McGill University Health Centre (MUHC) - Montreal General Hospital
The Lymphedema Clinic, run by Dr. Anna Towers, has been in operation as a medical clinic since 1994 and is now located at the MUHC Vendome site at 5252 de Maisonneuve Blvd West. Dr. Towers is qualified in Lymphedema Therapy (Casley-Smith). Since April 2008 the clinic has received charitable support to offer an interdisciplinary service, with the addition of a lymphedema-trained physiotherapist, an exercise trainer and a volunteer from the Lymphedema Association of Quebec. This interdisciplinary clinic operates one day a week where 10-12 patients are seen; a half day clinic for education in self-bandaging operates twice a month. The clinic offers an assessment, consultation and referral service to patients with cancer-related lymphedema. At a first visit patients consult with Dr. Towers and other team members; more complicated cases may be seen in the hospital by Dr. Towers and an oncology nurse. Patients requiring lymphedema treatment are referred to private suppliers for compression garments or to community therapists for Combined Decongestive Therapy. Patients are followed up every 3 months until their lymphedema is controlled and annually thereafter. 950 patients are followed; the majority are breast cancer patients although patients with other cancers are also seen. The clinic is open to referrals from anywhere in Quebec. There are some limited lymphedema treatment services offered to MUHC inpatients.
At the MUHC Outpatient Wound Clinic, outpatients with lower extremity lymphedema or mixed edema receive compression therapy from a nurse with a specialty in wound care. An estimated 200 patients annually are treated for lower extremity lymphedema in this MUHC clinic. Outpatients with post-breast cancer upper extremity lymphedema can be referred for treatment with compression pump therapy. The Royal Victoria Hospital has two pumps in use about 45 weeks of the year while the Montreal General Hospital has one pump that is occasionally used. Pumps are less often used in modern lymphedema therapy and alternative treatments involving compression bandaging are preferred, according to international practice guidelines.
Recently a proposal has been put forth for the creation of an MUHC Lymphedema Program whose aim would be to provide adequate, timely and individualized care for MUHC patients defined at risk for lymphedema, through a structured lymphedema prevention and treatment program.
Location
MUHC - Vendome Site
5252 de Maisonneuve Blvd. West
Montreal, Quebec
Contact: Tel: (514) 934-1934 ext 43919
** Patients must be referred by their treating physician**
McGill University Health Centre (MUHC) - Royal Victoria Hospital-Cedars Breast Centre
The Royal Victoria Hospital Lymphedema Clinic, located at the Cedars Breast Centre, began seeing patients in September 2008 thanks to the generous support of the Montreal General Hospital Foundation. The clinic is run by Marie-Eve Letellier, M.Sc. Kinanthropology, a kinesiologist who has training in Combined Decongestive Therapy (Vodder), Aqualymphatic Therapy (Tidhar), and Exercise Therapy following breast cancer (Lebed). The clinic sees predominantly breast cancer patients, although patients with melanoma are also seen.
The mandate of this clinic is to see patients before and (if necessary) after surgery for breast cancer and follow them over time, to ensure that they are not developing arm or shoulder problems. We provide women with information about the possibility of developing arm morbidity (such as pain, reduction of range of motion, loss of strength, and/or lymphedema) and encourage them to seek treatment early should signs appear. If the patient experiences arm morbidity they are either treated by Marie-Eve Letellier or are referred to a therapist or other health professional depending on the problem. Patients who had their surgery many years ago and show signs of lymphedema can also be seen and treated at the clinic. Those who require intensive therapy have access to two to three sessions per week of Combined Decongestive Therapy for approximately two to four weeks. The maintenance phase is then initiated where the patient is encouraged to continue with skin care, an exercise program, and daily use of compression garments. There are a number of patients who are referred to the clinic for prevention of arm and shoulder problems, and the appropriate risk-reduction practices are given as well as a prescription for a compression garment for all exercise, repetitive activities and air travel. More complex lymphedema cases/patients are referred to Dr. Anna Towers at the Montreal General Hospital. The clinic sees between eight to twelve patients per week.
Patients are encouraged to participate in exercise groups offered by the community including Tai Chi/Qi Gong, Aqua-Lymphatic Therapy (ALT), and the Lebed Method. Patients can pursue further CDT management in the private sector. A list of resources is published by the Lymphedema Association of Quebec.
The clinic hours are Monday 9:00 am-1:00 pm, Friday 12:00-4:00 pm and every other Wednesday 9:00 am-1:00 pm, with the possibility to expand to five days per week.
Location
Cedars Breast Clinic, pavilion S 10th floor
Royal Victoria Hospital
687 Pine Avenue West
Montreal, Quebec, H3A 1A1
Contact: Marie-Eve Letellier, M.Sc. Kinanthropology, Tel: (514) 934-1934 ext. 32829
**The RVH Lymphedema Clinic only sees patients from the Cedars Breast Clinic.**
Jewish General Hospital (JGH) - Segal Cancer Centre
The Jewish General Hospital Lymphedema Clinic, which began in April 2007 with funding from the JGH’s Weekend to End Breast Cancer, is the first hospital-based clinic in Montreal to offer both the evaluation and treatment of lymphedema secondary to cancer-related treatments. The clinic is run by Natasha Grant, Pht, a physiotherapist who has training in Combined Decongestive Therapy (Vodder). Dr. Bertha Fuchsman, a palliative care physician, is available as a consulting MD. Although the clinic sees predominantly breast cancer patients, patients with gynecological cancers, melanoma and other types of cancers are also seen.
The mandate of this program is to serve the oncology patients at the JGH, and referrals are made by the patient’s medical, surgical and/or radio-oncologist. The physiotherapist consults directly with the patient’s treating physician and primary nurse as well as with any other health care professional that may be needed (eg. social worker for psychosocial interventions). Patients undergo an initial evaluation with the physiotherapist after which they are seen every 3 months for follow-up. For those where intensive phase treatment is indicated based on circumferential measurements and physical impairment, they have 2 sessions per week of Combined Decongestive Therapy (CDT) for approximately 3-4 weeks. The maintenance phase is then initiated where the patient is encouraged to continue with skin care, an exercise program, and daily use of compression garments. There are a number of patients who are referred to the clinic for prophylaxis, and the appropriate risk-reduction practices are given as well as a prescription for a compression garment for all exercise, repetitive activities and air travel.
Regular communication is held with the patients’ respective CLSCs (Quebec community health care centre) in order to organize and relay information regarding their course of care. The JGH Hope & Cope Wellness Centre is a well-used resource for the program regarding patients’ training regime, and patients can be referred back to the clinic if any new symptoms arise. Natasha Grant has numerous contacts throughout the Quebec public and private system and is consulted frequently regarding a patients’ evolution with their lymphedema. More complex lymphedema cases/patients are referred to Dr. Anna Towers at the McGill University Health Centre (MUHC).
Patients are encouraged to participate in exercise groups offered by the community including Tai Chi/Qi Gong, Aqua-Lymphatic Therapy (ALT), and the Lebed method. Patients can pursue further CDT management in the private sector and a list of resources is published by the Lymphedema Association of Quebec.
Education and resources are also available as a risk reduction practice in cases where there is no development of lymphedema.
Since its inception, the clinic has grown and now follows over 200 patients. It currently functions 3 days per week (Wednesday-Friday, 9:00 am -5:00 pm) with the possibility to expand to 5 days per week.
Location
Segal Cancer Centre-Pav E-8th Floor
Jewish General Hospital
3755, ch. de la Côte Ste-Catherine
Montreal, Quebec, H3T 1E2
Contact: Natasha Grant, Pht, Tel: (514) 340-8222 ext. 5529; Fax: (514) 340-8727
** Patients must be referred by their treating physician**