Imagine a situation like this one: a man has a severe venous ulcer on his leg that will not heal. He is scheduled to have his leg amputated. The day before the scheduled surgery, the man decides to try a relatively new treatment to see if it might save his leg.
He approaches a specially trained therapist and asks if the therapist will begin a series of treatments. The therapist agrees. The amputation is postponed until the effects of the treatments can be assessed. Then a wonderful thing happens. The therapist's treatments work, and the man does not need to have his leg amputated after all.
The therapist was using a treatment known as manual lymph drainage (MLD) therapy and combined decongestive therapy (CDT).
"This is a success story that happened to one of our therapists," says Robert Harris. He teaches MLD therapy at the Dr. Vodder School of North America. "As an educator, hearing the successes that our therapists have achieved is very rewarding."
Harris began his career as a trained massage therapist. Then, in 1984, he read about a highly effective new technique known as manual lymph drainage therapy. "I talked to people who had taken the training, and they spoke highly of it," says Harris.
"I liked it because it is scientifically based. My background is in biology and research, so this appealed to me."
Harris was able to take the first two classes in his city. But to complete his training, he attended the Vodder School in Austria for the third and fourth classes.
After finishing training, Harris operated his own clinic, working with health-care therapists such as chiropractors, massage therapists and others. "It's hard to describe a typical day, because every patient is different," he says.
Treatments always began with an assessment and the development of a treatment plan. Then, in addition to the manual massage, there could be compression bandaging, exercise therapy, skin care and a home management program.
Since many patients were referred by physicians, Harris's work also involved consultation with physicians and making reports on patient progress.
Harris notes that the work can be demanding both physically and emotionally. "Oftentimes, we are working with cancer patients and cancer survivors. They can be emotionally drained and we have to deal with their emotional state. It can be challenging physically. The work requires a lot of focus and dedication."
Eventually, Harris founded the Dr. Vodder School of North America. Today, as director, he and the other instructors at the school provide training in places across Canada, the U.S., Australia and New Zealand.
Harris advises that anyone interested in learning this technique should first seek undergraduate training in the health-care field in an area such as physical therapy, massage therapy, nursing, or occupational therapy. "And I recommend that you talk to some of the therapists before you choose to pursue this route. Get a picture of the type of work we do and what is involved."
"And when you are looking for an employer, look for one who provides a lot of continuing education," says Leslie Benson. She is a lymphatic therapist in Minneapolis.
Benson points out that this is a new therapy and there are always new things to be learned. "You must be committed to ongoing learning," she says. "It's important that your employer is supportive of this."
Benson has an undergraduate degree in art history, but she decided to make a career change. Since she liked helping people, liked problem solving, and liked using her hands, she decided to study occupational therapy.
In 1995, after six months of managing the occupational therapy department in a long-term care nursing home, Benson took a job working with lymphedema patients.
The hospital sent her for two weeks of training at Lerner's clinic in Princeton, New Jersey. About a year after taking training at the Lerner clinic, Benson decided she wanted to know more about lymphedema. She enrolled in the Dr. Vodder School of North America, taking four weeks of training spread out over a year.
Two years ago, Benson went into private practice. Typically, she sees four to five patients a day for one or two hours per patient. "Depending on the nature of their lymphedema, I do a protocol called combined decongestive therapy. This includes manual lymph drainage followed by short stretch compression bandaging."
She also teaches specific exercises and shows patients how to perform meticulous skin care to avoid infection.
It can be hard work. Patients needing intensive treatment must be seen at least five days a week. The treatments can take up to six or eight weeks. Benson is careful to maintain contact with other therapists to provide backup if she is sick.
She tries to protect her health by eating properly, exercising daily and pursuing healthy activities like yoga.
Benson is currently developing a workshop for patients, caregivers and spouses to help them deal with issues about living with a chronic illness.
For Benson, the most rewarding aspect of her work occurs when a patient starts to problem solve for themselves. Patients with lymphedema often present difficult problems with highly specialized solutions.
For example, the patient might be required to apply a compression bandage to their arm every night before going to bed. If the patient complains that the bandage is painful, then the challenge is to find out why it is painful and what can be done to remove the pain.
"This is a good field for people who enjoy problem solving and who want to use their creativity," said Benson. "It is not a good field for someone who wants to be told what to do and how to do it."
Linda O'Donnell operates her own practice in Albuquerque. She is also president of the North American Vodder Association of Lymphatic Therapies (NAVALT).
O'Donnell is a physical therapy assistant (PTA). She was working at a hospital when she heard about the Vodder therapy and its uses. Believing it would be a good asset to the hospital's rehabilitation program, she enrolled and completed her training in 1994. "Then we started a lymphatic program at the hospital," she says.
Afterwards, O'Donnell moved around a bit and started three lymphatic programs in different hospitals. She and her partner now operate their own private practice. Many of O'Donnell's patients are cancer survivors, and many are women. Their lymphedema is caused either by surgical removal of the lymph nodes or by radiation treatments.
The thing O'Donnell likes the most is seeing patients return to health after they have come through a horrendous medical experience. "The treatments are relaxing, gentle and soothing. We're giving them hope that they can return to a better quality of life. It is very positive."
Often, patients show improvement after only one or two sessions. "It is awesome what can happen," O'Donnell says.
For example, there was a woman with extremely swollen legs and feet. She had been debilitated for several years and could not walk. Her health had deteriorated because she was so inactive and she was very overweight. "There were hills and valleys," recalled O'Donnell. "But in the end, she lost over 100 pounds and was able to walk again."
But of course, not every patient gets well and that can be very stressful. "Sometimes the cancer returns and the patient dies. It's hard because we grow very close to the patients over the course of giving treatments. We learn about their lives."
If a person is interested in pursuing a medical career and loves to work with people, O'Donnell believes that MLD therapy would be a great choice. She points out that this is an area with no boundaries. "You can take it to a very high level if that is what you want."
Ian Soles is a massage therapist. He discovered that MLD training could bring him surprising opportunities. In March 2000, Soles provided one MLD treatment session to a woman with bilateral lymphedema (swelling in both the arms and chest).
The woman, who had recently had a double mastectomy for breast cancer, was scheduled to fly out the next morning to Cambodia. She and her husband were working with the Save the Children Fund in Africa, and the woman had returned to North America for cancer surgery.
"One treatment wasn't enough," said Soles. "She needed at least 10 sessions if it was to make a difference."
The best Soles could do was try to teach his patient how to deal with lymphedema in a hot, humid climate, and how to manage symptoms during her 30-hour flight.
Later, Soles and his patient communicated by e-mail. Her symptoms were worsening and no MLD therapy was available in Cambodia. Using the Internet, Soles attempted unsuccessfully to teach the family housekeeper how to do the massage and the bandaging.
A little later, Soles received an e-mail from his patient offering to bring him to Cambodia to provide the treatments. "I wouldn't have gone if she had been doing some other kind of work," says Soles. "But if she was forced to return...the work with Save the Children Fund would have been cancelled. I decided to go."
The treatments were successful and the woman is now doing very well. Since Soles taught her how to manage her lymphedema in the Cambodian climate and environment, she can continue to look after herself and manage her symptoms.
"Unfortunately, I got a parasite while I was away," said Soles. "I was hospitalized twice when I returned home. Still, it was an unbelievable trip and a very memorable incident."
Soles points out that working with MLD patients is different than dealing with someone who has tennis elbow or whiplash. Many MLD patients have recently been diagnosed with cancer, or they have just completed treatment for cancer, or they are receiving palliative care for terminal cancer.
"I work with many patients who are dying," says Soles. "I often have to go to the hospital or to the person's home. I deal with family members as well. A degree of maturity is called for in these situations."
If anyone is interested in this line of work, Soles recommends that after completing your required course of study, you work first in an established clinic with more experienced people before setting up your own practice. "It is possible to shorten someone's life if you do not recognize the signs of a cancer recurrence. Being around an experienced therapist would be a good thing.
"But it is a very exciting field. You can really make a difference in people's lives."