From: hmgold@mcs.com I have a 65 year old obese diabetic woman with chronic stasis dermatitis. The skin of her legs is fibrotic and lichenified with elephantiasis verrucosa nostra changes. She has acute flares of the stasis dermatitis which produce bullae, erosions and ulcers. These have been treated successfully with Unna's boots. She cannot wear graduated pressure stockings because of the cone-like shape of her legs. I have ordered a Lymphapress pump for her to prevent leg edema/lymphatic edema and hopefully prevent ulceration. Does anyone have experience with these pumps? Is one better than another? Is there potential harm in using one on this patient? Harry Goldin, M.D. ======================= From: Marilynne Mckay I am definitely a fan of the Jobst pump =D1 I don't know if that's the "Lymphapress" you're talking about, though. This patient has some strikes against her, however...she's got chronic changes and she's a relatively elderly diabetic who may well have other health problems. She may have a very hard time using a pump on her own. I prefer to send the patient to a hospital near their home that has a Jobst pump (most around here, Atlanta, seem to) and let the therapists work with her on a regular basis for a few weeks or so to see if this is going to be successful. If it is and she thinks she can do it, fine. If she just gets one for herself and tries to use it with written instructions, I'd be afraid that she would not be able to use the darn thing correctly and you'd never know if it was a good idea or not. (As much as I believe in them I don't have any idea how to actually work one, so I couldn't be a resource to a patient--maybe you know more about it.) You could probably call the PT dept and talk to someone about your plans for the patient and they'd be glad to help.=20 By the way, I really like the physical therapy departments -- many can do outpatient whirlpool therapy for chronic ulcers and put on Unna boots or dressings, which is a real blessing when the patient lives a long way from your office and hasn't got transportation. Occupational therapists are very helpful too for patients with difficulty in "activities of daily living" (psoriatic arthritis or stroke patients, for example) who need special shoelaces and long reachers for applying medications (they're not "play therapists" like many people think they are.) I always like to take the residents on a "field trip" to the hospital's PT/OT department so they can talk to the therapists and see what they can do...they taught me a lot and it's been a real help to my patients. Marilynne McKay, MD ======================= From: "thomas r. brander" I have a patient with lymphedema verucosa nostra who responded quite well to a sequential intermittent pneumatic compression device. The device consists of a thigh length boot, with 5 pneumatic compartments, which attaches to a pump. The pneumatic compartments sequentially inflate from the foot to the thigh. One can adjust the pressure of the pump and the duration of therapy. Typical pump pressures range from 40 - 70 mm Hg and duration of therapy from 1 to 4 hours BID. My patient had a history of CHF. He was hospitalized upon the initiation of treatment to monitor for pulmonary edema. Within 1 week he lost 15 pounds of fluid and had a significant decrease in leg diameter. Most importantly to the patient is the diminution of the verrucous changes and the elimination of the fetid odor of gram negative colonization. I obtained the device from Health Units phone (312) 235-2061. Thomas R. Brander, MD =========================== From: Gfweb@aol.com I use lymphedema pumps frequently. Those with sequential inflation seem to work the best. I often try to get a home health aide to come by several times during the first week to be sure that its being used right. Guy Webster =========================== From: BJack10097@aol.com you might contact Dr. Duyen Faria,Henry Ford Hospital Dept of Dermatology 313-876-2171. She is a leg ulcer specialist and has alot of experience with these types of patients. Brooke Jackson, MD ================