LYMPHEDEMA

Case Study

Episode of Care:

Diagnoses: Lymphedema bilateral legs, Difficulty walking; Abnormality of gait

Medical History: Autoimmune disease, unspecified;

PT Start Date: 9/23/2015

PT End Date: 9/13/2016

Number of PT Visits: 56

Initial Evaluation:

Status:

1. 1.  Pain

   2.  Edema

   3.  blistering of lower legs

   4.  severely impaired and limited mobility

Note: This patient was referred specifically to add Treadwell System protocols to her plan of care. Treatment by a lymphedema therapy specialist continued as part of her plan of care during this episode of care. Treatment by the lymphedema therapy specialist, initiated by a referral from from a podiatrist specializing in wound care, was ongoing for the previous twelve months.

Conventional best practices of compression hose,  mechanical external compression device use, massage, and wrapping were being performed. Her lymphedema status was static during the prior twelve months.

Prognosis:

1. Continuing static edema with probable progression of skin breakdown from ongoing blistering.

2. Continuing mobility limitations

3. Continuing leg pain

Results:

Within the first two weeks:

1. Positive changes in her level of edema

2.  range of motion of her ankles improved

3. improvement in  her ambulatory abilities

Addendum: This patient continued to have blistering of her lower legs which persisted until an order was received from her referring dermatologist to discontinue use of compression hose. The top hose elastic interrupted superficial venous blood flow contributing to her blistering. Decreased blistering resulted following this change order received in late December. 

Subsequently, her wound healing podiatrist encouraged her to wear these hose again, and verbally threatened her with amputation if her condition were to worsen due to non compliance of instructions. From this point on she would wear the compression hose for limited periods of time, but expressed that they caused her pain after approximately one hour of application.

She had many medical complications during her episode of care and the interventions for these other medical issues slowed or reversed her progress at times, but she ultimately made excellent progress in controlling her symptoms of edema, skin breakdown, and in improving her ability to ambulate in and out of doors, which she had been unable to do at the onset of her episode of care.

Three months after the introduction of the Treadwell System to this patient’s plan of care, the lymphedema specialist confided to the patient that the Treadwell System had to have been responsible for the progress that she was making having achieved no progress in the prior year with traditional best practices.

After 12 months this patient and her husband re-located to the Reasearch Triangle Park area  (NC) to be closer to her many medical specialists. 

Conclusions: Her previous twelve months of medical interventions had yielded static results at best. In my professional opinion, her progress evidenced by reducing leg edema, reducing skin breakdown, increasing range of motion, and increasing mobility would not have been achieved without the inclusion of the Treadwell System in her plan of care.

Richard Hand, PT