Medicare Therapy for Lymphedema
Medicare therapy cover.
Until recently, Medicare did not cover all the costs involved in lymphedema therapy. It has been an uphill task for lymphedema patients trying to get the benefits of Medicare. Women’s Health and Cancer Rights Act directs that insurance companies must provide coverage for the complications resulting from breast cancer surgery, including lymphedema. But other types of secondary lymphedema and primary lymphedema have not been accorded the same status of a complete coverage. However, in February 2008, compression garments used in the therapy to treat lymphedema were defined as covered items.
Lymphedema is an ailment that has no surgical or medical cure, but can only be managed with the help of Complete Decongestive Therapy (CDT). The therapy consists of manual lymph drainage, compression bandages, compression garments, exercises and some skin care routine so as to manage the debilitating condition of lymphedema. The mainstay of lymphedema treatment is manual lymphatic drainage that helps to drain the fluids and reduce the swelling. The lymph drainage is carried out through manual lymph drainage (MLD) therapy or sometimes the sequential gradient pump is used. A therapist specifically trained to perform the massage will conduct MLD on the affected limb of the patient. These therapy sessions may be held at least five times a week in the initial stages of therapy. People who have no access to a therapist can make use of the Sequential Gradient Pump for lymphedema treatment.
Medicare coverage for lymphedema pump therapy has been modified recently. Earlier on, although pneumatic compression pumps were covered, the patient had to try all other treatments first. This process took more than a few months. However, this policy has now been modified and lymphedema patients can use it to their advantage. Compression pumps are covered as a treatment device under durable medical equipment for primary as well as secondary lymphedema. But the doctor must monitor the patient for a 4 week trial period of medication, compression garment therapy and limb elevation. If there is no improvement, then a pump can be considered with the doctor’s prescription. The doctor will provide a Certificate of Medical Necessity so that the patient can procure the pump from a supplier enrolled with Medicare. Medicare will not pay for the claim if the compression pump is procured from a supplier who does not have the Medicare supplier number.
With the issue of compression garments however, lymphedema patients have had to contend with legislatures that prevented them from being included in the Medicare coverage lists. However, due to a positive ruling in February 2008, compression garments were defined as meeting the standards of covered items. Compression bandages, stockings and sleeves were deemed medically essential and could be covered under Medicare for lymphedema therapy, as prosthetic devices. The good news is that patients can now obtain a reimbursement for these essential items of their lymphedema management therapy.
Return from Medicare Therapy for Lymphedema to Homepage
Medicare Physical Therapy
Medicare physical therapy cover.
Medicare benefits provided in part B includes payments made to occupational and physical therapists for physical therapy. Beneficiaries of Part B pay a monthly premium to be covered under part B which helps to pay for doctor’s bills and outpatient hospital care, which are some types of medical expenses that are not covered by Part A of Medicare. Physical and occupational therapy is becoming a standard treatment for many disorders related to the physical aspects of the body. There are different forms of healing available to treat conditions that are incurable. Physical therapy includes massages and special exercises to manage or control these incurable ailments.
Our body is prone to ailments of the bones and muscles which are often not curable. Apart from medication, these can only be managed with therapy. For instance, persons suffering from stroke have limited mobility and may require physical therapy to restore the mobility in the limbs. Another ailment that is treated by physical therapists is paralysis. Often, patients who have undergone knee replacement or hip replacement surgery may also need post operative care in the form of physical therapy.
In case a patient requires physical therapy, the physician must prescribe for it and also continue to monitor the need to continue it. Medicare covers physical therapy; it will cover only part of the expenses, usually eighty percent of the cost, with a certain limit or cap per year. These limits are followed irrespective of the fact of whether the treatment is medically essential or not. Occupational therapy helps people who have lost their mobility due to serious illnesses. It teaches the patients safe ways to conduct everyday activities like walking or lifting things. Medicare considers occupational therapy different from physical therapy so each of them has its own separate yearly limits for reimbursement.
In 2006, legislation was introduced to implement therapy caps but the Centers for Medicare and Medicaid Services (CMS) were allowed to use an exceptions process to recognize and permit medically necessary therapy. This was allowed for physical therapy, occupational therapy and speech language pathology services provided they meet the specific diagnostic criteria. The exceptions process was authorized till Dec 2009. Efforts are now being made to do away with a provision of the Balanced Budget Act that places a yearly financial limit on medically necessary therapies, with a view to ensure Medicare access to the patients.
The American Physical Therapy Association (APTA) works towards making Medicare benefits accessible to patients who require physical therapy. However, the Association believes that physical therapy should only be provided by qualified professionals. APTA wholly supports the qualification standards set by Medicare for physical therapists. Patients for whom physical therapy is medically essential are generally covered by Medicare Part-B, although they may have to contend with certain yearly limits for the reimbursement. Efforts are on from different quarters to bring various kinds of essential medical expenses within the ambit of Medicare.
Manual Lymph Drainage Therapy for Lymphedema
The Manual Lymph Drainage therapy (MLD) is a massage therapy that was developed by Dr. Emil Vodder in the 1930’s to treat sinusitis and other immune disorders. It is now being used as a primary tool for the management of lymphedema. MLD is a gentle massage to encourage the circulation of the lymph within the body. The rhythmic massage stimulates the lymph nodes to open and drain the lymphatic fluids and thus carry away the waste products in the body for excretion. MLD is a non-invasive technique used to activate the damaged lymphatic system and improve its transportation capacity.
Lymphedema is a condition caused due to the pooling of lymphatic fluids on account of the malfunctioning of the lymphatic system as a result of surgery or trauma. The condition has no cure but it can be managed with a therapy known as Complete Decongestive Therapy. This consists of manual lymph drainage, compressive bandaging and use of compression garments, a skin care regimen and therapeutic exercises. MLD is the first step in this treatment process where a certified therapist will perform the massage on the patient. A typical session lasts about 40 to 60 minutes where the therapist will massage the neck, the trunk and the affected arm or leg so that the lymph is stimulated and moves towards the blood circulatory system. The excess fluids are filtered and eliminated through the excretory system.
In order to understand how the manual lymph drainage therapy works to control lymphedema, it is important to understand the lymphatic system and its role in the functioning of the body. The lymphatic system transports nutrients to the cells and eliminates waste matter, toxins and extra fluids from the body. It also regulates the immune system which helps to protect the body from infection. If there is an obstruction in the lymphatic flow, the fluid will pool up and cause a swelling in one area of the body. In MLD, the therapist’s massage strokes induce the lymphatic fluids to move to the lymph vessels and on towards the trunk. This movement helps to clear the pooled fluids, break up the fibrotic tissues, and promote the removal of toxic waste, thus restoring the normal functions of the body.
During the initial stages of the treatment, the patient has to visit the lymphedema therapist at least five times a week. As the treatment progresses, the visits to the therapist are tapered off. Instead, the patient is taught the technique so that he or she can perform self- massage to manage the lymphedema. The patient must learn the technique well and must perform the therapy as directed in order to manage the condition. Generally, oils and lotions are not used in this therapy, but if the skin is extremely dry, some lotion may be used to soften it. If you have a fever or an infection, the self massage may be skipped till the problem is cleared up. Patients who undergo MLD should drink plenty of water. This is because the excess fluids moved will be processed by the kidneys to be eliminated along with the waste products through urination.
The manual lymph drainage therapy should only be performed by a trained therapist who is well versed with lymphedema and its requirements. It is highly effective in patients who have first stage lymphedema where the tissues are less fibrotic rather than in cases where the patient has severe fibrotic tissues. However, if the treatment is started right from the initial stages, MLD can prove to be very useful in reducing the swelling, which can then be maintained with the help of compression bandaging and compression garments.
Return from Manual Lymph Drainage Therapy to Homepage
Lymphoedema UK
Lymphoedema UK and support networks.
The countless lymphoedema patients in the UK rely on a network of support groups that provide help and information about lymphedema. Often people diagnosed with lymphoedema may find it greatly distressing to deal with the growing realization that this condition is incurable. They usually do not have links with other patients suffering from the same condition and hence may feel isolated. Until recently, there was lack of medical information and recognition for this disease as well. In such situations, membership of a support group can help reduce the isolation and enable patients to share their experiences with others.
The Lymphoedema Support Network (LSN) is a charitable organization that was set up in 1991 in UK to provide information and support to patients with lymphedema. The organization was meant to help patients with advice and support and to increase the awareness about lymphoedema. It works towards obtaining better resources for lymphedema treatment in United Kingdom and tries to maintain contact with other healthcare professionals that work in this field. LSN promotes a network of lymphedema support groups throughout Britain.
Over the years since its inception, LSN has been helping patients with information fact sheets. The high standard of information provided by the LSN has prompted healthcare professionals to use these fact-sheets in hospitals and clinics treating lymphoedema in UK. Being a patient-led organization at the national level, LSN has a unique understanding of the condition from the patient’s point of view. Self-help videos produced for patients are being used as a teaching aid for healthcare professionals. LSN maintains a website and a support telephone line for patients in addition to producing a quarterly newsletter. It promotes the formation of self-help support groups and campaigns for improved healthcare at the national level for lymphedema sufferers.
LSN closely works with the British Lymphology Society (BLS) which is an organization for health professionals involved in the field of lymphedema management at the national level. The British Lymphology Society members consist of health care professionals who work directly with lymphoedema patients. The Society promotes awareness about lymphedema among the public as well as the relevant departments in the Department of Health in UK. BLS aims to re-evaluate the current guidelines for long term management and lymphoedema treatment. BLS tries to help reflect patient’s views in relation to the development of health care for lymphedema sufferers. It also encourages research in the field of lymphedema to find newer methods of treatment for patients suffering from chronic edema with lymphatic deficiency.
Members of lymphoedema support groups in UK receive newsletters and information on how to cope with lymphedema. Information is provided with respect to numerous issues relevant to the condition like coping with infections, swelling and manual lymph drainage. Membership in a support group helps to interact with people who understand the situation. Members find that in sharing their experiences with others with similar conditions helps to lessen their feelings of isolation.
Return from Lymphoedema UK to Homepage
Lymphedema Treatment: An Overview
Lymphedema treatment involves a therapy known as Complete Decongestive Therapy. This consists of draining of the fluids through a massage, compression bandaging, exercise and skin care. The main aim of this therapy is to remove the stagnated proteins and fluids and to restore the circulation of the lymph. The treatment should begin at the early stages, because mild lymphedema is often reversible. This treatment therapy is time consuming, uncomfortable and inconvenient but the only one which can help to control the condition.
Hygiene is essential to remove the bacteria and debris collecting on the skin surface. A regular inspection of the skin helps to spot open wounds or cellulitis that is developing. Cleansing of the skin is very important to prevent infections. However, even with the best of skin care some lymphedema patients may encounter recurring bouts of cellulitis. These have to be treated at the earliest possible opportunity to avoid sepsis and further complications. It is a good practice for lymphedema sufferers to keep their weight under control as it helps to manage the condition much easily. Patients should avoid tight clothing or jewelry so that it does not have a constricting effect. Another precaution that must be taken is to avoid any injury, even a minor one. If at all there is a cut or bruise, it should be treated immediately before it gets infected.
Using compression garments is an integral part of lymphedema treatment; patients are required to wear them at all times during the day. The garment may be removed at night but the affected limb must be kept at an elevated position to promote the circulation. Compression garments must fit properly to afford the best compression. An ill-fitting garment, besides being uncomfortable for the patient, will be completely useless in exerting the pressure required to keep the swelling down. Exercises as instructed by the therapist are essential to keep the lymphatic fluids in circulation. Exercising in general, promotes the ‘feel-good’ factor that aids in the healing of the body.
Surgery is not recommended as a treatment method for lymphedema. However, for patients who are suffering from severe lymphedema that impairs daily activity or does not respond to the conventional methods of treatment, surgery may be an option. In such cases, surgery may be performed to reduce the volume of the affected limb so as to improve the functionality and facilitate the normal treatment methods. Surgical techniques involve the removal of the tissue build up or surgical intervention to improve the lymphatic drainage.
Alternative methods of lymphedema treatment are gaining popularity as people try to find new ways of managing this ailment. The use of some herbs is said to improve lymphatic flow and reduce inflammation. Some patients turn to homeopathy in the hope of finding relief from the condition. Acupuncture, liposuction, magnetic therapy, light beam generator therapy, Kinesiology and laser treatment are some of the alternatives that may be used by patients in a quest to find a cure for lymphedema.
Return from Lymphedema Treatment to Homepage
Everything about Lymphedema Therapy
Lymphedema therapy aims to control and manage lymphedema, as this is a condition for which no cure has been found yet. The best tool for management of lymphedema is the Complete Decongestive Therapy (CDT). Manual lymph drainage is the basis for this therapy which also includes the process of compression bandaging, exercise, use of compression garments and skin care. The technique itself was developed in 1930 by Emil Vodder. Today, there are various techniques being used for treating lymphedema but manual lymph drainage is considered to be the gold standard for the treatment.
A lymphedema patient is required to make frequent visits to a therapist who is trained in the art of lymphatic massage. The lymphatic ducts are manually manipulated around the blocked areas so that the excess fluids are drained into the venous system and are passed on for elimination. Unlike a regular massage, this is a gentle rhythmic massaging of the skin to stimulate the fluids. The lymphedema therapist will begin the massage to drain the neck region, the trunk and finally the affected extremity. This is to ensure that the pathways are clear to accept the excess fluids that will be moved from the swollen limb towards the trunk region.
There are numerous centers offering lymphedema therapy and they are usually staffed by trained professionals who specialize in lymphatic massage. LANA certified therapists are usually very competent to handle the massage therapy and often, patients experience good results. Most of the larger hospitals offer manual lymph drainage facilities. It is preferable not to travel long distances for the massage therapy, so patients need to find a center close to their residence. In order to plan the course of treatment, the therapist will first evaluate the patient’s medical history, range of motion and integrity of the skin besides taking circumferential measurement of the affected limb. Based on these factors, an individualized treatment plan is created to address the needs of the patient.
A typical plan for lymphedema treatment would include manual lymphatic massage to reduce the swelling and compression bandaging to maintain the reduction in swelling between the massage sessions. Sometimes the sequential gradient pump might be used to assist in the drainage of fluids. All treatment plans include patient education in self management of the condition along with guidance in skin care measures, instructions on special exercises as well as general care and precautions to be taken.
Lymphedema therapy training courses are open to doctors, nurses and physical therapists. The training program lasts for about two weeks and offers more than 130 hours of hands-on training and instructions. The massage technique and compression bandaging therapy is the main part of training. Specific exercises are also taught along with skin care measures to be taken by the lymphedema patients. Those who wish to train as lymphedema therapists must have a thorough understanding of the anatomy as well as the physiology and role of the lymphatic system in the body.
Return from Lymphedema Therapy to Homepage
Lymphedema Sleeve
For those suffering from a lymphedema arm, the lymphedema sleeve is of utmost importance. A diagnosis of lymphedema comes as a great shock as many people are often unaware of the existence of such a condition. The fact that lymphedema is an incurable condition and that it can only be controlled with therapy is another factor that causes great distress to patients. Although there are several options for treatment, using compression garments is an effective way to provide the compression required for the affected limb.
Wearing the compression garment daily is of vital importance for people with lymphedema. The garments can exert a specific amount of pressure on the limb which helps to prevent the fluid buildup in the affected limb. Compression sleeves are made up of tight stretchable fabric and can be worn on the arms, legs, or hands. The fitting of the sleeve must be carried out by an expert so that it fits the patient properly to exert the essential pressure on the limb. A loose sleeve will not be of any use for compression and instead may cause irritation to the skin. Sometimes, the compression sleeve may have to be custom made to fit the particular extremity, but usually the patients find a suitable garment that is readily available.
Lymphedema sleeves do not pump out excess fluid in the limb, but prevent the fluid from accumulating. Therefore, compression garments are mostly used after the lymphatic massage to maintain the reduction of the edema. Often, the patient may require more than one sleeve, as the size of the limb changes as a result of the therapy. A specific amount of compression is needed for the garment to be effective enough to prevent the fluid from accumulating. With continuous use and regular washing, the compression garment will lose its effectiveness over time and may need to be replaced. Since a compression garment is required for daily wear, it is practical to have a pair of sleeves so that they can be alternated with each other.
In order to be fitted with a compression sleeve, the doctor’s prescription is required. The doctor will prescribe the garment for the particular arm or leg along with the compression level required. A medical justification might also be required from your doctor, if your insurance plan allows for reimbursement of the expense. This could be an ongoing requirement as you may need to replace your compression garment at least once in six months, so your doctor should be apprised of this.
The cost of lymphedema sleeves may vary and usually the custom- made ones are more expensive than the ones available over the counter. Although Medicare does not reimburse these expenses, it might be a good idea to get a medical insurance plan that does. However, a recent ruling has deemed compression garments to be included as prosthetics, which are covered under Medicare. Compression garments may be procured from a store selling durable medical equipment or can even be purchased at one of the online stores.
Return from Lymphedema Sleeve to Homepage
Difference Between the Traditional Massage and Lymphedema Massage Therapy
There are some basic differences between a traditional massage and a lymphedema massage. Lymphedema is the swelling of a part of the body due to retention of lymphatic fluids. The condition is treated with Complete Decongestive Therapy which includes a form of massage known as the manual lymph drainage. This method of treatment is said to give excellent results and therefore it is considered to be the standard treatment for lymphedema.
Since lymphedema is the result of accumulation of a protein-rich fluid in the issues, the control of the condition involves stimulation of these fluids to drain into the venous system. The Manual Lymph Drainage (MLD) is a procedure wherein the lymph vessels are activated to move the stagnated interstitial fluid. The MLD technique uses very little pressure on the skin so as not to increase the blood flow. However, in case of a traditional massage, special strokes are used to increase blood circulation. The traditional massage aims at loosening the stressed ligaments, muscles and tendons that are deeper into the tissues. Therefore, the massage strokes are applied with pressure so as to affect the deeper tissues.
With lymphedema, the lymphatic system is impaired and is unable to drain the protein-rich fluids because its transportation capacity has fallen below the level of fluid volume produced by the body. In other words, the lymphatic system is not working properly to remove the fluids and proteins from the affected part. A traditional massage will cause hyperemia or an increase in blood flow in the massaged area. This will also increase the water accumulation in the tissues requiring the lymphatic system to remove some of this excess fluid. In lymphedema patients, with the lymphatic system already weakened, it will not be able to handle this additional load of water and a swelling may result. So a traditional massage will actually have negative effects unlike the lymphedema massage which tries to move out excess fluids.
Manual lymph drainage therapy utilizes a gentle, specialized massage technique to stimulate fluids. With this massage, there is no damage to the lymphatic structures situated just under the skin. It is a relaxing massage that helps to reduce the swelling and provide relief to the patient. MLD is a non-invasive and painless procedure that shows excellent results in breaking up fibrotic tissues in severe cases as well. MLD is the first phase of CDT, after which compression bandages are applied. The patient has to follow a regular exercise regimen to keep the body flexible and to promote circulation of lymph.
The lymphedema massage must be performed by a trained therapist who has undergone an additional training in Complete Decongestive Therapy which includes MLD. These therapists are also trained in compression bandaging, since there is a special method to apply a compression bandage for a lymphedema patient. The therapist also helps in fitting the compression garments which the patients are required to wear daily as a preventive measure to keep the swelling under control. Lymphedema patients are taught special exercise and skin care measures so that they are able to manage the condition at home, after the therapy sessions are completed.
Return from Lymphedema Massage to Hoempage
Lymphedema Infection and Treatment
For people suffering from lymphedema infection is the major cause for frequent visits to the hospital or medical emergencies that need prompt attention. In a normal person, a thin layer of the skin known as the acid mantle protects the body and prevents bacteria from entering. However, in case of a lymphedema patient, this protective covering is weakened, making it very easy for bacteria to enter. Additionally, the immune system is also weak and thus unable to fight off the bacterial infection, rendering the patient prone to repeated bouts of infection.
The most common form of infection that a lymphedema patient may develop is cellulitis, which can be a major complication requiring hospitalization. The bacteria cause an infection in the swollen skin tissues and may attack the lymph vessels or travel through the lymphatic system and enter the blood stream. The protein-rich accumulated fluid in the swollen limb forms a rich culture for the bacteria to multiply and spread into the body. The clinical signs of the infections will appear as red streaks on the skin and the area will feel warm to the touch. The swelling as well as pain may increase. The patient may run a fever with chills or show flu-like symptoms. Sometimes, the lymph nodes may become enlarged as they fight against the infection.
Any signs of infection in lymphedema sufferers should not be taken lightly and prompt treatment should be started. Patients at risk of lymphedema should be alert to these clues which show that the lymphedema is developing even though they have not yet been diagnosed for the ailment. In such situations, if the treatment is delayed, the issue will become serious and the complications may be very difficult to treat. Patients may have to be hospitalized for administering antibiotics intravenously.
Treatment for infection is usually a course of antibiotics. Any manual lymph drainage therapy and compression bandaging must be stopped till the infection is cured. This may take about 3 to 8 days to clear, depending on the severity of the infection. Fungal infections are difficult to diagnose as the symptoms are present very deep in the tissues. Fungal infections may be mild and resolve without the use of antibiotics.
People who are at risk of lymphedema must take adequate precautions to protect themselves. Minor nicks, cuts and bruises can be treated with the appropriate first aid, so as to prevent it from getting infected. In case of itchy rash, it is advisable to apply an anti-itch cream to the affected area. Bruises, insect bites and burns are other causes for infection and must be treated immediately. If the problem is not resolved with first-aid, it is advisable to consult the doctor. Since lymphedema patients are easily prone to infection, it might be a good practice to carry some antibiotics or at least a prescription for them while travelling.
Return from Lymphedema Infection to Homepage
Choosing a Lymphedema Doctor
Even though lymphedema has no cure, it can be managed and so you need to talk with your primary doctor to formulate your treatment plan. In case of lymphedema, it is very essential to have a lymphedema doctor with whom you are comfortable with. The standard and most accepted form of treating lymphedema is Complete Decongestive Therapy (CDT). It involves a lymphatic massage for which you will need to visit a physical therapist specially trained in lymphedema massage. The other part of CDT is the compression bandaging and the exercises that the patient has to perform according to the instructions of the therapist.
Lymphedema is a complicated condition, basically involving the lymphatic system. And, since the lymphatic system is linked to all the other body functions, the slightest malfunctioning of the lymphatic system has a profound effect on all other systems, especially the immune system. Hence, lymphedema patients additionally suffer from various other ailments like bacterial infections and cellulitis. Weeping wounds may be an issue for severe lymphedema cases. Treatment is not only a single surgery or medication that can be prescribed by one doctor alone. Therefore, while selecting a doctor for treating lymphedema, all the other ailments need to be considered as well. You may actually need to choose a number of doctors depending on what your immediate treatment need is.
Secondary lymphedema is usually acquired by most patients who have been treated for cancer. In such cases, they already have an oncologist treating them. Other doctors who would be in a position to help are vascular surgeons, doctors treating infectious diseases, doctors treating wounds dermatologists, plastic surgeons and physiatrists. For example, a dermatologist can help with skin problems while the doctor for infectious diseases can treat a severe bout of cellulitis. A patient of lymphedema may require to select a ‘team of doctors’ comprising of various specialists. This team should ideally consist of the primary care doctor, a doctor to treat infectious diseases, an oncologist if cancer is involved, a wound doctor and a lymphedema therapist.
Generally, doctors that treat lymphedema are physical therapists who are specially trained to tackle lymphedema. They are also known as occupational therapists. The therapist, with the help of your medical history and case details, will proceed to evaluate your condition. Based on the extent of the swelling, the range of motion in the limb and skin condition, he or she will design a treatment plan suitable for you.
Physiatrists are medical doctors who are best suited to deal with lymphedema. A physiatrist will treat the ailment through physical therapy and aims to deal with the secondary effects of chronic ailments like cancer. The physiatrist will try to reduce the patient’s dependence by improving the functionality of the muscles and joints, which is usually a problem for those suffering with lymphedema. The physiatrist will attempt to reduce the swelling in the limbs, something which is very essential in managing lymphedema.
The best approach for managing lymphedema condition is to have a group of doctors that can help you with the symptoms and treat them effectively. However, it is essential that all the doctors coordinate with each other and work towards the treatment of the lymphedema patient, as a team. All this may appear to be a pretty daunting task, but you must make a choice, based on your own judgment and confidence. Simple rules can be followed in this regard, like understanding whether your primary doctor refers you to a certified therapist with experience in lymphedema management. Visiting the doctors and speaking to them will give you an idea about their experience in the field and also give you an insight about your comfort levels in dealing with them.
Return from Lymphedema Doctor to Homepage
