What's New in Lymphedema Therapy in America?
There is much confusion among American medical professionals regarding the treatment of lymphedema. Much of it has to do with the fact that lymphedema "falls between the cracks" of all standard specialties in modern American practice. Partially for this reason and because of a general misconception among American physicians that lymphedema is not a "serious" problem, the condition has been virtually ignored and deprioritized for many decades. This study is intended to clarify the confusion and reasons for apathy toward the subject of lymphedema and its treatment. Lymphedema, for the most part ignored or poorly treated in the United States, is currently being effectively treated by complete (or complex) decongestive physiotherapy (CDP) in many American facilities. CDP was introduced to the United States by the author in 1989 and is a gentle, effective, cost-effective, safe, and noninvasive treatment. It is and must be performed by specially trained therapists under the supervision of lymphologists with expertise in lymphedema, its diagnosis, treatment, complications, and natural history. This article describes the author's experience in treating 1000 upper and 1000 lower extremity lymphedema patients by the CDP method. These patients were treated between 1989 and 1995 for an average of 25 treatments, each patient returning for a follow-up examination 1 year after the completion of his or her course of treatment. The variables recorded in this study were as follows: the patient's sex, type of lymphedema, and volumetric reduction achieved immediately following treatment and as measured 1 year after treatment. The therapy and follow-up procedures are explained in detail and examples (before and after photos) of actual cases are included. Based on the results of this study and others, it is the author's opinion that CDP therapy is superior to any surgical procedures currently being used and to the pneumatic pump therapies often erroneously recommended for this condition.
Lerner
R
State University of New York Health Science Center, Brooklyn, New York