Combined Decongestive Therapy

Combined Decongestive Therapy

Dr Vodder’s Combined Decongestive Therapy offers a practical and long lasting solution to the millions of lymphedema patients throughout the continent.  Lymphedema is a swelling of a body part, most often an extremity, resulting from an accumulation of fluids, in such proportions to be palpable and visible.  Lymphedema can occur whenever lymphatic vessels or nodes are absent, underdeveloped, obstructed or damaged. 

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Lymphedema is a serious condition, indicating that the lymph system is unable to handle the lymph load.  Unlike the blood which circulates, lymph flows only one way.  The lymph vessel system carries away fluid and metabolic waste from tissues.  Lymphedema occurs when the lymph system is not able to fulfill its function of resorption and transport of the body’s protein and lymph load.

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Lymph originates from the interstitial fluid found in tissue spaces.  In a healthy lymph system, the initial lymph vessels, which are close to the blood capillaries in any given area, take in excess fluid and proteins.  Once inside the lymphatic system, this interstitial fluid is now considered lymph.  The lymph is transported from the initial lymph vessels by a precollector vessel to the closest collector lymph vessel.  Collector vessels are composed of valved segments, called angions.  Angions are comprised of smooth muscle and connective tissue.  The collector vessels pump the lymph forward toward lymph nodes.  Lymph, moving from one area of the body to the next, passes through many regional lymph nodes.  Organic and inorganic debris, cells, viruses and bacteria  are filtered out and either stored or broken down within the nodes. Up to fifty percent of the water that is part of lymph is removed and transferred to the blood capillaries inside the lymph node.  Approximately 1.5 to 2 litres of lymph will enter the blood stream at the venous arch just before returning to the heart.  Once it reaches the circulatory system, this filtered and cleansed fluid is now considered plasma, a component of blood.

It is crucial for the lymphatic system to function efficiently.  If the lymph pathways become congested, damaged or blocked, or if lymph nodes are removed or irradiated, excess fluid and proteins can build up and stagnate in the tissues.  This raises the colloid osmotic pressure and a protein-rich edema, known as lymphedema, arises.  These proteins attract even more water by osmosis.  The affected area becomes swollen, enlarged and uncomfortable.  This swelling decreases oxygenation of the tissues and interferes with their normal functioning and repair which may result in chronic bacterial or fungal infections and formation of fibrous tissue.  Left untreated, severe cases are associated with thickening of the skin, hardening of the limb, leakage of lymph and massive swelling.  This, in turn, can lead to depression and a general decline in the patient’s health and quality of life.  

Treatment should begin as soon as lymphedema is diagnosed.  Lymphedema is a chronic and, if left untreated, progressive condition.  It can, however, be brought under control by appropriate treatment and care.  The goal of treatment is to reduce swelling.  The most effective method is known as Combined or Complex Decongestive Therapy (CDT). It is a four step process, carried out over a four week period.  The individual elements are Manual Lymph Drainage, Compression Therapy, Remedial Exercises with Breathing, and Skin Care and Hygiene.  The patient receives treatment three to five times a week or in accordance with the physician’s recommendations.

Dr Vodder’s Combined Decongestive Therapy

  1. Manual Lymph Drainage (MLD): Ideally, patients receive Dr Vodder’s Manual Lymph Drainage daily to move excess fluid and protein.  MLD increases lymphangion activity and moves fluid from a compromised area to an area where lymph nodes are plentiful and lymph vessels are working properly.
  2. Compression Therapy:  Bandaging of the affected limb follows each MLD session.  This is a specialized procedure using a specific type of bandage and interfacing material.  This helps to maintain volume reduction until the next MLD treatment is performed.
  3. Remedial Exercises with Breathing:  Gentle movement against the resistance of the bandages further promotes venous and lymphatic flow by activating auxiliary muscle and joint pumps.  Diaphragmatic breathing takes advantage of a pressure differential in the thoracic region to help move lymph through a deep central vessel.
  4. Skin Care and Hygiene: Conscientious skin cleansing with antibacterial washes and neutral balanced ph lotions will help to eliminate bacterial and fungal growth and minimize the possibility of repeated bouts of cellulitis and/or lymphangitis.

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After intensive daily CDT has been completed, the patient is responsible for continuing exercises, breathing techniques and self-care, including MLD.  A correctly fitted compression sleeve or stocking must be worn on a daily basis.  In lieu of a night garment, self bandaging can be done every night before bed.  It is advisable to have a check up once a month after  treatment has ended, as well as 6 months later to assess progress.  Garments should be replaced every 3-6 months since they lose their elasticity over time. 


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