Clinicals / Case Studies
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 treatment.

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 treatment.

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 noticed 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 DWs 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 easily 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 of 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 prescribed 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 DWs case; however, with the size and shape of DWs lower extremities and 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. DWs 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. DWs 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 DWs physician, nutritionist, myself, the team at Peninsula BioMedical and Alexander 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
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