What to expect at your first lymphatic drainage appointment

A first lymphatic drainage appointment has four parts: a conversation about your history and what you want, a short assessment of the swollen area, the treatment itself, which is light, slow and done on a table, and a plan for follow up and home care. It takes 60 or 90 minutes, there is no pain involved, and there's no downtime afterward.

I'm Raegan Brumer, a Registered Massage Therapist and Licensed Practical Nurse, and I provide manual lymphatic drainage at my practice in Kensington, Calgary. This article walks through a first visit from the night before to the end of the appointment, so there are no surprises. If you want the background on what manual lymphatic drainage is first, start there.

What should I do before I arrive?

Not much, and that's the point.

Bring your paperwork. If you're coming after surgery, bring your post-operative instructions and anything your surgeon has said about lymphatic treatment, including whether they've cleared you for it. For anything post-operative or medically complex, that clearance comes before I put hands on you. If you have a lymphedema diagnosis, a physician's note, a referral or a previous therapist's measurements are all useful, as is a list of your medications.

Wear whatever is comfortable. You'll undress to your level of comfort for the area being treated and be draped for the rest. Loose clothing is easier to get back into, and if you've been prescribed a compression garment, wear it in so I can see how it fits.

Eat normally and drink water. There's no need to fast or to drink unusual amounts.

Skip lotion and oil on the area. The technique works by stretching the skin, which needs a dry surface. Moisturizer, body oil or sunscreen makes the work less effective.

What happens in the intake conversation?

The first part of the appointment is talking, and it's the part I don't rush. I want to know what's swollen, since when, and what makes it better or worse through the day. I'll ask about surgeries, including dates and what was done; about cancer treatment, radiation and lymph node removal if relevant; about medications, especially blood thinners, diuretics and anything for blood pressure or the heart; and about heart, kidney or thyroid problems, previous blood clots and infections in the area.

Some of these questions are screening. A handful of conditions make lymphatic treatment unsafe or might mean I need your physician's clearance first, and I'd rather find that out in a chair than on the table.

Then I'll ask what you want from this. Less swelling, a softer scar, a garment that fits, or simply a professional opinion on whether this is worth your time. All of those are good answers and they lead to different plans.

What does the assessment involve?

Assessment is brief and hands-on. I look at the area and compare it with the other side: skin colour and temperature, shape, any firmness, dimpling, scarring or bruising. I'll press gently to feel the texture of the tissue and whether it leaves a pit, which tells me something about how much fluid is there and how long it's been there.

Where the swelling is in a limb, I take circumferential measurements at set points with a tape, so we have a baseline. Those numbers are how we'll know whether treatment is working, instead of guessing from how it looks. For swelling in the face, trunk or genitals, measurements are less useful and I rely more on photographs with your consent, how the tissue feels and what you report. ( I do not treat genitals directly, but MLD in the affected limb(s) will help indirectly relieve any swelling around the genital area).

What does the treatment itself feel like?

You lie on a treatment table, dressed to your comfort and draped with sheets, with only the area I'm working on uncovered. The room is quiet. I always start with the neck or terminus. I ususally ask you to perform diagphragmatic breathing while I open the abdominal nodes because deep breathing moves lymph through the large vessels in the abdomen and chest.

The pressure is very light, about the weight of your hand resting on your skin. First-time clients regularly ask whether I've started or if the treatment is really doing anything. The movement is a slow stretch of the skin in one direction, a release, and a pause, repeated many times in the same spot before moving on.

I always begin at the neck and trunk, even if your swelling is in an ankle. That clears the pathway the fluid has to drain into before any of it is moved along. Only then do I work out toward the swollen area, directing fluid toward lymph nodes that are working well. The pace is unhurried and repetitive. Most people drift; some fall asleep. That's fine, and it doesn't change the result.

If any part of the plan includes compression bandaging or checking a garment, that happens at the end of the treatment.

How will I feel afterward?

Most people stand up feeling that the area is lighter, softer or less tight. Some feel noticeably relaxed, some feel tired for the rest of the day, and some feel nothing in particular. None of those responses is more "correct" than the others.

The one effect almost everyone notices is needing to urinate more over the next day or two. Fluid that was sitting in your tissue has been returned to your bloodstream, and your kidneys remove it. That's the treatment working as intended. Drink water normally; there's no need to force fluids and no reason to restrict them.

What you should not expect is a so-called healing crisis. You may have read that lymphatic drainage "releases toxins" and that feeling unwell afterward is a sign of detox. That isn't how the lymphatic system works and it isn't something I tell my clients. Mild fatigue or a headache in a small number of people are some noted after-effects. If you feel genuinely ill after a session, with fever, redness, heat or pain in the area, that is a reason to call your physician.

There is no downtime. You can drive, go back to work and carry on with your day. If you've been given a compression garment, put it back on before you leave.

How many sessions will I need?

That depends on why you came, and I'll give you an honest answer at the end of the first visit.

After surgery, a short series is typical: often two or three sessions a week for the first few weeks while swelling is at its peak, then tapering to weekly or less as your body takes over. The schedule follows your surgeon's instructions and your recovery, and I go into timing in lymphatic drainage after surgery.

For lymphedema, treatment has two phases. An intensive phase of frequent sessions, combined with a possibility of compression bandaging, exercise and skin care, brings the swelling down. A maintenance phase keeps it there, mostly through your own routine, with periodic check-ins and remeasurement.

A single session is a reasonable choice if you want an assessment and an opinion before committing to anything. I won't talk you into a series you don't need.

If you're nervous, or recently diagnosed

Many of the people I see have just had surgery or just been given a diagnosis they didn't want, and arrive tired and a little wary. A few things to know:

You can stop at any time, for any reason, and you don't need to explain. You can keep as much clothing on as you like. You're welcome to bring someone with you and have them stay in the room. You can ask anything, including the questions you think are silly or that your surgeon didn't have time for. And if what you need in that first visit is mostly to talk, we'll do that.

Payment and insurance

Sessions are paid at the end of the appointment, and you'll receive a receipt under my Registered Massage Therapist registration, which most extended health plans that cover massage therapy accept. Check your plan's annual limit and whether it needs a physician's referral. Manual lymphatic drainage at my practice is a 60- or 90-minute appointment depending on the area and whether compression is part of the plan.