therapist, will you get to work with the same therapist each session or will you be assigned to work with other therapists as well? If so, what is their level of training and experience? Ask how many years of experience the clinic's therapists have and how long the clinic has provided lymphedema services. Is this a new program? Look for clinics with experienced therapists with longevity in providing lymphedema services.
- Is your clinic or therapist affiliated with national or local lymphedema networks and support groups?
Another indicator of the degree of professionalism and level of commitment to the lymphedema program is a clinic's affiliation with national or local networks and support groups. Ask if your therapist or clinic has membership with a national organization such as National Lymphedema Network, the Lymphedema Education and Research Network, or the American Cancer Society. Is your clinic is involved in local lymphedema or cancer support groups?
- What can I expect in my treatment sessions?
As mentioned earlier Complete Decongestive Therapy (CDT) is the most effective way to treat lymphedema. Ask if your treatment will include all four components of CDT: skin care; manual lymph drainage, compression (what type), and exercise. Also, ask about the frequency and duration of therapy. How long is each therapy session? How many times per week? For how many weeks? Will you be monitored after you have finished therapy? If so, for how long? What happens if you experience problems? Is there always a therapist on call?
Resources to Help Find a Lymphedema Therapist
There are several organizations that endorse standards for the treatment of lymphedema and provide directories of therapists:
NALEA is an alliance of four lymphedema therapy certification schools that adhere to the Lymphology Association of North America (LANA) standards. The current NALEA member schools are:
- Academy of Lymphatic Studies
- Dr. Vodder School International
- Klose Training and Consulting
- Norton School of Lymphatic Therapy
The National Lymphedema Network provides educational opportunities, networking opportunities, and interventional resources. They inspire clinicians to provide world-class care for people with lymphedema by promoting best practice guidelines and standards of care.
LANA promotes standards for the certification of healthcare professionals who help individuals with lymphedema and/or related disorders manage their lymphedema and to promotes lymphedema awareness and the science of lymphology.
LE&RN fights lymphatic diseases and lymphedema through education, research, and advocacy. It seeks to accelerate the prevention, treatment, and cure of these diseases through research fellowship grants, an international patient registry and biorepository, live-stream symposiums, the journal "Lymphatic Research & Biology", weekly e-newsletters, scholarship grants to lymphedema therapists, conference travel awards to young researchers, and a vibrant website with features such as Ask the Experts. LE&RN has State Chapters in the USA, as well as International Chapters. In 2016, LE&RN created World Lymphedema Day on March 6th, which was established by a unanimous vote of the United States Senate.
Find the Right Lymphedema Therapist for You
Remember, you deserve the highest quality care for your lymphedema. Make sure you have all the information you need to make the right choice for your lymphedema journey.
Did you know that Therapy Achievements is a Lymphedema Center of Excellence? We provide comprehensive treatment for lymphedema and have over 5 highly-qualified lymphedema therapists available to assist you. Give us a call today to schedule your first appointment!