[aptaoncology] Re: [EXT] Re: [External]Re: Lymphedema pump question

From: Lesli Bell <lesli.belldpt@xxxxxxxxx>
To: aptaoncology@xxxxxxxxxxxxx
Date: Wed, 30 Jun 2021 22:45:54 -0400

Hi Andrea,

I will frequently suggest a pump for home when the patient is struggling
with fibrosis, (I have them use channel foam strips that I make them, or
maybe a quilted garment under the pump if this works for them). If it will
make their life and management of their condition easier, if it’s
appropriate and will cause no harm,  why not?  I find it helpful for post
thrombotic syndrome, venous insufficiency, primary and secondary lymphedema
usually stage 2 or higher, and for pts with lipedema. Sometimes patients
may not be able to tolerate garments or Velcro appliances for as long as
would be optimal and a pump can be helpful with controlling the swelling
during the day.

In the end I am looking for compliance in keeping the lymphedema under
control. I’m looking to help the patient with the ‘least amount of work to
stay the same’. These pts struggle enough with trying to manage this
condition.  Sometimes it feels good to just have another type of pressure
on the legs (or arm). Sometimes they are short on time. Yes, they should
wear garments of some sort and we have serious talks about this and I am
very careful about educating them about genital swelling. I have several
pumps in my clinic so pts get to try them and decide if this will be
beneficial for their home management. I often use LymphaPress as I have a
lot of control with pressures and wave patterns especially if they are
using some type of textured or chipped foam under the sleeve. Some models
can be controlled by their phone app.

I believe these pts deserve any tools that will help them manage this
problem. We decide together after they trial the pump option  (if it is
appropriate) along with all of the other traditional approaches and
together decide if it makes sense from many fronts including financially
(depending on the insurance or if they want purchase independently ). Our
responsibility is to introduce all options that will help our pts.
Sometimes it’s surprising what a Pt can afford and might choose to do.
In the absence of published research we need to consider what is best for
our Pt and make sure it will not do harm. Clinical evidence is very valid.
Hope this helps.

Lesli

On Wed, Jun 30, 2021 at 10:02 PM Cohn, Joy <Joy.Cohn@xxxxxxxxxxxxxxxxxxxxxx>
wrote:

Hi Andrea- the lack of really compelling evidence re; Flexitouch always
makes me hesitant to order one. Is it a helpful/not harmful adjunct to
regular self care ? (ie- consistent use of compression garments and
proximal MLD). I would say yes- a nice addition, but I have never seen
research evidence that it can take the place of the standard consistent
well fit compression garments and proximal MLD.  I don’t think Flexitouch
is harmful to any patient, But I have seen far too many who don’t have good
control over their lymphedema when it is the only self care ‘tool’ they are
using….

Joy

Get Outlook for iOS <https://aka.ms/o0ukef>
------------------------------
*From:* aptaoncology-bounce@xxxxxxxxxxxxx <
aptaoncology-bounce@xxxxxxxxxxxxx> on behalf of Paddison,Nancy V <
nvpaddis@xxxxxxxxxxxxxx>
*Sent:* Wednesday, June 30, 2021 2:42:22 PM
*To:* 'aptaoncology@xxxxxxxxxxxxx' <aptaoncology@xxxxxxxxxxxxx>
*Subject:* [aptaoncology] Re: [EXT] Re: [External]Re: Lymphedema pump
question

I agree with the information from Andrea and Andrea thanks for the
additional reminder/review of the literature results.

We give appropriate patients a pump with the same criteria as mentioned.
Generally, this is for Stage 2 patients.

We also look at if the patient is compliant with skin care, exercise and
compression but cannot perform MLD or does not have a caregiver to do so.
If that is the case, we would recommend a pump, again on the lowest
settings. We exclusively recommend Flexitouch as it includes a trunk piece
component where others do not.

Nancy

Nancy V. Paddison, PTA, CLT-LANA, BA

Senior Physical Therapist Assistant

Rehabilitation Services

MD Anderson Cancer Center

713-792-3192

*From:* aptaoncology-bounce@xxxxxxxxxxxxx <
aptaoncology-bounce@xxxxxxxxxxxxx> *On Behalf Of *Branas Andrea R
*Sent:* Wednesday, June 30, 2021 12:37 PM
*To:* aptaoncology@xxxxxxxxxxxxx
*Subject:* [EXT] [aptaoncology] Re: [External]Re: Lymphedema pump question

*WARNING: *This email originated from outside of MD Anderson. Please
validate the sender's email address before clicking on links or attachments
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The information that has been passed to me (via lymph experts) was that
pumps cause long term damage to the lymphatic system. However, when reading
the literature, one thing that stands out is that the pump pressures and
times have decreased significantly over the past 20 years. And while none
of the literature says it, I would imagine that the decreased pressure on
the superficial lymphatic structures causes less (or no damage to the
system). That being said, we do need to be very thoughtful about who gets a
pump and why.

In the adult population (which likely carries over to teens/young adults),
there seems to be a net benefit to the use of pump when used in conjunction
with daily compression and some proximal manual lymphatic drainage. If our
patients are not willing to wear garments, they should not waste the time
and money to have a pump. There is no evidence that true lymphedema will be
reduced with the use of pump and no compression.

I work in pediatrics, and in this setting there is zero evidence that the
pump works. My guess is that it’s very difficult to study pumps in
pediatrics, partly because the pumps are not the right size for kids. My
experience in providing manual lymph drainage and bandaging in kids is that
the tissues are extremely pliable, and we are able to reduce most edema
quickly without the need for a pump. Offering a pump to a family prior to a
trial of PT makes them think that pumps are instead of CDT, not as an
augment to the treatments we already provide.

The 2 issues that I would worry about the most with use of the pump are
genital edema, and proximal volume overload (without the patient knowing
how/when to report/stop). If a patient is compliant with coming to PT for
education, manual lymph drainage and wearing garments, then a pump may be a
great way to give them long-term independence.

Bottom line is... if a patient is already compliant with wearing garments,
regular replacement of garments and finds that regular MLD is helpful...
then a pump on the lowest effective setting could give them long term
independence. If they are not wearing garments, then they should not have a
pump.

Andrea

Andrea Richtel Branas PT, DPT, MSE

Certified Lymphedema Therapist

Physical Therapist

Division of Rehabilitation

Children's Hospital of Philadelphia

branasa@xxxxxxxxxxxxxx
------------------------------

*From:* aptaoncology-bounce@xxxxxxxxxxxxx <
aptaoncology-bounce@xxxxxxxxxxxxx> on behalf of Louis-Ferdinand, Amelia <
alf@xxxxxxxxxxxxx>
*Sent:* Wednesday, June 30, 2021 11:52 AM
*To:* aptaoncology@xxxxxxxxxxxxx <aptaoncology@xxxxxxxxxxxxx>
*Subject:* [External][aptaoncology] Re: Lymphedema pump question

https://klosetraining.com/2013/11/22/to-pump-or-not-to-pump/
<https://urldefense.com/v3/__https:/nam10.safelinks.protection.outlook.com/?url=https*3A*2F*2Fklosetraining.com*2F2013*2F11*2F22*2Fto-pump-or-not-to-pump*2F&data=04*7C01*7CBRANASA*40chop.edu*7C4346cef2c9f94265be1208d93bdf1f8f*7Ca611241607b041a59bb1d146b575c975*7C1*7C0*7C637606652355151095*7CUnknown*7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0*3D*7C2000&sdata=tLqzjNbuIvo75A4IPS3uS9FS8oF071c5JLIgqetTlJ0*3D&reserved=0__;JSUlJSUlJSUlJSUlJSUlJSUlJSUl!!PfbeBCCAmug!xS3UfVKIZ1sCxPGyWCzT5TJX8EBQnMzLW0Um9D02X1d_ib9s2DXwxwxmbGqJfyFhFA$>

I don’t use pumps often so might not be the best in recommending specifics
but when I do or if I come across a patient who already has one and wants
feedback on settings I generally use this info.  IF there is more updated
info would love feedback on that myself.

Best-Amelia

*Amelia Louis-Ferdinand PT, OCS, CLT-UE*

Clinical Specialist

<https://www.google.com/maps/search/325+E.+Eisenhower+Pkwy.,+SPC+5744++%7C++ANN+ARBOR,+MI++48108+%0D%0A+OFFICE:+734?entry=gmail&source=g>

Physical Therapy

Burlington Bldg Lower Level Suite 1

325 E. Eisenhower Pkwy., SPC 5744
<https://www.google.com/maps/search/325+E.+Eisenhower+Pkwy.,+SPC+5744++%7C++ANN+ARBOR,+MI++48108+%0D%0A+OFFICE:+734?entry=gmail&source=g>
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ANN ARBOR, MI
<https://www.google.com/maps/search/325+E.+Eisenhower+Pkwy.,+SPC+5744++%7C++ANN+ARBOR,+MI++48108+%0D%0A+OFFICE:+734?entry=gmail&source=g>
48108
<https://www.google.com/maps/search/325+E.+Eisenhower+Pkwy.,+SPC+5744++%7C++ANN+ARBOR,+MI++48108+%0D%0A+OFFICE:+734?entry=gmail&source=g>

OFFICE: 734
<https://www.google.com/maps/search/325+E.+Eisenhower+Pkwy.,+SPC+5744++%7C++ANN+ARBOR,+MI++48108+%0D%0A+OFFICE:+734?entry=gmail&source=g>
-763-6464

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*From:* aptaoncology-bounce@xxxxxxxxxxxxx <
aptaoncology-bounce@xxxxxxxxxxxxx> *On Behalf Of *Mary Fisher
*Sent:* Wednesday, June 30, 2021 9:35 AM
*To:* aptaoncology@xxxxxxxxxxxxx
*Subject:* [aptaoncology] Lymphedema pump question

*External Email - Use Caution *

Hi all,

Just looking for what criteria you use to determine if someone would
benefit from a lymphedema pump.  If so, what are the brands recommended?
What parameters?

*Mary I. Fisher, PT, PhD  |  Chair and Associate Professor*

*Board-Certified Clinical Specialist in Orthopedic Physical Therapy*

*Cer**tified Lymphedema Therapist*

300 College Park |
<https://www.google.com/maps/search/300+College+Park+%7C+Dayton,+OH+45469-2925?entry=gmail&source=g>
Dayton, OH 45469-2925
<https://www.google.com/maps/search/300+College+Park+%7C+Dayton,+OH+45469-2925?entry=gmail&source=g>

mary.fisher@xxxxxxxxxxx | Telephone: 937.229.5617 | Facsimile:
937.229.5601

she/her/hers

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--
Lesli R. Bell PT, DPT, CLT-LANA

321 Main St., Suite D
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Home: 802-879-2868
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lesli.belldpt@xxxxxxxxx

References:
- [aptaoncology] Re: [EXT] Re: [External]Re: Lymphedema pump question
  - From: Cohn, Joy

[aptaoncology] Re: [EXT] Re: [External]Re: Lymphedema pump question

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