Healthtronix Lymphedema Treatment Center Susie Wills, BSN, RN, CLT Director of Clinical Services
PATIENT INFORMATION: Ms. J.D. is a 56 y/o female who has lymphedema in her (L) upper extremity secondary to a lumpectomy of her (L) breast with lymph node dissection followed by radiation therapy. She states that her lymphedema began immediately after her surgery. She denied ever having cellulitis in her affected arm.
PREVIOUS TREATMENT: She has in the past used a compression pump and compression sleeve; however, she admitted that she did not use any of these on a routine basis and had not used her compression pump in months.
EXACERBATION: The patient reported that she had a significant increase in the edema in her (L) arm which she attributed to the summer heat. The neurological symptoms had increased in her arm. She stated that on a scale of 1 to 10 with 10 being unbearable that heavy, tired and aches were 9/10. The quality of her life was decreased due to the pain, fatigue and loss of function of her arm. The weight of her (L) arm was also affecting her posture and spinal alignment.
OBSERVATION: The (L) arm was visibly larger than the (R). Her (L) forearm appeared to be 2X the size of her (R) forearm. There was a deep fold at the (L) wrist with edematous tissue covering the wrist and part of the hand. The arm went in at the elbow; however, it protruded anteriorly and posteriorly at the upper arm and there was a bluish-red discoloration on the anterior upper arm. After measuring the circumference of both arms at 4 cm. intervals, the edema volume chart revealed that the volume her (L) arm was 42.7% greater than that of her (R) unaffected arm. This was approximately 2,820 ml. of excess fluid.
TREATMENT: Her treatment plan consisted of MLD/CDP daily X 20 treatments, an Optiflow SC insert to be worn under the Lymphapress 201M pump that she already owned, the Reid Sleeve to be worn at bedtime and a custom fitted Juzo compression sleeve and gauntlet to be worn during the waking hours. She was also instructed in arm and breathing exercises, precautions, skin care, nutrition, and self MLD.
RESULTS: The patient responded almost immediately to her therapy. On 9/13/99, after 3 MLD/CDP treatments she was again measured and her edema volume chart showed an 84% reduction of the fluid which approximated 2,368 ml. of fluid. After 7 MLD/CDP treatments, the patient was again measured and this revealed a 94.4% reduction of fluid (2,662 ml.) The patient reported that her neurological symptoms had been diminished greatly and that she could actually see her (L) wrist for the first time in years. At this time, the patient opted to discontinue her MLD due to her out of pocket expense. Her home equipment was set-up with her, so that she could continue her treatment at home. HOME PROGRAM: The patient was discharged with a printed instruction sheet covering all aspects of her home maintenance program. (See attached)
FOLLOW UP: The patient is to return in 4-6 months for a new compression sleeve and gauntlet. She also has orders for further MLD should she need it. She was encouraged to attend a lymphedema support group in her area. She is continuing her career as a pre-school director.