Healthtronix Lymphedema Treatment Center Susie Wills, BSN, RN, CLT Director of Clinical Services
PATIENT INFORMATION: Ms. D.S. is a 44 y/o female who presents with LE in her (L) arm secondary to treatment for Hodgkin's disease.
DIAGNOSIS: Pt was 18 y/o in 1972 when she was diagnosed with Hodgkin's disease. At that time she received radiation which alleviated the cancer. However, in 1977, the patient again was diagnosed with Hodgkin's and at that time received surgery and chemotherapy. She reports that she first noticed edema in her arm in 1980. She presented on 9/18/98 with 21.6% more volume in her (R) arm as compared to her (L) arm.
PREVIOUS TREATMENT: Pt. had had no treatment for her LE, but had obtained a compression sleeve, which she had worn off and on for years, and that did not fit her arm well.
EXACERBATION: Ms. D.S. is a remarkably fit 44 y/o who had been lifting weights, doing long sequences of pushups, and had just finished taking Navy Seals Training. During this training, she had sustained scratches and insect bites on the arm and had performed rigorously strenuous exercises.
OBSERVATION: On assessment, pt. did have significant edema of her (L) UE. Several minor abrasions were noted, as well as, red, raised areas which appeared to be insect bites. Pt. was unable to say how much of an increase of LE had occurred recently, but was experiencing much discomfort in the limb. She described the arm as feeling extremely stiff, achey, hard, heavy, tired and painful.
TREATMENT: Her treatment plan consisted of MLD/CDT X 20 treatments. Pt. broke down into tears when the compression bandage was applied and asked that it be removed immediately. She stated, "I can't live like this!" After talking with the patient at length, it became apparent that she would not be persuaded to wear bandaging or to self-bandage. The patient admitted that she had always been in denial of her LE, and that this was more than she could take in. We discussed the pros and cons of continuing MLD therapy without bandaging. Together we designed a treatment plan that the patient could accept and that would hopefully be effective with her LE. The patient was fitted for a proper fitting compression sleeve and a Reid sleeve. As soon as these were obtained, the pt. had MLD daily and then wore her compression sleeve during the day and her Reid sleeve at night, and with an exercise and breathing regimen. She also attends a monthly LE awareness group and has joined the NLN. RESULTS: Ms. D.S. was treated from 9/18/98 to 10/29/98 and at the end of her treatment, she had achieved an 85% reduction of her lymphedema and was pain free. The volume of her affected arm had decreased from 21.6%, as compared to her unaffected arm to, 3.2%.
HOME PROGRAM: The patient was discharged on 10/29/98 with a home maintenance program which consisted of wearing her compression sleeve during the day and her Reid Sleeve at night, and limb and breahting exercises. She also attends a monthly lymphedema awareness group and has joined the NLN.
PROGRESS: Goals were met with this patient despite the alteration in the conventional treatment plan. Had the alterations not been made, the patient would have refused treatment, and I believe would have suffered a major exacerbation. It has been very difficult for her to accept her LE but she has maintained the progress despite episodes of non-compliance with her maintenance program and strenuous exercise.
FOLLOW UP: The patient received a prescription from her physician for monthly PRN visits for MLD, but has not yet had to return. I do see her monthly at the awareness group and follow her progress.