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Decongestive Lymphatic Therapy Courses (DLT)
Elsebeth Petersen specialises in teaching ALA and NLPR accredited courses for the management of lymphoedema - Casley-Smith method. These courses were originally taught in Adelaide, by Drs John R. and Judith R. Casley-Smith, under the auspices of the Lymphoedema Association of Australia. Casley-Smith International was established in 2010 to continue with the Casley-Smith's educational work.

DLT courses are suitable for a variety of health professionals who encounter lymphoedema, and need to know either, how to work safely "around" it, or how to directly treat the symptoms. Experienced lymphoedema-management therapists, who have undergone the accredited Casley-Smith teacher training programme, ensure that DLT courses satisfy the education requirements set by governing lymphology associations.

Accredited Casley-Smith courses are a minimum of 135 hours. They are available in: Australia, Holland, Israel, the UK and USA. The scope of practice dictated by each health profession, will determine what an idividual therapist is able to offer.

To determine if an instructor is an accredited Casley-Smith teacher, please check the listing on the Casley-Smith International website, where you will also find further background on the two "pioneer" lymphologists.

Elsebeth also trained in the Földi Klinik, in Hinterzarten, Germany. Professors Michael and Ethelda Földi's hospital in the Black Forest, is an exceptional and enviable achievement. John Casley-Smith was a colleague of the Földis and collaborated with Professor Michael Földi in writing a textbook.

Clinical Practice
Southern Highlands Lymphatic Drainage offers manual lymphatic drainage, compression therapy, and education regarding the treatment options that are covered by private or government health funding. It aims to complement services provided by our health system. Where other health professionals are required, the client will be referred on, eg diagnostic tests, wound care, prescription medications.

What is "Decongestive Lymphatic Therapy"? (DLT)
DLT includes skin care, manual lymphatic drainage, exercise that stimulates the lymphatic system, multi-layered bandaging, and the supply of compression garments. Education for self-care is provided to support the outcome of therapy.

Manual Lymphatic Drainage: (MLD)
This component of DLT, is time consuming. It is the most oft requested treatment at this clinic. (In Germany, patients receive 2 sessions per day!!) Careful palpation of the affected tissues reveals the extent of congestion. The techniques required to manually move fluid are very light and repetitive strokes. The aim of MLD is to stimulate the movement of lymph inside the lymphatic vessels and to decongest the swollen tissues by diverting the excess fluid to existing lymph nodes. Most experiences of MLD, are of a lighter and freer feeling in the affected area. This can occur over time or in each session.

Compression Bandaging & Garments
Compression bandaging is applied to reduce a limb. The number of days involved depends on the size of the limb and stage of lymphoedema. It is preferable that bandaging is done in the morning and worn for the day. When this is done day after day, re-accumulation of fluid is prevented, and tissue fluid in the limb is driven towards the trunk. The purpose of wearing a compression garment (sleeve or stockings) is generally to prevent further accumulation of fluid. Sometimes they may be used as a means to reducing lymphoedema. Relatively inexpensive garments can be bought off the shelf, but for superior garments with a taiored fit, they should be made to measure.

Exercises
Exercise in conjunction with the other aspects of treatment enhance the movement of fluid. When exercises are performed with a garment or compression bandage being worn, the muscles have something to push against. The lymphatics lying between the skin and the muscles are then "squeezed" from both sides. Exercises that cause overheating of the affected limb should be modified or discouraged if symptoms of further swelling occur.

Skin Care
Skin in good condition helps to keep germs and bacteria out. If these enter an area affected with lymphoedema they can cause more trouble than usual. Antibiotics may be needed to prevent or combat infections (commonly called cellulitis). Simple preventative measures and swift action may help to minimise problems.

Education
Understanding how to manage and avoid the triggers of lymphoedema will lead to greater independence. The results of a little self-help may not be too noticeable in the short term, but over time contributes to the maintenance of an at-risk lymphoedema limb.