2019 Wisconsin Lymphedema Pathways Conference

The Wisconsin Lymphedema Pathways Conference is a two-day event detailing the latest advances in diagnoses, treatments, and innovations for the chronic condition of lymphedema. Attendees will experience evidence based state-of-the-art scientific sessions and participate in workshops on the current issues that face therapists, physicians, caregivers, and patients. In addition, interdisciplinary sessions and workshops will focus on the latest therapies employed to treat the condition.

November 1-2, 2019

13 Contact Hours (1.3 CEUs)

Location: Crowne Plaza Milwaukee Airport: 6401 South 13th Street, Milwaukee, WI, 53221

Audience: OTs, PTs, OTAs, PTAs, and Certified Lymphedema Therapists

Level: Introductory – Advanced

Domain of OT: Performance Skills

Occupational Therapy Process: Evaluation, Intervention, and Outcomes


  • David A. Doubblestein, MSPT, OCS, CLT, Cert. MDT, LLCC
  • Maureen McBeth, MPT, CLT-LANA
  • Victoria (Vicki) Ralph, MPPA, OTR/L, CLT-LANA
  • Julia Rodrick OTR/L, CLT-LANA, WCC
  • David C. Zawieja, Ph.D
  • Jeannette Zucker, DPT, PT, CLT-LANA, CSCS, WCC, CKTP


David C. Zawieja, Ph.D
David C. Zawieja, Ph.D., received his Ph.D. in Physiology from the Medical College of Wisconsin, and conducted his post-doctorate work in Medical Physiology at Texas A&M University, where he is currently a Professor in the Department of Medical Physiology. The focus of his research is the generation and regulation of lymph flow, investigating the mechanisms by which physical and humoral factors alter lymph pumping.

Conference Speakers: 

David A. Doubblestein, MSPT, OCS, CLT, Cert. MDT, LLCC
David A. Doubblestein, MSPT, OCS, CLT, Cert. MDT, LLCC is a graduate of Grand Valley State University’s Physical Therapy Program. His career began at Gerber Memorial Hospital in Newaygo County, Michigan in outpatient orthopedics. Mr. Doubblestein has studied many orthopedic manual modalities including myofascial release, positional release therapy, muscle energy techniques, craniosacral therapy, and various concepts and approaches to joint mobilizations of the spine, pelvis, and extremities. He pursued training through the Upledger Institute International studying the Chikly method of complete decongestive therapy and created a lymphedema treatment program after receiving his LLCC certification. Mr. Doubblestein began teaching for the International Alliance of Healthcare Educators and the Chikly Institute in 2005, and taught various lymph drainage therapy courses internationally. During this time he authored a case study of the effects of lymph drainage therapy on idiopathic Bell’s Palsy, which was published in the Advance for Physical Therapists. In 2005, Mr. Doubblestein started his own outpatient physical therapy clinic, Living Hope Physical Therapy and currently practices at this location. In 2013, Mr. Doubblestein pursued further studies in complete decongestive therapy through the Academy of Lymphatic Studies and successfully completed the CLT certification. He is currently teaching for the academy. Mr. Doubblestein became a credentialed MDT practitioner in 2014. Currently, Mr. Doubblestein is pursuing a Ph.D. in physical therapy at the University of Michigan – Flint.

Maureen McBeth, MPT, CLT-LANA
Maureen McBeth, MPT, CLT-LANA, is a nationally known lymphedema specialist with over 21 years of experience as a physical therapist. During the past 14 years, she has developed a working knowledge and understanding of the lymphatic system and the many diseases that develop as a result of impairment. Having worked alongside many of the current thought leaders in the world of lymphology and lymphedema treatment, Maureen has developed a reputation for her passion and ability to articulate the needs of both clinicians and patients.

Victoria (Vicki) Ralph, MPPA, OTR/L, CLT-LANA
Victoria (Vicki) Ralph, MPPA, OTR/L, CLT-LANA, has been developing lymphedema and edema management programs in both Maryland and Colorado since 2005. In 2010, she began teaching lymphedema certification courses throughout the USA and in Malaysia since 2013. In 2014, she developed a two-day course titled Orthopedic Swelling Solutions specifically for occupational and physical therapists through Klose Training and Consulting. She created this course after observing and researching the benefits of manual lymph drainage and compression with orthopedic post-surgical edema. In addition to teaching, Vicki has been a full-time clinician in both Maryland and Colorado for the past 15 years. She has seen the effects of using traditional lymphatic management techniques on orthopedic edema – specifically manual lymph drainage and compression.  Edema reduction has a direct correlation with a reduction in pain and increase in range of motion and function, yet few physicians and healthcare providers understand these techniques.

Julia Rodrick OTR/L, CLT-LANA, WCC
Julia Rodrick, OTR/L; CLT-LANA; WCC, is a Registered Occupational Therapist recognized as an international mentor and lecturer in the treatment of Lymphedema. She specializes in areas of oncology rehabilitation, orthopedics and wound care. As owner and director of Essential Therapy Education, LLC Julia strives to advocate for lymphedema awareness and clinical education, committing her skills to the development of effective lymphedema treatment through her practice in central Illinois.  She received advanced training of Manual Lymph Drainage and Complete Decongestive Therapies (MLD/CDT) through the Foeldi Clinic and The National Alliance of Wound Care and has taught the principles of MLD/CDT as an instructor with The Norton School of Lymphatic Studies (2016-present) and through Klose Training and Consulting, LCC. (2006-2014). Julia has served on the Lymphology Assoc. of North America, Board of Directors from 2004-2011 and as a long-standing patient educator for the National Lymphedema Network. Currently, she serves on the steering committee for the American Lymphedema Framework Project, contributing to the adaptation of the International Best Practice Document, (2006 and 2013) in association with the ILS. Over the years, she has collaborated with fellow colleagues on several published works intended to promote the provision of quality care to those who struggle with the condition of lymphedema

Jeannette Zucker, DPT, PT, CLT-LANA, CSCS, WCC, CKTP
Jeannette Zucker, DPT, PT, CLT-LANA, CSCS, WCC, CKTP, holds a clinical Doctorate in Physical Therapy from New York University. She received her lymphedema certification from the Klose Norton School in 2002 and started her career at Memorial Sloan-Kettering Cancer Center (MSKCC) in 2003. In 2004, Jeannette established the lymphedema therapy program at the main campus and as the Lymphedema Clinical Specialist she continues to work on further developing the service to promote awareness, early diagnosis, and risk minimization of lymphedema. She leads the support groups for patients who have and are at risk for lymphedema through the Post-Treatment Resource Program. Jeannette received her LANA certification in 2005 and was awarded the Susan G. Komen Conference scholarship by the National Lymphedema Network (NLN) in 2006. In 2007, she developed the Lower Extremity Lymphedema Prevention Program for MSKCC and joined the Scientific Committee of the NLN. She is grateful for the continued opportunity to serve on the committee and for the opportunity to lecture at the biennial NLN Conferences.

Friday, November 1, 2019: Lectures

7:30AMExhibits Open
8:00AM - 8:15AMWelcomeMike Bond, MS, PT, CLT, CIDN
8:15AM - 9:45AMRelationship Between Lymphatic Dysfunction and InflammationDavid C. Zawieja, Ph.D
9:45AM - 10:45AMThe Rapidly Changing Landscape of Cancer-Related LymphedemaMaureen McBeth, MPT, CLT-LANA
10:45AM - 11:45AMThe Effects of Breast Cancer Related Lymphedema on Motor Control:
Biological Plausibilities
David A. Doubblestein, PT, MS, LLCC, CLT, Cert. MDT
11:45AM - 12:45PMLunch
12:45PM -2:15PMThe Lymphedema / Wound DilemmaJulia Rodrick OTR/L, CLT-LANA, WCC
2:15PM - 3:30PMThe Physical, Psych-Social, Emotional and Financial Impacts of LymphedemaVictoria (Vicki) Ralph, MPPA, OTR/L, CLT-LANA
3:30PM - 4:00PMBreak
4:00PM - 5:00PMLymphedema Clinical ExperiencesJeannette Zucker, DPT, PT, CLT-LANA, CSCS, WCC, CKTP
5:00PM - 5:30PMPanel DiscussionConference Speakers
5:30PMExhibitor Reception

Friday Course Descriptions

1. Relationship Between Lymphatic Dysfunction and Inflammation


2. The Rapidly Changing Landscape of Cancer-related Lymphedema

Current methods of lymphedema diagnosis rely heavily on the physical measurements and observable characterization of excess limb volume and/or symptom report that denote changes of the soft-tissue matrix in the limb. In effect, we are only measuring the damage to the environment, without understanding the risk(s) that may have already been there. Our expanded knowledge of the pathophysiology of lymphedema in relation to the genetic, inflammatory, and dysregulatory mechanisms that accompany this disease may provide the window of understanding and opportunity to challenge our current thinking about cancer-related lymphedema. The advent of newer imaging technologies, and the hypothesis that baseline lymphatic defects amplify the effect of lymphatic injuries resulting in secondary lymphedema, provides potential actionable data to guide the adoption of newer technologies in the diagnosis, anticipation, prevention, and management of cancer-related lymphedema


    • Describe areas of emerging lymphatic research
    • Identify resources to help healthcare professionals stay abreast of the current evidence
    • Describe how implementing pre-treatment baselines could reduce error in diagnosing cancer-related lymphedema

3.  The Effects of Breast Cancer Related Lymphedema on Motor Control: Biological Plausibilities

This is a presentation about motor control and breast cancer related lymphedema (BCRL). I will establish the underpinnings that in BCRL, RT and MT of the ipsilateral upper extremity are extremely important for protective reactions and in recuperating balance. A brief anatomical overview of lymphatics and exposition on body systems will provide a plausible cause for motor control deficits in BCRL. Concluding summaries of the plausiblities explored will establish a cohesive framework.


    • Outline the events involved in the motor control paradigm.
    • Outline the factors that affect reaction time and movement time.
    • Characterize breast cancer related lymphedema (BCRL)
    • Establish underpinnings to investigate a biological plausibility for BCRL effects on motor control.
    • Summarize pertinent anatomical structures and pathophysiological events related to BCRL.
    • Establish justifiable biological plausibilities for BCRL effects on motor control.
    • Summarize the established biological plausibilities into a cohesive framework that aligns with the performance based outcome measures for motor control.

4. The Lymphedema / Wound Dilemma

“Edema is the presence of an excess of interstitial fluid and is an important sign of ill health in clinical medicine” (Mortimer, 2014). In recent years, advancing medical technology has supported more intimate research findings that validate the essential contributions of the lymphatic system regarding health and wellness. The study of disease has also advanced through the new millennium and with it, a growing appreciation for the vital role of the lymphatic system regarding the microcirculation process and homeostasis within the extracellular space. However, when we consider the Lymphedema/Wound dilemma, there may be an underlining disconnect among wound care professionals and our perceptions of how lymphatic dysfunction and problematic edema should be defined and managed. The disconnect may be the reality that we are still learning to appreciate distinctions in the etiology of edema types, the perceptions of priorities to promote healing and what effective wound management considerations entail. This course discussion is designed to provide essential, clinical knowledge to support the effective treatment and management of lymphatic disorders as they present in a clinical wound care setting. The presentation intends to empower the lymphedema specialist with essential wound care skills to identify the obstacles to achieve the desired outcomes for the non-healing/ chronic wound with lymphatic influence.


    • Review the current evidence regarding the unique physiological contributions and significant role of the lymphatic system in maintaining skin integrity
    • Review Etiology of wound types and the barriers to healing
    • Identify the critical role of the lymphedema specialist in a wound care setting

5. The Physical, Psych-Social, Emotional and Financial Impacts of Lymphedema

Patients with lymphedema experience multiple psycho-social, emotional and financial problems. Healthcare professionals who provide treatment to patients who have been diagnosed with lymphedema are uniquely positioned to help address these issues. This presentation will highlight many of the issues faced by these patients and will identify approaches that can be used to address these issues with compassion based upon an understanding of the difficulties and frustrations they may be experiencing.


    • Describe the physical, psych-social, emotional and financial impacts of lymphedema
    • Identify resources available to patients struggling with the life altering impacts of lymphedema

6. Lymphedema Clinical Experiences

Saturday, November 2, 2019: Workshops/Labs 8AM-1:30PM

Applying Lymphedema Techniques for Orthopedic InjuriesVictoria (Vicki) Ralph, MPPA, OTR/L, CLT-LANA
Lymphedema Management Through the Magic EyeJulia Rodrick OTR/L, CLT-LANA, WCC
Manual Lymphatic Techniques for The Upper Quadrant: Suprafascial and Subfascial TissuesDavid A. Doubblestein, PT, MS, LLCC, CLT, Cert. MDT

Saturday Course Descriptions

1. Applying Lymphedema Techniques for Orthopedic Injuries

Lymphedema therapy interventions have gained recognition in the treatment of edema associated with orthopedic injuries to the musculoskeletal system and surgeries such as minimally invasive hip replacements and knee arthroscopic procedures as well as with bilateral lower extremity edema and wounds. If the circulatory system and/or the musculoskeletal system is compromised, gentle manual and compression techniques can be utilize to facilitate the excess fluid movement into circulation and to assist in excess fluid elimination. This stimulation restores bodily functions by decreasing edema and pain. This workshop will cover the application of the common Lymphedema treatment techniques to treat orthopedic injuries.

2. Lymphedema Management Through the Magic Eye

The intention of this workshop is to present evidence-based research and seasoned, “in the trenches, clinical experience” shared by a recognized expert in the field of lymphedema and wound care. It is designed for the lymphedema therapist who desires a comprehensive review of the lymphedema therapy essentials and adds a “dash” of advanced lab techniques to enhance clinical skills and provide problem-solving strategies for the lymphedema patient who might require “Thinking Outside the Box” to overcome functional outcome challenges.


    • Identify the components of the lymphatic system, its functions and it’s unique features and contributions to wellness
    • Identify the application, medical indications, and contraindications for Manual Lymph Drainage (MLD) and Complete Decongestive Therapy (CDT).
    • Identify compression therapy strategies for patients with lymphedema and related problematic edemas.
    • Recognize the importance of skin care and identify basic wound care considerations for lymphatic recovery and the healing continuum
    • Explore and discuss exercise protocols for lymphedema staging
    • Identify risk-reduction practices for patients at risk for lymphedema.
    • Demonstrate basic assessment skills for wound care associated with lymphedema
    • Identify effective lymphedema treatment modalities to enhance outcomes

3. Manual Lymphatic Techniques for the Upper Quadrant: Suprafascial and Subfascial Tissues

This five hour course teaches the hands-on skills of manual lymphatic techniques that specifically addresses the lymphatics as it pertains to upper extremity.  These techniques are gentle, rhythmic, and employ stretching of the interstitium, and the lymphatic structures at various tissue depths.  Techniques from various doctrines will be taught, as well as refined manual skills from the instructor.  This course will teach the importance of lymphatics as it pertains to suprafascial and subfascial tissues.


    • Recognize and recall basic anatomy, physiology, and pathophysiology of the supra and subfascial lymphatic systems
    • Therapeutic Interventions:
      • Recall and execute a manual lymphatic technique (stationary circle, pumps, “V’s”, “T’s”, dynamic strokes, etc.)
      • Execute a manual lymphatic technique on regional nodal groups
      • Execute a manual lymphatic technique on the integument of the upper extremity, trunk, and cervical regions
      • Execute a manual lymphatic technique on the muscle tissue both locally and generally
      • Execute a manual lymphatic technique on the joint capsule and tendon