Lymphedema is overwhelming in and of itself. Additionally, for many patients, beyond the condition being overwhelming, the costs for treatment adds considerable stress to an already stressful and life altering condition. Patients will except less then satisfactory solutions for treatment based purely on lack of funds, sadly, many patients forgo any treatment what-so-ever; they simply can not afford care and their insurance denies coverage for care.

The National Lymphedema Network had provided valuable information to the Lymphedema patient at a time where little to no information was available. While the NLN continues to provide information, fortunately through the efforts of many people, patients as well as health care providers, there is more information and education available. I recall a time when I signed on the Internet less then 5 years ago and typed in keyword "Lymphedema" and a mere 33 sites appeared. Now, thousands of sites appear that are l inked to Lymphedema.

The biennial conference that is held by the National Lymphedema Network is a wonderful conference and provides patients and health care providers an opportunity to have continued education about lymphedema. However, of recent, it has been expressed that the same patients that could benefit from the knowledge and education provided by such a conference, are the same patients that can not afford to pay for treatment let alone the cost of the conference.

This year Peninsula Medical is proud to sponsor NLN conference registration fees for two patients. For those who would like to be entered into the drawing for a chance at this paid registration, simply fill out the on-line form. The drawing is to be held on Friday, July 14th 2000.

Peninsula Medical manufactures quality garments for the treatment and maintenance of Lymphedema. Additionally, we offer other services to help better serve the needs of the patients; insurance verification and financial consultation, fitting clinic, EdemaCalc, patient support services, insurance billing services, on line message board, lymphedema chronicles, monthly eNews, targeted surveys, referral services.

CASE STUDY
59-year-old female, post mastectomy, lymphedema.

The University of North Carolina Hospital referred a 59-year-old female to Joanna Burgess, RN of LymFlo Therapies, Inc. for evaluation and treatment for her right upper extremity lymphedema.

HISTORY
In 1996 the patient underwent a lumpectomy of her right breast with subsequent modified radical mastectomy with node resection 3 months later. All nodes were negative for disease; neither chemotherapy nor radiation were performed.

In addition to lymphedema, the patient has been diagnosed with, hypertension, diabetes and diverticulitis. The patient began developing lymphedema two weeks post mastectomy. She presented with significant stage II lymphedema of the upper and lower right arm and hand. The upper arm and hand were soft, but the forearm was non-pitting and fibrotic. Patient reported severe sensations of pain, tingling and numbness. Tumor recurrence and DVT's were ruled out. She was diagnosed with bursitis to the right shoulder and underwent a series of cortisone injections which have helped to lessen the chronic pain, however, she continues to report moderate pain, decreased range of motion and weakness. In 1998 she was treated for a deep vein thrombosis and cellulitis to her right arm.

A trigger finger to the second finger on the right hand additionally complicates the patient's condition. She has worked with an occupational therapist with minimal results. Surgery is not recommended due to her current edematous condition.

PRIOR TREATMENT
The patient's only report of prior treatment for lymphedema was a daytime elastic compression garment with glove of which the patient complained was very uncomfortable and were abandoned.

TREATMENT PLAN
Patient will begin a treatment plan use of the ReidSleeve with eventual Complete Decongestive Therapy. The patient received the ReidSleeve in October 1999. Progress was slow, but she presented with steady improvement. Due to her chronic pain, initially the patient was only able to tolerate compressive therapy for short periods of time. She began by wearing the ReidSleeve 2.5 to 3 hours per day, and by December was tolerating compression 6-7 hours per day. She stated that although she was able to wear the R eidSleeve, she was not able to tolerate a daytime compression garment.

January 2000, patient continued to wear the ReidSleeve for 6-7 hours per 24-hour period. Over the next 5-month period of time, the patient was able to increase her wearing time to 8-9 hours and currently is tolerating a daytime sleeve and gauntlet.

GOALS MET
Patient is spending 8-9 hours a day in the ReidSleeve.
Patient has tolerated daytime compression sleeve and gauntlet.
Patient continues to soften in the areas that presented fibrotic tissue.

UNMET GOALS
Patient is unable to begin program of CDT. Unfortunately it is a funding issue.

RESULTS
Since beginning treatment with the ReidSleeve, patient reports a 55% reduction in over all volume.