eNews Online - November 2000 Edition

eNews Online
November 2000 Edition

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

Gradient Compression

When lymph nodes are removed during surgery, the lymphatic drainage is altered to the extent that some patients develop lymphedema. The mainstay of treatment for lymphedema is compression, but there are many ways to apply compression. Gradient compression is one method that is useful because the pressure exerted by a column of fluid is greater at the base of the column of fluid. For example, when a person is standing, blood will drain into the legs and the blood has to return to the heart against the force of gravity. Edema is usually most evident in the ankles because that is where the pressure is the highest. Patients with edema of the ankles will often notice that the edema is worse when they are standing and will improve when they lie down. When the legs are at the level of the heart, there is no column pressure and the edema that has accumulated in the ankles will improve. Therefore, one of the methods for treating edema is to reduce the column pressure by lying down.

Unfortunately, people cannot spend all their time lying down and compression can be applied to the arm or leg to help control the accumulation of edema. Since the pressure is higher in the ankles than in the thigh, patients can benefit from a gradient of compression that is higher in the ankles than in the thigh.

Gradient compression has been used when a column pressure causes higher pressure in the distal extremity; however, since every patient is different, it is difficult to determine the most effective gradient and degree of compression. Some patients have edema that improves with lying down, these patients have relatively mild edema and need only modest compression to control their edema. Other patients have swollen and hard tissues that do not respond to simply lying down and require higher levels of compress ion and a greater gradient of pressure. Therapists train extensively to develop a knowledge of the patient's needs and a feel for the proper gradient of compression. Therefore, it is important for a patient to find experienced and well-trained therapists; however, even the most experienced therapists have difficulty accurately gauging the level of compression and gradient and this can result in diminished effectiveness due to the tourniquet effect.

A gradient of compression is generated when the pressure is higher in the distal extremity (hand / ankle) than in the proximal extremity (biceps / thigh).

The tourniquet effect results when the pressure is too high causing compression of the lymphatic and venous vessels, blocking effective outflow. When this happens, the condition can become worse.

When I introduced the ReidSleeve, I designed it to be fully adjustable making it ideal for generating not only accurate levels of compression but accurate compression gradients. I evaluated numerous pressure sensors to determine which would be best for helping measure the compression applied to the skin; however, there are problems with most sensors on the market. Most sensors are not designed for medical use and are either too large or too small. The large sensors do not fit easily under bandages or the R eidSleeve and as a result are hard to use and inaccurate. Small sensors are inaccurate because small changes in the shape or contour of the skin result in much different measurements. Most of the sensors have to be perpendicular to the skin to be accurate so that if the position is slightly twisted, the pressure measurement is inaccurate.

Many of the sensors had hard or sharp edges and can be hazardous to patients. In addition, most of the sensors did not conform to the contours of the skin and as a result were not accurate. Finally, most of the sensors were very expensive. To overcome these problems, I turned to a well established technology in medicine, the blood pressure cuff. The soft flexible bladder of a blood pressure cuff conforms to the contours of the skin. Since it is flexible and flat, it fit easily under wraps and the ReidSleeve and since the bladder covers a reasonable surface area, it is accurate and easy to use. In addition, there are accurate and reliable compression gauges for use with the bladder. The Precise compression gauge has been used by thousands of patients and therapists and can be used with many types of compression garments to determine the pressure that is applied and optimize the compression and gradient.

Tony Reid MD Ph.D

Indigo Precise Gauge

We are introducing a new version of the Precise, the Indigo Precise with a larger, easy to read dial and a cool Indigo cover for the bladder. The Indigo Precise is ideal for measuring the actual compression applied to the skin so that the correct gradient pressure can be applied at all times and the tourniquet effective can be avoided. The Indigo Precise can help optimize compression so that the best possible results can be achieved.

(This item has been discontinued)

Medical Alertband

Prior to any medical procedure it is imperative that patients with lymphedema or at risk to develop lymphedema, have a mechanism to alert medical professionals of their condition. Many times a patient is sedated or under anesthesia and can not protect or prevent at risk procedures such as, injections, blood draws, IV insertion, blood pressure readings ect. By donning a hot pink Alert Lymphedema band on their wrist or ankle this will alert technicians to the risk. Although there are medical alert jewelry, i n a medical setting, this can be overlooked as jewelry and not bring the desired attention to the extremity.

Peninsula Medical will send, at no charge, an Alert wrist band to any patient with or at risk of developing lymphedema. The band will accommodate up to 9 1/2 inches/24 centimeters. If your extremity is larger than this, please indicate the circumference of your ankle or wrist so that we can provide extra bands that snap together in order to accommodate a larger circumference. If two extremities are involved, please indicate this so that two bands can be sent.

Lymphedema is not curable, but it is treatable, controllable and there are preventative measures that can be taken to help protect patients from worsening and to lessen the risk of infection. If you have not yet viewed our Risk Reduction links page, please click here. Education and Prevention is within reach!

Simply fill out this form to receive your FREE Alert Lymphedema band.

Case Update

P.V. has been undergoing Complete Decongestive Therapy and utilizing the ReidSleeve Classic in place of bandaging. P.V. was unable to wrap and subsequent previous treatment failed due to the inability to apply effective compression. Her response to therapy and the ReidSleeve has produced incredible results in a very short time.

Peninsula Medical will post her entire case, as submitted by her therapist, at the conclusion of her treatment. Until then we will keep you posted on her progress.

Depicted is her before pictures, her current (still in treatment) pictures and her graph of progress.

P.V. July 2000 - Before TreatmentP.V. November 2000 - Treatment In Progress