DIY

John Fuller Beckwith10/4/2025

We all understand the concept of DIY, do it yourself projects. It’s kind of a thing in homeownership to take on and complete DIY projects. It can give a sense of accomplishment and even pride. Building your own deck, re-tiling your bathroom. Part of the appeal is to challenge yourself and maybe, hopefully, bring to life a skill that has been untapped. And there is creativity associated with it, adding personal touches or even a hidden talent for expression.

Yet there is another side to DIY, which is that the trained professional is not the one to have completed the project. Many times this can be seen in the finished product. And it may mean some difficulty come time to sell the house. The experienced professional simply does a better job and achieves a better outcome. They are the expert. It is actually the exception that a DIY home project will come out as good as one done by the trained and experienced professional.

In lymphedema treatment we see something like this happening. A patient recently told me she was directed to several Youtube sites in order teach herself to treat her lymphedema at home. This usually included self-MLD instruction and often includes self-bandaging. Sometimes it involves measuring one’s self for compression garments. She was given the impression that this DIY lymphedema treatment was just fine, along the lines of what she would receive in the clinic with the lymphedema specialist anyway.

Let’s put this into proper perspective. This is not skilled lymphedema therapy. It is in fact the avoidance of providing lymphedema therapy. The gold standard for lymphedema therapy is Complete Decongestive Therapy as defined by Michael Foldi. Famously it is applied in two phases: the first phase is the Intensive Phase. This phase is applied by the skilled therapist in the clinic and involves 3-5 visits per week with the CLT performing the MLD and applying the multilayer short-stretch compression bandage. The second phase is the self-maintenance or optimization phase. It occurs after the intensive phase and in this phase the patient is performing daily maintenance interventions. The goal of the self-management phase is to preserve the gains achieved in the intensive phase. What happens in DIY lymphedema therapy is the patient is expected to get the results of the first phase, even though they have been pushed too early into the second, self-management phase. The patient is expected to implement the skills of the trained therapist by doing the project at home.

The problem here is that, unlike a home DIY project, the patient did not make a conscious choice to avoid having the professional do the work. They didn’t look at their worsening lymphedema and determine they would avoid the expert and precede to do the work themselves. The patient sought out the expert and then makes the reasonable assumption that what the expert tells them is the best that can be done for them. And if this ‘expert’ lymphedema specialist goes straight to telling the patient how to treat themselves the patient assumes that is the best that can be done.

It would be as though I went to a roofing expert wanting their expertise to complete the project, and they directed me to Youtube and told me where to find supplies, but billed me as though they had done the job. I am sold DIY quality for expert price. In lymphedema treatment the patient thinks they received the full range of skilled intervention, but they were tricked into do-it-yourself treatment.

There is another more insidious message here. This is that the skill of the trained expert just isn’t really that important. This approach, which happens too much in the US, in effect devalues the skills of the trained CLT. It tells the patient, the referring provider and the insurance company that skilled lymphedema therapy isn’t really that skilled. Ask any patient who has received authentic CDT and you will hear how false this is.

The take home point here is that a person with lymphedema should not have to do DIY treatment unless they have chosen to do so. They should have the option of fully comprehensive CDT so that the skill and experience of the trained professional can attain the best outcome possible.