Lymphedema care in Calgary: what does treatment actually involve?

Lymphedema treatment is a structured program, not a single appointment. It starts with an assessment and measurements, moves into an intensive phase of manual lymphatic drainage, multilayer compression bandaging, exercise and skin care to bring the swelling down, then shifts to a maintenance phase built around a fitted compression garment and a routine you run yourself.

I'm Raegan Brumer, a Registered Massage Therapist and Licensed Practical Nurse, and I provide lymphedema care at my practice in Kensington, Calgary. This article walks through what a first visit covers, what each phase involves, why compression carries so much of the result, and how private care fits alongside your physician and the public programs here.

What happens at a first lymphedema appointment?

The first visit is mostly assessment, and it's longer than a treatment session for that reason.

We start with your history: when the swelling began, whether it followed surgery, radiation, infection or injury, whether it comes and goes or stays, and what your physician or oncology team has already said and done. Bring any imaging, diagnosis or treatment plan you have. I also screen for the things that would change the plan or rule treatment out for now, including signs of infection, a possible clot, or heart or kidney problems that affect fluid balance.

Then I look at and measure the area. For a limb, that means circumferential measurements with a tape at set intervals, compared with the other side where possible; these are the baseline we track against. I check whether the swelling pits when pressed, the texture and thickness of the skin, and the Stemmer sign, which is whether the skin at the base of the second toe or finger can be lifted in a pinch. A fold that won't lift is a common sign of lymphedema; a fold that does lift doesn't rule it out, which is one reason I never diagnose from a single test.

I've covered what manual lymphatic drainage is separately; for lymphedema, the technique is one part of a larger plan.

How is lymphedema staged, and why does it matter?

The International Society of Lymphology describes four stages, and knowing where you sit shapes what we do.

• Stage 0: the lymphatic system is impaired but there's no visible swelling yet. This can last months or years.
• Stage I: early swelling that goes down with elevation, often overnight, and pits when pressed.
• Stage II: swelling that no longer resolves with elevation. Pitting lessens as the tissue firms up.
• Stage III: long-standing lymphedema with marked skin and tissue changes.

Severity within a stage is also described by how much larger the affected limb is than the other. Earlier stages generally respond more readily to conservative care. Where a diagnosis isn't yet established, your physician may order imaging first.

What does the intensive phase involve?

Once we have a baseline and any clearance we need, treatment follows a model called complete decongestive therapy, or CDT. It has two phases, and the first is intensive.

Its purpose is to reduce the swelling as far as it reasonably will. Each session includes manual lymphatic drainage to move fluid toward working pathways, followed by multilayer short-stretch bandaging that stays on between visits. The bandaging matters as much as the hands-on work: it keeps the limb from refilling, and because it's low-stretch, it resists when the muscles push against it during movement, which supports lymph flow. I teach you a short set of exercises to do while bandaged, and we go over skin care from day one.

Frequency is high in this phase. Clinical descriptions of CDT typically call for daily or near-daily treatment over roughly two to eight weeks depending on severity; in practice I plan the schedule around what's realistic for you. Bandaging is a skilled task, so early on I apply it; as we go, I teach you or a family member to do it so the reduction isn't dependent on seeing me every day. Sessions in this phase run 60 or 90 minutes depending on the area and whether bandaging is included.

Why does compression hold the result, not manual drainage alone?

This is the part people most often misunderstand, and it's the reason I don't offer lymphedema care as a series of hands-on treatments without compression.

Manual lymphatic drainage moves fluid out of the tissue during a session. It doesn't change the underlying reason the fluid accumulated, so without something holding the limb at its reduced size, it refills. The International Lymphoedema Framework's guidance on compression is blunt about this: compression has to be continuous, and stopping it lets the swelling return. The 2023 International Society of Lymphology consensus document likewise describes custom-fitted garments as essential for long-term maintenance after CDT.

The research agrees. A Cochrane review of manual lymphatic drainage for breast cancer-related lymphedema found that compression bandaging on its own produced substantial volume reductions, that adding MLD gave a modest further reduction, and that at one-year follow-up people were likely to keep their swelling down if they kept wearing a custom-made sleeve. The hands-on work earns its place, but compression is what makes the gains last.

What does the maintenance phase look like?

When measurements have plateaued over a couple of sessions, we move into maintenance. This phase is long-term, because lymphedema is a chronic condition.

You're measured and fitted for a compression garment, typically a flat-knit, made-to-measure sleeve or stocking, sometimes with a separate night garment. You wear it daily and continue the exercises and skin routine. Manual lymphatic drainage continues as needed rather than on a fixed schedule; for some people that's monthly, for others it's a refresher when the limb feels heavier or a garment wears out. I re-measure at check-ins and when garments are replaced, because fit drifts as the limb changes. Garment types, wear and refitting are covered in a separate article on compression garments after lymphatic drainage.

Self-management is the backbone of this phase: simple self-drainage, putting on and caring for your garment, your exercises, and what to watch for on your skin.

How does skin care reduce the risk of cellulitis?

Protein-rich swollen tissue is an easy place for bacteria to take hold, and the skin over it is more prone to dryness and cracks. That's why cellulitis, a bacterial skin infection, is a recognised complication of lymphedema and tends to recur once it has happened.

The routine is unglamorous and effective: wash daily, dry thoroughly between toes and in skin folds, moisturise with a low-pH or fragrance-free emollient, protect the limb from cuts, burns, bites and sunburn, treat athlete's foot or other fungal infection promptly, and clean and cover small wounds right away. If an area becomes red, hot or painful, or you feel feverish, see a physician the same day; I'll pause treatment until it has been treated. People with repeated episodes are sometimes prescribed preventive antibiotics; that's a conversation with your doctor.

How does private care fit with physicians, oncology and public programs?

Lymphedema care works best when everyone involved knows what the others are doing. I don't replace your physician or oncology team, and I don't compete with the public clinics. Alberta Health Services runs the Calgary Ambulatory Lymphedema Service for people 16 and older with lymphedema not related to cancer, and the Rehabilitation Oncology program for cancer-related lymphedema. Both provide assessment, bandaging, education and garment fitting, and both work through physician referral. The Alberta Lymphedema Association offers education and peer support. If you qualify, use them.

Private care tends to fit in three places: before a public program starts, for people who want hands-on treatment sooner; alongside it, for more frequent manual drainage; and afterward, for maintenance check-ins and refitting once a program has discharged you. You don't need a referral to see me, but your physician should know, and for anything cancer-related or medically complex I want your physician's or oncology team's clearance before we begin.

One note on cost. Compression garments for chronic lymphedema may be eligible for coverage through the Alberta Aids to Daily Living program, which requires assessment by an approved authorizer or a physician's prescription and involves a client cost-share for most people. My treatment sessions are billed under my RMT registration and are typically eligible under extended health plans that cover massage therapy.