Lymphedema Therapy with Emilia Dewi, OTR/L, CLT

Do you know whaat lymphedema is? Did you know that as an occupational therapist, you can specialize in lymphedema therapy? Today, Emilia Dewi, answers all the questions about why she chose to become certified in lymphedema therapy, what a typical day looks like for her, and how to become certified in lymphedema therapy!

First of all, lymphedema is swelling, usually in the arms and/or legs, caused by the build-up of lymphatic fluid in the body. The lymphatic system is essentially a drainage system that carries lymph fluid and cells to help fight infections throughout your entire body. When there is a blockage in the system, damage and/or removal of lymph nodes (such as in cancer treatment), or any disease, surgery or medical treatment (such as radiation) that impacts the lymph vessels, this can cause a build-up of fluid, and thus swelling in one or more appendages.

This swelling can impact many areas of functioning, including slower wound healing, stiffness or soreness in the affected limb, higher risk of infection in the swollen area, and can cause discomfort physically and emotionally to the individual impacted. All of these impacts can lead to a decrease in participation of ADLs, IADLs and other meaningful occupations for our clients.

A CLT course will include topics like anatomy and physiology, techniques in manual lymph drainage (MLD) and complete decongestive therapy (CDT), treatment of lymphedema and related conditions, pediatric lymphedema, bandaging techniques, exercises, measuring techniques, compression garment measuring, home maintenance and self-treatment, skin and nail care, indications and contraindications for treatment, and medical billing for lymphedema management.

Links:

CDC Lymphedema Info

Lymphatic Network: List of qualified training schools

Academy of Lymphatic Studies

Norton School of Lymphatic Therapy

OT’s Role with Breast Cancer Rehabilitation

AOTA Comments on Lymphedema for Meeting the Medicare Evidence Development and Coverage Advisory Committee on Nov. 18, 2009 – Role of OT in Lymphedema Treatment

Total Estimated Time to Complete Certification (depends on course/certification you choose): 135 hours

Total Estimated Cost (depends on course/certification you choose): +/-$3200


Emilia Dewi, OTR/L, CLT attended OT school at USC in Los Angeles, California and graduated in 2009. She completed her OTD in 2010, though she started practicing in November of 2009. She currently works in a hospital outpatient therapy clinic with clients who primary have neurological conditions, cancer, lymphedema, and multi-trauma injuries. Emilia is originally from Indonesia and has been in the US since starting college in 2003. Emilia loves food and enjoys eating her way around new cities. She also loves to travel but did not start until she started working full time as an OT – initially only going back to Indonesia to visit family, but then started traveling to other nations in 2014. Since that time, she has visited 14 countries and would like to add more to her list, once COVID is over.

Why did you choose OT?

I chose OT for several reasons – I was a psychology major in college and was on the research path. While I was working as a research assistant at UALR dunking people’s feet in water to see if the cold affect their p-wave, I realized that I wanted to impact people’s lives more directly. So my friend who’s an SLP actually recommended that I looked into OT. The rest is history. My father had a stroke in 1999 – so going to neuro-rehab is also a given in some ways…

Why and when did you choose to become certified in lymphedema therapy?

I was exposed to lymphedema therapy in 2009 during my level 2 rotation. My CI is a CLT and she showed me the “magic” of lymphedema management. It was fascinating to me how effective the treatment can be for the patients. My OTD project was to establish a preliminary program for breast cancer prehabilitation for our OT department. I actually thought I left that behind in 2010 since I moved away to Texas for my first work in an acute care hospital. However, when my current employer decided to expand our OT services with lymphedema therapy, I thought it was a sign and I went to get certified.

What settings have you worked in? Do you have a favorite, and why?

I’ve worked in acute care hospitals (4 different ones), inpatient rehab (PRN work), and outpatient (1 clinic). My favorite is outpatient (naturally I’ve been an outpatient OT for 8.5 years now). I think I like it most because I get to see a wide variety of clients in the OP settings and we can really focus on intervention that they’re interested in since they’re medically more stable by the time they see us.

What does a typical day with clients look like for you?

I am serving in different roles now, so out of 40 hours work week, I only see 16 patients/week. On my longer days, I see about 6-7 patients back to back. We have 55 mins with each client (one-on-one), which is lovely. Although a majority of my clients have lymphedema, I also still see patients who have neurological conditions. I would spend 30 mins at lunch to do my morning documentation, and then spend about 30 mins to 1 hour at the end of the day to document as well. In outpatient, we do a few different types of documentation – daily notes, monthly summary, discharge summary, evaluation, script for DME. We also communicate to pt’s family and doctors on a regular basis, as well as count/monitor the # visits approved/#visits used to make sure we’re in compliance. I’ll answer emails and questions throughout the day and when I have cancellations.

How do you stay client-centered and occupation-based in your practice?

Client centered in OP setting is easier I guess – they come to us on their own accord. So a lot of what we do in OP is to empower them to do what’s beneficial for their health. We also often become the client-advocate to make sure they get their equipment, their therapy visits, and connect them with other health care practitioners since it’s difficult for them to understand what’s going on medically once they’re out of the hospital.

Occupation-based with lymphedema management – I think this will look so different from what we consider occupation based. Lymphedema management is all about self-care – taking care of your lymphedema on a daily basis because it’s chronic and progressive. So all the skills that we are performing for our patients – manual lymphatic drainage, compression bandaging/therapy, skin care, and education for lifestyle management – are all life-skills that they need to learn to manage their lymphedema once they leave us.

How often do you use the skills you learned from acquiring this certification in your practice?

Almost 80% of my caseload is lymphedema. I also lead the cancer core group now so I also use my knowledge to mentor others, problem solve cases, and discuss with others.

What are the steps to acquiring the credentials? Is there a renewal process?

Lymphedema Certification Course – The certification process is quite lengthy and expensive =). Currently, to be considered a proper certification course, the students will complete 135 hours of intermediate-level education. They will complete about 45 hours of home study, followed by 90 hours of hands-on instructions and live lecture.

When I went to my course, I flew to Salt Lake City and stayed there for 10 days. For 9 days, I went to class from 8-6 or 8-7 – lectures in the morning and hands-on practicum on how to do manual lymphatic drainage and bandaging in the afternoon. We were tested on our knowledge breadth as well as hands-on skills. If we don’t pass the test, we will have to repeat the process all over again (aka get retested in another certification course, in another city possibly as the course happens all over the US).

There is currently no official renewal requirement; but it’s recommended that you take a refresher course every 5 years (14 hours online based course).

Do you get paid more for having this certification?

Not directly – but having this certification has allowed me to be a go-to person for this particular diagnosis, as well as has helped the company to develop a program to widen their reach. So I did use this as an accomplishment for my yearly performance review and it has helped me getting ahead in my career ladder.

Can you name the various settings that a CLT can practice?

Mostly outpatient, but there are CLTs who practiced in acute care, inpatient, and home health settings. Home health is definitely needed as a lot of our patients are not able to walk/get out of the house, but I don’t think it’s as readily available because of many reasons (some of the reasons may be lack of PT/OT/PTA/OTA who have the qualifications, lack of reimbursement and coverage).

Do you believe the credentials are worth it? (Could you work in the setting you do now without the credentials? Is it worth the money and time?)

Definitely. The Lymphatic system is one of the most fascinating, important systems of the human body that is very under-studied. I think we will see an expansion of knowledge and understanding in this area in the future. But I do think you have to count the cost when you are pursuing this certification because it is expensive and time-consuming.

Do you have any other OT interests that you would like to pursue? (other certifications, a specialty area you want to work in, etc.)

My other certification/specialty areas that I’ve worked on are NeuroIFRAH certification, Myofascial Release (John Barnes), head and neck lymphedema, and cancer rehabilitation. I think I’d like to pursue more understanding in pelvic rehabilitation (as 1/3 of our lymph nodes are in the abdominal/pelvis region). If I can, I also would like to get some advanced certification in NeuroIFRAH.

Do you have any words of advice for someone wanting to pursue the CLT credential?

I would observe in a local clinic to see what lymphedema management really includes. It is an amazing specialty area, but may not be for everyone. The certification costs between $2500-3150 and you’ll need days to study. It’s even better if you can get support from your company.

Another great way to learn more is to attend free webinars that are available right now. If you want more information, you can contact me at emilia@thelymphtherapist.com and I can provide you with information on that =)


List of Resources from Emilia:

My website (still under construction): http://www.thelymphtherapist.com

My instagram: @the_lymph_therapist

Website for certification information:

https://lymphaticnetwork.org/living-with-lymphedema/find-a-lymphedema-therapist – this one has a link to some of the accredited CLT program

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