eNews Online - June 2001 Edition

eNews Online
June 2001 Edition

This Lymphedema eNews is being generated through your request from our website.

Ivanhoe Medical Breakthroughs reports "Hope for Lymphedema"

Dr. Reid was interviewed by Ivanhoe Medical Breakthroughs and the report will be shown around the country in the month of August on various news stations. For a week, the news clip can be seen on the Internet here.

Lymphedema Case Study - D.W. Left Lower Extremity

Lymphedema Case Study D.W. Left Lower Extremity
Cleveland Regional Rehab
Cleveland Regional Medical Center
Shelby, North Carolina

The following is an update on case study DW.

To re-cap our last report, DW had made significant progress in the treatment of his right lower extremity lymphedema using a combination of bandages and the ReidSleeve. Bandages were only used when the ReidSleeve was sent back for alterations. DW had also had treatment for abdominal lymphedema without use of either bandages or a ReidSleeve. Progress for the right lower extremity was depicted using a volume reduction graph.

On July 19, 2000, DW was fitted with his left ReidSleeve, and MLD/CDT (manual lymph-drainage/complete decongestive physiotherapy) was initiated.

The left lower extremity presented to us much in the way as the right did with the exception of the open wounds. The skin was darkened in the distal one-third with severe underlying fibrotic tissue. A thick scarred area was present on the medial portion of the distal lower leg from the cauterization in 1994 to repair a ruptured varicose vein. The toes presented with papillomas (lymph fluid filled cysts), hyperkeratonosis, and a fungal infection which was treated by his physician prior to start of the treat ment.

On August 7, 2000, after 14 treatments of MLD/CDT to the left lower extremity, the ReidSleeve was sent back for alterations to accommodate the reduction in volume. Bandages at this point were introduced into treatment.

On August 16, 2000, after 20 treatments, DW was admitted to the hospital by his physician to have his heart shocked into rhythm. This was a planned procedure by his physician and not a result of MLD/CDT. DW had developed this complication as a result of his weight and was closely monitored by his physician throughout treatment. DW did show some signs of CHF (congestive heart failure) prior to treatment being initiated in February 2000 but was cleared medically by his primary care physician to begin treatme nt.

On August 19, 2000, treatment was re-initiated per physician, and on August 28, 2000, after 25 treatments, the ReidSleeve was re-introduced.

On September 1, 2000, after 28 treatments, DW was measured for a compression class III (40/50-mmHg) stocking. A Juzo stocking was recommended which was used on the contralateral lower extremity; however, DW decided to be fitted for a garment that could be made in much less time. Let me note that DW was very happy with the results and feel of his first Juzo garment. At this DW had been in treatment for six and a half months and chose the quickest option.

DW was sent one week later, on September 8, 2000, to be fitted with his compression stocking.

Over the course of the next month, DW was seen twice a week to track continued volume reduction. It was noted that DW actually presented with an increase in volume since being fitted with his compression stocking. DW reported that his left compression stocking felt loose and did not give the support his right stocking provided. On October 24, 2000, DW was measured for a Juzo compression class III stocking. At this time we increased ReidSleeve use from nighttime to 24 hours a day. Volume reduction was notic ed immediately as well as a continue decrease in underlying fibrotic tissue. MLD/CDP was performed once a week and volume reduction was tracked.

On November 17, 2000, DW was fitted in his left lower extremity Juzo compression stocking. Over the next month, gains made in therapy were maintained and even further reductions were noted.

Depicted below is DW’s Volume Reduction: Left Lower Extremity.

Treatment approaches varied between the left and the right lower extremity, but the outcomes were similar. With the right lower extremity, we started with bandages initially; but after two weeks decided on another approach, The ReidSleeve. The shape and size of the right lower extremity made bandaging difficult and timely. An immediate reduction in volume was noted in bi-weekly circumferential measurements. I attribute this to the softening in the underlying fibrotic tissue, which was not accomplished as e asily with bandages, comprex, and fibrotic techniques. When the ReidSleeve was sent back for alterations, bandages were much more effective. Total treatment time for the right lower extremity was 43 visits. This included abdominal treatment, which was performed simultaneously with the right leg.

Drawing on the experience of treatment using the ReidSleeve with the right leg and patient satisfaction, we jointly decided to start treatment of the left leg with the ReidSleeve. Both the right and left legs were similar in size, skin tone and the amount of fibrotic tissue present in the interstitial tissue when we started. The right leg presented with an open wound, which the left leg did not have, and both legs presented with medial distal lower leg scars from cauterized varicose veins. When treatment o f the right leg began, we measured the left leg to establish a baseline. When treatment of the left leg began, there was little difference between current measurements and baseline measurements. Abdominal techniques had little impact on the circumferential measurements of the left leg, which may have made some difference in the total treatment time of the right vs. left. The left leg required 28 treatments vs. 43 for the right. The left lower leg did require some extra visits secondary to the initial presc ribed compression stocking which was not sufficient enough to control swelling.

In the case of DW, we concluded that the ReidSleeve reduced on the total amount of treatments. We arrived at this conclusion by comparing 43 treatments needed for decongestion of the right leg vs. 28 treatments for the decongestion of the left leg. Remember that The ReidSleeve was used to treat the right leg, however, it was not introduced until after 4 weeks of treatment. This is not to say that bandages would have been ineffective in DW’s case; however, with the size and shape of DW’s lower extremities a nd the fibrotic tissue present, the ReidSleeve offered a method to achieve the same results in a shorter period of time. With the ReidSleeve, there were no incidences of sliding or unraveling which we experienced with bandages in the first 4 weeks of treating the right leg.

Currently DW is utilizing his compression stockings during the day, his ReidSleeve at night, and has resumed all prior activities independently. DW’s estimated weight in January 2000 per his report was 535-550 lb., and his first recorded weight during treatment was 453.9 lb. on April 24, 2000. DW’s last recorded weight was 361 lb. in January 2001; a total loss of 92.9 recorded pounds. This was achieved as team efforts consisting of DW’s physician, nutritionist, myself, the team at Peninsula Medical and Ale xander Health Services for supplying their expertise, and fine ReidSleeve products. More importantly, the patience and commitment of DW and his family contributed to the achievement of this outcome.

Submitted by:

Santo Russo, CTR/L. MLD/CRT

Cleveland Regional Rehab at Cleveland Regional Medical Center

Shelby, North Carolina

ReidSleeve® Precise Tape Measure

Over the years we have found that one of the most encouraging aspects of treatment is for our patients to see the improvement in black and white. Unfortunately, taking measurements of an arm or leg has always been a problem for patients with lymphedema. While any tape measure can be used, it is very difficult to apply the same tension each time and to avoid twisting, turning or sagging of the tape measure. It is especially difficult to measure an arm when you have only one free hand to make the measurement and many patients find it is difficult to reach their legs or to use both hands to make the measurement. On many tape measures the numbers are small and difficult to read. I have also found that how tight someone pulls the tape can make a difference in the measurements. One person will pull the tape measure very tight, another will pull it just snug and another person will pull the tape measure until it just fits loosely around the limb. The amount of tension applied can vary from day to day making big di fferences in the accuracy of the measurement.

The New ReidSleeve Precise TapeMeasure overcomes these problems. It is ergonomically designed to be easy to use. The numbers are large and easy to read. Patients can make most measurements with one hand and it applies a consistent amount of tension for accurate, reproducible results. Encouragement is sometimes difficult to come by and the added encouragement of seeing measurable improvements has helped many patients stay with their treatment program and achieve maximal results.

For more information on this product, click here.