In-patient LE care

kira66715

This came up on google alerts, and Pat O'Connor, highly respected, endorsed them:

http://www.mdnews.com/news/2011_06/05867_mayjune2011_comprehensive-lymphedema-management

Comprehensive Lymphedema Management

By: Staff Writer
Thursday, June 16, 2011
Siskin Hospital for Physical Rehabilitation in Chattanooga, TN, offers all-inclusive inpatient and outpatient services for patients suffering from lymphedema.

In 1999, Siskin Hospital for Physical Rehabilitation launched an outpatient lymphedema program. When it became clear that patients with advanced disease were experiencing transportation, home, and traditional outpatient therapy challenges, an inpatient program was developed. Since then, patients throughout the region - with some coming from as far as Oklahoma and Illinois - have turned to Siskin Hospital for help managing their lymphedema.
Inpatient Care for Advanced Lymphedema

Patients with stage III lymphedema - characterized by severe swelling and the presence of fibrotic tissue - are indicated for inpatient care. At this stage, limbs are so swollen that the ability to carry out daily activities is compromised. Patients also usually suffer from other comorbidities and have an increased risk of developing nonhealing wounds. These complications make it necessary to provide an intensive inpatient multidisciplinary treatment program.

Siskin Hospital for Physical Rehabilitation requires a physician's referral for inpatient lymphedema treatment. As soon as a referral and medical records are received, the lymphedema program coordinator and the medical director determine the patient's appropriateness for the inpatient level of care. Treatment typically starts on the day of admission and discharge plans are rapidly developed as specific information related to the patient's needs are identified. In addition to lymphedema therapy, treatment includes physical therapy, occupational therapy, nutritional counseling, nursing care and education.

"Extensive training is necessary to help patients achieve success," says John Jordi, B.S., PTA, CLT-LANA, CI, Lymphedema Program Coordinator at Siskin Hospital. "Our goal is to eventually work ourselves out of a job, so that patients with this chronic condition can manage it on their own, allowing them to live a more normal and functional lifestyle."

Therefore, a large focus of the inpatient lymphedema program is educating patients on how to self-manage this chronic condition for the long term. Patients are taught self-MLD (manual lymphatic drainage), a customized exercise plan, how to wrap their limbs to maintain the right amount of compression, how and why to wear compression garments and how to do regular skin checks to help prevent skin breakdown, wounds and infections.

When patients arrive for inpatient care, they spend three hours a day with a certified lymphedema therapist. Patients generally begin seeing results during their first week of therapy. "While they are here, we expect that patients will have a fair amount of independence," says Jordi. "Most patients with severe lymphedema have limited range of motion, so our occupational therapists work with them and assist with activities of daily living, such as bathing, toileting and dressing. Their limbs have often become so swollen that they have stopped performing basic tasks at home, such as tying their own shoes or even wearing shoes."

Physical therapy is initially a large part of the program because patients have to learn proper and safe walking techniques, particularly while wearing compression wraps. The Fitness Center at Siskin Hospital located on the hospital's main campus offers a multitude of adaptive fitness equipment that can accommodate patients who have limitations.

According to Jordi, family support is also paramount to achieving successful outcomes. Family members and caregivers are encouraged to participate during therapy sessions to learn how to assist lymphedema patients with wrapping, while also helping the patients to maintain as much independence as possible.
Enhancing Patient Convenience

As more patients have sought care through Siskin Hospital for Physical Rehabilitation's inpatient lymphedema program, it has recently expanded to include an in-house durable medical equipment (DME) company. This service allows patients to be fitted with the proper compression garments on site. It is especially beneficial for breast cancer patients who have trunk swelling following lymph node removal, as it can be difficult for them to find the correct garments.

"With wrapping, we expect change every day," says Jordi. "As patients' limbs continue to shrink and approach normal size, we have to customize wrappings to accommodate these changes. Once the limbs have reached optimal size, patients can be fitted for more permanent compression garments. Having the DME component on site is advantageous for everyone involved. Patients can receive their bandages and garments much faster than if they ordered them online."
Transitioning to Outpatient Care

Following four weeks of inpatient care, most patients complete two to four weeks of outpatient therapy. "To ensure success, we make the transition from inpatient to outpatient care as seamless as possible," says Jordi. "After completion of the inpatient program, most patients experience great improvements in their overall health. Wounds resolve or improve and blood sugar levels improve in patients with diabetes. It is essential that patients maintain the skills and healthy habits they have learned. We don't want them to lose any ground that they have gained."

During the outpatient phase, their customized garments are ready, so a large portion of therapy focuses on teaching patients how to use them appropriately. "These garments can be difficult for patients to get on and off when they first receive them," says Jordi. "Currently, we are working with a research team at Western Carolina University to develop a product to assist patients with putting on their compression garments."
Collaborating With Referring Physicians

The staff at Siskin Hospital for Physical Rehabilitation puts special emphasis on ensuring that patients' primary care physicians are kept updated on their progress, so physicians can see how patients improve once the excess fluid has been removed. Every patient who completes the lymphedema program at Siskin Hospital for Physical Rehabilitation is referred back to his or her primary care physician for follow-up.

To make an inpatient referral, please call (423) 634-1246.

*Patients who have stage I or stage II lymphedema do not require inpatient care, but may benefit from outpatient therapy consisting of 15 treatments over a four-week period. To make an outpatient referral, please call (423) 634-1500. For more information, please visit www.SiskinRehab.org.

Here is Pat's comment:

Pat O'Connor

Posted Sunday, June 19, 2011 at 7:39:55 AM

I know John Jordi, the LE therapist and have heard many many good things about him and his care of his patients. I would recommend Siskin and John to anyone. Pat O'Connor

High praise from an expert in LE.

Kira