A Day in the Life of a Certified Lymphedema Therapist
We are thrilled to feature a day in the life of Sarah Johnson, OTR/L as a Certified Lymphedema Therapist. Sarah previously shared her day in the life when she was an OT student and is now giving us the ins and outs of working as a CLT. We want to give her a huge thanks for sharing her knowledge and experience!
For any OT students or current occupational therapists out there wondering if lymphedema therapy is for them, I would like to take you along with me on a typical day in the life as a Certified Lymphedema Therapist (CLT).
I would like to start with how I became a CLT. I have done OT student rotations and worked in a variety of settings where I encountered many patients who were dealing with acute, sub-acute, or chronic swelling due to various reasons. In OT school there is so much to learn, that treatment for edema and swelling is one of those topics that is not taught for very long.
Most of what I learned about lymphedema related to the basics such as completing retrograde massage, elevating, icing, and wearing a simple compression garment, and that was about it.
However, there is so much more to learn about swelling, the lymphatic system, and treatment options for decreasing swelling and long term management of lymphedema. Treating edema can help a patient feel so much better, move better, thus helping other outcomes related to strength and range of motion. Additionally, it makes them feel so much more confident in their appearance and mobility.
My Morning Routine + Tips I’ve Learned
I clock into work and review my schedule and cases for the day. I work in a few different settings, so depending on where I am working depends if I am treating solely lymphedema and edema related cases or cases that incorporate traditional occupational therapy goals and treatments.
Even if I have been seeing a patient with lymphedema or an edema related condition for a while, I still review my notes for what their measurements were from the previous session such as pain levels, functional impact, pitting levels, and notes regarding skin condition, such as color, temperature, tension, and integrity.
In the morning, I also check my emails before I start seeing patients to see if there is an update from nursing regarding the patients I am seeing or if they have a schedule conflict that day and I need to reschedule them.
If I have an evaluation on my schedule for a lymphedema case or edema related condition, I review the physician order, patient’s past medical history, and any hospital or office visit notes that are available and try to start to understand why they have developed swelling.
I typically try to see patients in the morning back to back until lunch time. I mentioned that I do work in a few different settings. In the assisted living facility (ALF) setting, I typically go to a patient’s room to remind them of therapy and bring them down to the therapy gym. In the therapy gym at the ALF and outpatient setting I work at, I have a treatment table or mat that I typically will have patients on if I am doing manual lymphatic drainage on the patient or compression bandaging.
There are some situations where I will need to do a modified position during manual lymph drainage if the patient does not tolerate lying in supine. If I do treatment in the patient’s home space or apartment, I will make the best of the resources I have. If I do manual lymph drainage on a patient, I may do this in their bed or in their recliner and have the patient recline their legs.
I always try to bring a chair or stool with me for a manual lymph drainage session and bandaging to maintain good ergonomic positioning and to avoid back pain for myself. This is something as a young therapist right out of school I took for granted but it definitely catches up with you quickly so take care of your body from the start!
I have mentioned that I do manual lymphatic drainage and compression bandaging if indicated during treatments but I wanted to go over other typical treatment options I do with patients. I do A LOT of patient education. Education can be in regards to nutrition, exercise, activity choices, positioning, skin care, infection prevention, and education regarding compression garments.
Education regarding choices for compression garments has been one of the most challenging things I have come across as a CLT. There are SO MANY compression garment choices out there, especially for the lower extremities. Having so many choices can be a great thing but can also make things complicated. Having so many options can be difficult to sift through with the patient and their family and also makes pricing difficult because there are so many options out there.
This is something I am continuing to learn more about as I grow as a CLT. Talking with a local sales representative from a compression garment company can be helpful as they can talk through their brand choices and can provide garment examples which can be more helpful than looking at pictures online with patients and their families.
Over the lunch hour, I try to give myself a short mental break, but then a lot of the time is spent catching up on things such as emails and documentation. I have found if I work straight through lunch, it can save time at the end of the day, but I may have less energy in the afternoon during treatment sessions with patients.
My afternoons look pretty similar to the mornings. I go right into treatments and evaluations after lunch. I try to do most of my compression wrappings in the morning to allow for more time for them to be worn by the patient throughout the day, however if I see someone in an outpatient setting, I may have to do wrappings at the end of the day if someone is coming to the clinic right after they get off of work.
Getting towards the end of the day I may take care of some last minute items such as taking inventory of supplies and requesting to order more supplies that we are low on or researching resources that I discussed with my patient earlier that day to be prepared for their next session.
Some of these recommendations may be stores online or in the area that sell lymphedema specific apparel and shoes, researching names and brands of compression garments, pumps, lotions, or local and online DME suppliers.
End of the Day
At the end of my day, I will check the room and treatment space I have been working in and clean it up, put away dirty laundry, and organize and put away supplies.
I will try to finish the day with finishing all or most of my documentation. I put off documentation that takes longer to do such as an evaluation, updated plan of care, progress note, or discharge until the end of the day as these are hard to finish completely with the patient. Lastly, I will make sure all my billing charges have been entered for the day, peak at what my schedule looks like the following day, then lastly, clock out for the day.
If you are a Certified Lymphedema Therapist or thinking about becoming one, let me know what you think of this article. How does your typical day look? I really hope this insight into my day helps someone out there have a better look at what being a CLT is like!
Check out our Day in the Life Series