I want to thank everyone for the great response to last month's questionnaire on lymphedema for Sammie Pry's Capstone project. The responses are extremely helpful to her. We will be providing updates on the results of the study as they become available.

There have been several questions relating to pregnancy and lymphedema on the forum recently. The questions asked about the precautions that should be taken to reduce or prevent worsening of lymphedema during pregnancy. The questions also asked whether weight gain, especially during pregnancy, affects lymphedema.

I reviewed the literature on this subject. Unfortunately, there is very little information on lymphedema in general. However, in this case there is almost no information.

One small study was published in a French journal in 1989*. In this study, 15 patients with primary lymphedema were reviewed. The authors concluded that lymphedema was reversible after the first and second pregnancy but became irreversible after the third pregnancy. Obviously, this is a very small study and as a result, I cannot feel very confident about the conclusions. The most I think we can conclude is that pregnancy can make lymphedema worse and that, in some maybe most cases, the increase in lymphede ma is reversible. Perhaps some of the readers can be of help. If you have either primary or secondary lymhedema and had one or more pregnancies please let us know how pregnancy affected your lymphedema, here.

Tony Reid MD Ph.D

* Brunner U, Lachat M. Primary lymphedema and pregnancy. Phlebologie, 42:481-4, 1989.

In November of last year a primary lymphedema patient contacted us , as she was interested in ReidSleeves for all four of her extremities. The first hurdle to overcome was to get insurance approval.

One of our billing specialists contacted her insurance carrier and was told the patient must obtain durable medical equipment through their contracted facility, which happened to be a large chain drugstore. The patient was under the care of a therapist specializing in lymphedema treatment and compression garment fitting and follow up care. The insurance company didn't seem concerned with the fact that a large chain drugstore knew nothing about the ReidSleeve, let alone lymphedema. They refused to write an outside referral. Additionally, they only wanted to pay for two of her extremities, even though she exhibited lymphedema in all four limbs.

The patient had been receiving complete decongestive physiotherapy (CDP) , including MLD, compressive bandaging, sequential pump therapy and an exercise program. She exhibited stage IV elephantiasis. She had a history of seven hospitalizations for acute cellulitis, with 12 additional bouts of less severe cellulitis that required antibiotics.

It was explained that it was unrealistic for this patient to bandage all four extremities herself every day for the rest of her life to maintain the results she had gained through the intensive therapy. Additionally, it was not satisfactory to send a patient in this type of therapy to a drugstore to be fitted for custom compression garments, properly gauged, and to be followed up and evaluated for the various complications associated with lymphedema. Patient compliance is extremely important with compressi ve therapy and it was imperative that she had a treatment modality/compressive therapy that was easy to apply to ensure a high compliance.

Multiple letters of medical necessity were sent to the insurance carrier from her prescribing physician and therapist along with almost daily calls from the patient and our billing department. The insurance carrier held their ground stating that they would not authorize outside their contracted providers, no exceptions. Finally, after relentless pursuit, they agreed and authorized lower extremity ReidSleeves to be applied by the patient's treating therapist.

This was not the only success for this patient, but the first of three . The next success was her continued reduction in her legs. The ReidSleeves were not just maintaining the efforts and good results of her therapy, but she lost another 146 centimeters of excess edema in her legs. These results prompted the therapist and physician to go back to the insurance company and appeal for approval for upper extremity ReidSleeves. The insurance company authorized with very little resistance. The third success was the reduction results she experienced in her arms, to date she has lost 57 cm of excess edema in her arms.

The total reduction in all four extremities to date is 203 cm of edema.

The process of attaining insurance approval was 6 months, but to this patient, not giving up, and with the efforts of her therapist, doctor and our billing department , it was well worth it!

If you are finding challenges with your insurance company for coverage , and would like us to check on coverage for the ReidSleeve with no obligation, please contact one of our billing specialists at 1-800-29-Edema.

Additionally, we have a broad referral source of therapists and clinics trained in the treatment of lymphedema with the ReidSleeve in conjunction with other therapies. We are also happy to educate your therapist or doctor should they be interested in learning more about treatment with the ReidSleeve to compliment their therapy programs.