Hi Suzanne,

The edema only appears after strenuous exercise, how long does it take
before the edema clears? If that is in a couple of hours, I would do nothing
at all. Nevertheless I would still recommend the sleeve. The sleeve can be
therapeutic, but also diagnostic. If this patient notices that the sleeve
doesn't fit anymore, usually, the edema has increased. In most cases I let
patients find their own way of living with the sleeve. They often don't like
that idea, the expect me to tell them how frequent and how long they have to
wear there sleeve. I don't like a dogmatic approach to this, because I don't
know either what is best in each case (I never had edema myself). Most
patients do find there way in wearing the sleeve in a couple of weeks. I
let them experiment with it and measure the circumference of the arm
periodically. The circumference is the parameter for the adjustment of the
sleeve.
I have patients who wear the sleeve:
- every day
- every morning (till noon)
- 4 days a week
- only with warm weather
- only when they expect increasement of the edema
If they notice increasement of the edema, it is obvious that they should
wear the sleeve more, I think they can arrange that themselves. I only
provide strict guidelines when a patient really cannot find it out by
herself or panics from the idea.
Don't forget an Lymphedema can always appear, even years after surgery of
the axilla. If a patient has a sleeve at the time there is no significant
edema yet, a lot of trouble can be prevented.


Bye
Tom
-----Oorspronkelijk bericht-----
Van: Resnick/Solomons <[log in to unmask]>
Aan: [log in to unmask] <[log in to unmask]>
Datum: dinsdag 17 november 1998 21:51
Onderwerp: Re: compression pumps


>Tom
>Let me elaborate on the case I mentioned and tell you that the edema only
>appears after strenuous excercise such as excercises that involve weight
bearing
>on the upper extremities or gardening, digging etc. would you still
recommend
>the sleeve as a prophylactic measure  and how often is the sleeve worn and
does
>the limb have to be elevated?
>Thanks for the help
>Suzanne
>
>T. Zee wrote:
>
>> Hi Suzanne,
>>
>> I tried to find evidence for the efficacy of the pump, and I found only
>> little. There is a lot of (non-evidence based) information about the
pump,
>> written by experts in Lymphology. Most lymphologists agree that the pump
>> must be adjuvant, and not a treatment alone. I also believe the pump
could
>> be beneficial in mild Lymphedema cases, and not when the edema is big.
>> There was a randomized clinical trial in Lymphology vol 31, No 2 june
1998
>> where the pump was compared with manual lymphatic drainage. The manual
>> lymphatic drainage was a little bit better.
>> In the discussion of cost-efficacy there would be a favor for the pump,
BUT,
>> the pump can has a danger of fluid accumulation at the proximal end of
the
>> sleeve. If this fluid accumulation turns into fibrotic tissue, the
patient
>> has more trouble than before the pump started. Judith  Casley-Smith did a
>> lot of research  on cost-efficacy for the several treatment methods.
>> The treatment of Lymphedema should nearly always be  a combination of
>> several treatment methods. Exercise, good information on skin care,
>> compression-therapy by bandages, sleeves etc is just as important as the
>> manual lymphatic drainage. I use to call this treatment regime: complex
>> decongestive therapy (CDT or CPT). In my practice the pump is often a
part
>> of the treatment, with low pressures (50 mmHg).
>> In my opinion (please comment me) the case you describe will be best off
>> with a compression sleeve. The patient will be independent of any
therapist
>> or pump. An adequate sleeve will definitely prevent worsening of the
edema.
>>
>> Hope this helps
>> Tom Zee
>> Netherlands
>>
>> -----Oorspronkelijk bericht-----
>> Van: Resnick/Solomons <[log in to unmask]>
>> Aan: [log in to unmask] <[log in to unmask]>
>> Datum: maandag 16 november 1998 18:02
>> Onderwerp: compression pumps
>>
>> >Hello all
>> >Would like to ask any of you working with oncology patients if you have
>> >any knowledge of the efficacy of compression pumps vis a vis manual
>> >lymph drainage in the prevention of lymphadoema. This pertains to a 37
>> >year old mother of four who underwent a level 3 axillar dissection
>> >followed by radiation to the breast and axilla 18 months ago who
>> >occassionally gets some swelling distally iin that extremity. Any
>> >thoughts on this would be appreciated.
>> >Suzanne
>> >
>> >
>
>
>
>



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