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Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 63 eyond decreased fluid retention, MLD has secondary benefits that include decreased pain, improved ambulation efficiency and respiratory effort, renewed socialization, assistance in the healing of situational depression, the soothing of anxiety, elevated body image, cessation of infectious portals, and engaging of trust in medical personnel. The disease processes impacted by MLD that are discussed here are only a sampling of the many that may be aided. A few that are not mentioned—but that I have encountered—include the extension of MLD into palliative management of lymphedema due to lymph node dissection, radiation scarring, tumor obstruction, and deep vein thrombosis. Patients who have experienced MLD in other settings often marvel at the transformation that occurs psychologically and spiritually as the hospice therapist accompanies them on their journey using the hand, mind, and heart as a healing bridge beyond the physical world. This illustrates one of the profound differences between MLD delivered in a nonhospice setting and MLD provided by a hospice therapist who is sensitive to the many multidimensional issues patients encounter as they journey through the stages of release. For those therapists seeking to employ MLD in hospice care, a word of advice: Acknowledge that adaptation and modification of every aspect of treatment will be a requirement. Hospice MLD is more than mobilizing fluid. MLD should be performed as a loving intervention that serves to accompany patients through the transition from this life to the next. Here are three case studies that depict the value of MLD in hospice care. MANUAL LYMPH DRAINAGE IN HOSPICE CARE By John F. Mramor HOW MLD HELPS The principal reasons for employment of MLD in the hospice environment are to: • Assist with negative self-image issues • Decrease pain or discomfort, especially pain or discomfort related to distension, compression, or pressure—including sternal discomfort due to diaphragmatic compression (primarily from ascites) • Enhance multidimensional comfort and psychosocial/emotional well-being • Make ambulation, transfers, or positioning easier • Provide ease of respiratory effort or dyspnea (from ascites or other weight increase) • Provide infection control (weeping lymphatic fistulas or cellulitis resolution) • Provide management of lymphedema • Provide paracentesis support or eliminate the need for paracentesis • Provide wound care Manual lymph drainage (MLD) is a useful intervention employed in hospice and palliative care. It is comprised of the four Vodder strokes (stationary circles, pump technique, scoop stroke, and rotary technique) and is an exceptionally gentle experience for patients, while simultaneously being a functional clinical modality. It has the potential to effect a powerful change in the lives of hospice patients coping with various disease-related swellings. B

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