Cleveland Regional Rehab Cleveland Regional Medical Center Shelby, North Carolina
Mr. DW is a 34 year-old male who presented to Cleveland Regional Rehabilitation on February 28, 2000 with state III bilateral lower extremity lymphedema and stage I lymphedema of the abdomen.
This patient's lymphedema is secondary with complications from his weight and questionable CVI. His medical doctor has not made a diagnosis of CVI. Prior to February 28, 2000, patient has not been treated for his lymphedema.
Functionally, this patient was unable to drive secondary to the size of his abdomen, had difficulty walking secondary to back pain and shortness of breath, and had difficulty finding clothes to fit.
This patient reports the initial signs of swelling first appeared one month after surgery in 1993 for a ruptured vericose vein to the distal anterior portion of the right lower extremity, darkened discoloration, and textured skin changes.
One year after surgery in 1994, this patient experienced a ruptured varicose vein to the left distal lower extremity what was treated with cauterization. This patient again reported an onset of swelling one month post, with no reported history of wounds and one episode of cellulitis.
In January of 2000, this patient presented to his physician with an infection to the lining of his stomach, a significant weight increase and a hard pitting edema in the abdomen. This patient was treated with oral antibiotics and referred for lymphedema treatment.
This patient's initial evaluation was on February 28, 2000 with treatment beginning on March 6th after the patient was cleared medically. A baseline weight was unable to be recorded on evaluation secondary to the patient's size; however, this patient reports an estimate of 525-550 lbs. On April 24, 2000, after 34 treatments, a weight of 453.9 lbs. was recorded.
MLD/CDP was initiated on March 6, 2000 on the right lower extremity after the patient was cleared medically and treated for a fungal infection noted on February 28, 2000. The right lower extremity was selected to treat first because of the open wound that was leaking lymph fluid. The abdomen was treated simultaneously.
The patient was sized for a ReidSleeve Classic two weeks after his treatment began secondary to difficulty maintaining a good fit with bandages/foam/idealbinde. On April 8, 2000 (after 22 treatments), treatment was initiated by using the ReidSleeve Classic. The patient reported immediate reduction in the size of the right lower extremity and softening of the underlying fibrotic tissue.
On April 18, 2000, after nine treatments of MLD/CDT with the ReidSleeve and the 31st treatment overall, the garment needed to be re-sized secondary to the volume reduction in the right lower extremity. Bandages were re-introduced and used until May 4, 2000 when the ReidSleeve was refit to the patient.
On May 10, 2000 (43rd treatment), the patient was sized for a compression garment. MLD/CDT treatment continued 3x/week until June 7, 2000 (52nd treatment) when the patient was fit in his custom CCL III, 40-50mmHg stocking. This patient continues to use his Juzo compression stocking for waking hours and the ReidSleeve for sleeping hours with continued reduction since discharge. This patient continues to be monitored, taking measurements Monday and Friday to track volume reduction.
Depicted below is DW case study: Prior to treatment
Depicted below is DW case study: Volume Reduction: Right Lower Extremity
(Since initiation of treatment with the ReidSleeve Classic)
The graph does not represent volume reduction in the abdomen, for which we had no good measuring tools. Functionally, however, this patient reports decreased pain in the back, decreased difficulty with ambulating, and the ability to fit into his clothes. This patient resumed driving on April 25, 2000 after 35 treatments.
09/08/2000 In the case of DW, The ReidSleeve classic and short stretch bandages complemented each other nicely allowing for the optimum benefit of MLD. The ReidSleeve Classic considerably cut down treatment time, especially in the initial states of treatment when the bandages were difficult to conform to the contours of the body. The patient's physician, Dr. Mike Ridabenayra of Shelby Medical Associates, P.A., worked closely with therapy in coordinating care, and DW was compliant will all aspects of MLD/CDP.
Currently, DW is undergoing treatment for his left lower extremity lymphedema. This patient has chosen to use the ReidSleeve Classic for his left lower extremity secondary to the success he experienced with the right lower extremity. Bandages will be used when sleeve is sent back in for alteration. Patient's weight on September 1, 2000 was 361.6 lbs.