Class II Custom Glove and Sleeve - Medi or Elvarex

Sher · February 2010

Sher · February 2010

I developed hand LE last month 2 days after I started having pain in my wrist from what I was told was Tendonitis. My hand isn't completly normal, but better than it was after therapy and compression bandaging - therapist said my measurements have stabilized. (Guess that means it might not get any better?) Anyway, she sent me to be fitted for my first compressions garments and I am not sure what to order. The place where I went to be fitted (I live in Northeast PA) is the only place around and as I have read that sometimes happen, fitters have a favorite. Elvarex seems to be it. I was able to get a little information about Medi, but could only see samples in Class I materials and was told their garments are more expensive and take longer to be made than Elvarex. The fitter didn't really go into other makes.

I'd love to hear pros and cons of both garments (or if any other custom Class II is preferred) so I can place an order asap.

kira66715 · February 2010

Sher, why class 2? You do want to avoid over-compression as it can set you up for rebound swelling and inflammation.

Personally, I've had Elvarex--and they contain latex, and currently I have a custom Juzo and for other times, I have off the shelf medi 95. I started with the medi 95 and got the custom Juzo (after 5 attempts) recently.

I don't like the off the shelf Juzo, but I do like this custom one.

I've only worn class 1--except a brand new fitter didn't realize that off the shelf Juzo is compression class 2 in 20-30 mm and as soon as I slipped that on, my fingers turned cold and purple.

I vote for custom Juzo. I do like the medi 95 though.

On the stepupspeakout site we have information on correct fitting of gloves and compression classes.

http://www.stepup-speakout.org/proper_fitting_of_lymphedema_garments

Kira

Your hand can still improve, this is just a maintance step, to get a compression glove

Marple · February 2010

Kira, I too am having some problems with Juzo custom fit. What's up with that? I do like them though.

Sher · February 2010

Kira, I don't know for sure about the Class II? I thought Class I was mostly just for prevention when exercising, etc? Both my therapist and the fitter said if a Class II is used on the hand, the same is needed for my arm.

kira66715 · February 2010

Sher, class 1 is the usual class you start with for compression--it is true that if you use class 2 on the hand, you should use the same class on the arm so as not to push the fluid up.

The only lower class is made by Jobst as a below class 1--it's a 15-20 mm sleeve and some therapists have women at risk use it for flying. No one else seems to make that below class 1 compression.

As Binney wrote on the stepupspeakout site, compression is confusing as some manufacturers class 1 is 20-30 and some use the European 18-20 (like Juzo).

Over-compression is not good, and I personally have wrapped too tightly and caused myself problems, there is a desire to wring that fluid out of there, but "less is more": you want to use the least amount of compression that does the job, because over-compression traps fluid and can cause swelling.

Sharon: FIVE gloves--finally the rep got called in and the next one was right. And they acted like it was my problem....

Kira

Sher · February 2010

Which Juzo is in that you like Kira? I think only the Varin is available class II custom, right?

LindaLou53 · February 2010

I have worn both Jobst Elvarex and Mediven 550 Custom sleeves and gloves. In Jobst I wear a CCL3 and in Medi I wear a CCL2. You need to closely note the differences in how each company defines the compression level for each class. Its more important to have your LE therapist determine the compression level you need rather than the class designation. Also there is distinct difference between a CCL1 Circular Knit garment vs a CCL1 Flat Knit garment. Circular knit tends to be softer, more comfortable but also more elastic. Flat knit is coarser and heavier, but may be more effective especially for fibrotic areas.

JOBST ELVAREX CUSTOM FLAT KNIT

CCL 1 = 14-18 mmHg

CCL 2 = 20-25 mmHg

CCL 3 = 25-30 mmHg

MEDIVEN 550 CUSTOM FLAT KNIT

CCL 1 = 18-21 mmHg

CCL 2 = 23-32 mmHg

CCL 3 = 34-46 mmHg

JUZO CIRCULAR KNIT (Varin Soft-in, Soft 2000)

CCL 1 = 20-30 mmHg

CCL 2 = 30-40 mmHg

CCL 3 = 40-50 mmHg

JUZO FLAT KNIT (Juzo Strong, Juzo Helastic)

CCL 1 = 18-21 mmHg

CCL 2 = 23-32 mmHg

CCL 3 = 34-46 mmHg

I have tried wearing off the shelf Juzos in circular knit but they just cannot provide the compression level I require. Custom Flat Knit garments are slightly heavier and coarser fabric but can be more effective against persistent swelling and fibrosis. I have found that the Mediven 550 custom flat knit gloves are much more effective on my LE hand than the Jobst Elvarex glove was. Elvarex had a tendency to stretch out at the fingers after several wearings and the base of my fingers would get puffy with inadequate compression there. The Mediven glove tends to keep its shape longer and provides good compression at the base of my fingers.

Having very persistent hand LE myself, it is almost impossible to get adequate compression across the dorsal and palmar areas of the hand with a glove alone. I usually insert pads or wrap short stretch bandages with pad over top my glove on days I can stay at home or don't need to do a lot of fine motor functions with my hand.

I agree that you should use the minimum amount of compression that effectively keeps your LE under control. That amount of compression will vary between individuals. Use your therapist's expertise and your own personal experience to determine what works best for you.

Binney4 · February 2010

Sher, definitely personal experience helps. But it's a daunting process. Frown Hang in there!

As Linda points out, "compression class" is a tricky concept, and it's better to get the mmHg numbers your therapist wants so you and she and the fitter are all on the same page. As far as I understand, custom garments can be made to any number -- that's one of the reasons they're "custom."

As far as personal experience goes, I've ended up with Gottfried garments. The fit is excellent, their turn-around time on an order is four days, and my fitter loves working with them because they seem to really want the stupid garments to fit correctly (will wonders never cease!) If you pay a percentage, they're also competitively priced. Smile I've used them for a year now (two sets in that time), and find they hold up very well. I told my fitter about Gottfried because I wanted to try it, and she was willing to contact them for information and samples, so you might see if your fitter is open to new experiences.

You might suggest to your fitter that she do a bit of "comparison shopping" in the garment section at StepUp-SpeakOut.org. Most fitters have no idea how many brands are available. (Why would they? THEY don't wear them! Undecided )

Keep us posted!
Binney

Sher · February 2010

I don't think my fitter is open to new experiences. When I asked her today if either Elvarex or Medi contain Latex, she said "where did you find that - on the internet?" She was making a pointed reference to a few other questions I asked based on product information I'd found here.

I'm told by fitter that my insurance will not cover any of the cost of this $400 + combination, so if I'm paying for it, I want it to be an educated choice. My insurance company tells me they need a 'code' to check if LE garments might be covered under orthotics at 50%, but no-one seems able to come up with the code.

My therapist wrote on the paper for the fitter that she wanted me in 30-40mm compression. I thought she also wrote Class II but I might be mistaken about that. I will call her tomorrw to check for sure.

Gottfried turnaround 4 days for custom? Sounds much better than 10 days to 3 weeks!

kira66715 · February 2010

Sher, it's not covered? That's absurd. Almost all insurances, except medicare, cover garments. The ICD-9 code is 457.1 (post mastectomy lymphedema), but there are specific garment codes, and I know that Bob Weiss: lymphactivist@aol.com would know the codes.

Linda and Binney gave you expert advice.

If you are supposed to be paying the entire cost, the fitter better give you exactly what you want and need. Linda wrote a great summary about types of garment cloth and different compression class.

Moogie had issues with Elvarex, I didn't like my elvarex glove much--I like the Juzo varin much more. I also need finger control, and it gives it.

Bob Weiss posted the codes on lymphedema people:

http://www.lymphedemapeople.com/thesite/lymphedema_insurance_codes.htm

Code Description

A4454 Tape
A4460 Elastic bandage (e.g. compression bandage). Use this code to report compression bandages associated with lymphatic drainage
(CIM 60-9, MCM 2133, ASC)
A4465 Non-elastic binder for extremity. Use for Reid, CircAid, ArmAssist, etc manually-adjustable sleeves and leggings. Medicare jurisdiction DME regional carrier (CIM 60-9, MCM 2133, ASC)
A4490-4510 Surgical Stockings
A4490 Surgical Stockings above knee length (each)
A4495 Surgical Stockings thigh length (each)
A4500 Surgical Stockings below knee length (each)
A4510 Surgical Stockings full length (each)
A4649 Miscellaneous Surgical Supplies, Compression bandaging kit
E0650-0652 Pneumatic Compressor and Appliances
E0650 Pneumatic Compressor, non-segmental home model
E0651 Pneumatic Compressor, segmental home model, without calibrated gradient pressure
E0652 Pneumatic Compressor, segmental home model, with calibrated gradient pressure
E0655-0673 Arm and Leg Appliances used with Pneumatic Compressor
L0100-L4398 Orthotics
L2999 Lower Limb Orthosis, not otherwise specified
L3999 Upper Limb Orthosis, not otherwise specified
L4205 Repair of orthotic device, labor, per 15 minutes
L4210 Repair of orthotic device, repair or replace minor parts
L5000-L5999 Lower Limb
L6000-L7499 Upper Limb
L8000-8490 Prosthetics
L8010 Mastectomy Sleeve, Ready-Made
L8100-L8239 Elastic supports
L8100-8195 Elastic Supports, elastic stockings various lengths & weights
L8210 Gradient compression stocking, custom made
L8220 Gradient compression stocking/sleeve, Lymphedema, Custom
L8239 Gradient stocking, not otherwise specified. Carrier discretion.

I know my fitter told me there was a non-specific code that started with an A that most insurances accepted.

I take offense that the fitter gave you any grief about learning that Elvarex has latex in it through the internet. She's only willing to order from two companies, and really prefers Jobst/Elvarex. That's not consumer friendly.

A good fitter is an important person.

Good luck.

Kira

Sher · February 2010

I've put in a call to my insurance company representative who is checking coverages for compression garments. I'm also going to try and locate a different fitter, even if it's necessary to travel some distance out of my area.

Thank you all for your very informative and helpful responses. I appreciate all of you so much and would be totally lost without your help!

kira66715 · February 2010

Sher, this board is a life saver. I went on a hunt for the newest DME code, and found this for

2010HCPCS Code: A6549

Long Description: GRADIENT COMPRESSION STOCKING/SLEEVE, NOT OTHERWISE SPECIFIED

Have your insurance company use this code, I'm pretty sure it's the "A" code my fitter told me about. The other codes were about three years old and they change them yearly, just to be confusing.

Hang in there.

I worked with an initial fitter who was good at what she did, but a terrible business woman, and hit me up with a bill for "balance billing" which is illegal if you're a participating provider--you have to accept the contracted rates. Blue Cross went after her (ironically, I'd called them to see if they would give her more money because I felt sorry for her--having already paid her a lot of money, and they got upset and went after her).

Now, I have a local fitter who gets things reimbursed properly. It took almost a year to find someone. I was going to medical suppliers and buying things, and buying things on the internet. It shouldn't have to be this hard.

On the proper fit page on stepupspeakout, there are also stories of fitting mishaps.

http://www.stepup-speakout.org/proper_fitting_of_lymphedema_garments.htm

Kira

Kicks · February 2010

Fri. morn I picked up my day sleeve and glove (Juzo - sleeve - off the shelf, glove custom as I have short finger compared to width of hand). By the time I had gotten to rads my hand and arm had swollen drastically/majorly (palm to back of hand was 2 1/2 - 3 in. thick). Put in a call to him but got voice mail so I stopped on the way back to rads and talked to rad Dr.'s nurse - she got through to him and he said to take it off as he thought that probably a reaction to the material (no itching or redness so don't "buy" that).or maybe too much compression. Anywho, I can't see him til Tues. morn at 8 am as he won't be in - so any help to pass on to him would be appreciated.

My night sleeve has been working pretty good (got it a week ago Thurs.) except for hand. He gave me a very light glove to use with it and last night it worked much better.

He seems to be a knowledgable young man with a 'bunch' of experience with old men's legs but has basically no experience with women with mastocetomies. I'm the 2nd, or maybe 3rd, woman he's dealt with (he's a VA employee).

So - I'm trying to find as much as I can before I see him on Tuesday so any thoughts/info appreciated.

Susan

kira66715 · February 2010

Susan, that kind of dramatic swelling sounds like possibly over-compression.

Hands are very tough, and a fitter who really knows legs is on a learning curve with you. There is usually a Juzo rep that he can call and that person can come and see you with the fitter and give advice.

Do you have a lymphedema therapist? Because a therapist should be involved with the glove recommendation and checking the fit, as well as the compression class.

Does your night sleeve go down to the hand? What brand is it? I have difficulty with my night sleeves working well for my hand.

It doesn't sound like you should be wearing the compression garments until you're checked, and hopefully there is a lymphedema therapist who can help advise the fitter.

I once checked out a fitter who primarily did legs and he was clueless about gloves. Just clueless.

Here is a link to our site about proper fit:

http://www.stepup-speakout.org/proper_fitting_of_lymphedema_garments.htm

I realize the link was on the last post, but hopefully it helps.

When I had trouble getting a Juzo custom glove to fit, they called in the Juzo representative and I finally got a glove that fits.

Let us know how you make out.

Kira

Kicks · February 2010

The young man I'm seeing (who measured for and ordered the sleeve and glove) is a certified lymphadema therapist at the local VA hospital. Basically why he sees almost exclusively men.

I took the sleeve and glove off as soon as rad. Dr's nurse said to and haven't had it back on since.

My night sleeve is a Tribute by solaris. It comes down almost to knuckles. It seems quite loose in the hand area to me but the light glove did a lot last night - it's made by Isotoner, very light weight with seams to the outside and no finger tips. Except for being 'inside out' and no tips it feels very much like a pair of Isotoners I had years ago.

The more info I get - the more I think that he ordered too much compression. I remember him saying that he was ordering with quite a bit and after waking up this am with the least swelling in hand in a very long time with the light isotoner. It really doesn't make sense to me how more compression would make the area compressed swell more but I guess it does.

I'm out in the 'boonies' with there being no town bigger than about 70,000 closer than 300 miles so not a lot of options. Mon. afternoon I go to a local health/med store to try the bras and prosthesis they ordered, so might ask them for info if they have any.

Thanks!

Susan

Binney4 · February 2010

Hi, Kicks,

Bummer! Frown

Overcompression causes rebound swelling as your body reacts to what it considers "trauma" by sending more lymph fluid to the area -- an immune response intended to help fight off the bad guys. Since our lymph systems are already compromised, however, it's just too much of a good thing. Way too much. Tongue out Legs require more compression than arms because of the gravity -- all the lymph has to be pumped UP to the trunk against gravity, and it's a long way. Our arms are less of a problem that way.

Some people are more sensitive to compression than others -- me, for instance. Pressure sensitivity seems to be mostly a problem with women who have a small build, which I'm guessing has something to do with the physics of compressing the sides of cylinders (our arms, in other words). The bigger around the cylinder is, the less pressure is exerted overall, or some such thing, so that a higher pressure is magnified in smaller arms.

None of which solves your problem, but it does sound like your therapist is aware of the problem of overcompression. What he may not be aware of (since he's a leg person) is that overcompression can also be complicated by the material used -- some work better than others. The Juzo Dreamsleeves, which are very soft, work well for me, but their custom garments turn my fingers blue and make me swell in a very short time. Bio-Concepts will make garments in a fabric called "Soft" that also works, but it's not real durable. I now regularly use Gottfried garments which I can tolerate very well. My fitter has learned to give me extra room across the palm of my hand so the compression doesn't make my hand pull in at the sides and allows for more even compression across my palms. An the Gottfried garments come with a wide, silky lining in the elbow area that cuts down on chafing. I am, in short, a mess to try to fit. Takes a few tries, but once they get it right it's such a relief. Hang in there, keep your arm elevated as much as possible until Tuesday (or, do you know how to wrap it? That's better). Or wear the Isotoner and Solaris around the house (or even out shopping if you're comfortable with that.)

Let us know what you discover!

Gentle hugs,
Binney

Binney4 · February 2010

Kicks, last night when I was getting into my night gear I thought of you and your Solaris Tribute, and I wondered if you have the finger spacers in the hand part? You have to specify that when you order it or they leave the fingers without any separation between them -- doesn't work for me. If not you may want to consider sending it back to them for revision. Shouldn't come out of your pocket because it'd be your therapist's error.

Also, I do use a Solaris Swell Spot called a Palmer Spot inside my Solaris, against my palm. That helps a lot to add compression to the hand.

I also have night gloves by Jovi-Pak (I've been at this a long time Tongue out ) that have the palm compression spot sewed in -- a bit less bother. I find their gloves made better in the fingers too -- no spacers, just stitched between the fingers so it seems to fit the fingers better.

On the other hand, I like the way the Solaris fits my arm better than the Jovi-pak. Undecided Makes every night a toss-up!

Be well!
Binney

Sher · March 2010

Night gloves? Are there other manufacturers for these, or just Jovi-Pak?

Binney4 · March 2010

Sher, Jovi made me gloves separate from the night sleeves. I prefer the one-piece arm/hand arrangement that I have from Solaris because...well, because the more moving parts there are the more likely I am to misplace one! Embarassed Not real clever here, and especially not at night. Because I'm bilateral, Solaris makes mine with a wrist to near-the-top zipper for ease of donning, but Jovi doesn't do that, so I have to have separate gloves. (Did that make sense? If not, try picturing pulling on a very tight sleeve/glove with the other hand already encased in one Tongue out ). Jovi will sew in a palm spot and for me, and the finger fit is better, but the Solaris arm part is just a better fit and more comfortable. Sometimes I think I might just cut the glove part off the Solaris and wear the sleeves with the Jovi gloves, but the thought of all those chipped foam pieces flooding out of those cute little channels all over my sewing table, and trying to stuff them back in with a tweezers or something, always stops me.

You could ask Solaris if they'll make you separate pieces, if that's what you're after -- I believe Kira has such a thing as a Solaris night glove. Telesto Medtech does that too. If we don't tell these people what we want, they can't guess. And if they don't make what you want, tell them that too -- mostly these folks are open to hearing us, since their livelihood depends to some extent on our goodwill, and we need to keep them aware of that. Kiss

Let us know what you discover!
Binney

kira66715 · March 2010

Sher, I have a few products: an open fingered glove to elbow by JoviPak, an open fingered glove to axilla by JoviPak and a one piece, fingertip to axilla with finger spacers by Solaris.

I have to say, I think the Solaris works best--although the first one they made was too short and they had to make me a second, new garment that covered my whole hand, which they did quickly and well. (I sent back the first which barely came to my first finger joint.)

I tried to work with Telesto Medtech, but at the time, they didn't make gloves and the custom garment they tried to make didn't work out.

Hands are tough, so I still wrap at night most of the time, and use the Solaris for a break. I'm not using the Jovipaks at all (an expensive waste, but when I read about the flexitouch pumps that aren't being used, it's all relative.)

Kira

Sher · March 2010

Gosh, I had no idea that night gloves were available! Separate pieces might be an advantage sometimes.

I haven't made any progress in finding a different fitter so don't even have an order in for a daytime glove and sleeve yet and I'm getting very, very tired of bandaging. It's not too bad when I can stay home and take as long as I need and wear any old clothes that are comfortable, but work days are not fun. I normally don't get around too quickly in the morning and now it takes me even longer Sleeping with bandages has been hard for me to get used to. Last night I was trying to arrange the blankets up around my shoulders and managed to unwrap my thumb, so back out of bed to fix that. Except for internet pictures, I've never seen any night garments - are they any smoother/slipperier on the outside so they don't catch and drag on the blankets like the bandages do?

The Solaris fingertip to axilla with finger spacers - it's kind of hard to see in the pictures, but does it completely cover the fingers an thumb? And you put the spacer in separately or is it fastened in when ordered that way? That is the Tribute, right?

I called my therapist today to double check her recommendations for compression. She thinks I definitely need a 30-40mm daytime glove to keep my hand from getting worse, but that I should be able to do less compression for the sleeve. I called her at a bad time and still not understanding compression ratings. If a custom garment is ordered at 30-40mm compression, does that mean the classhas nothing to do with it? Or is the garment ordered by class which determines the compression?

Do I sound confused? I think it's getting worse instead of better.

kira66715 · March 2010

Sher, typically 30-40 is class 2 (but not always as Liinda and Binney wrote)--so I think she wants you in a class 2 glove.

The night garments: Tribute is a rougher fabric, but very durable, and JoviPak uses a soft polartec fabric. I complained to Binney that the Tribute material was like burlap, but the more I use it, the more I like it, and it feels like a big, soft oven mitt.

My Tribute came with the fingers only going to the first knuckle, and I had them remake it to go to the nail beds. They said people want it shorter so they can read in bed, I said "I don't want my fingers to swell." I can still read in bed...

The finger spacers are sewn in. You can trim them if needed.

This stuff is incredibly confusing. And you go to pick up garments you never wanted to wear...

Kira

Jennifer1295 · March 2010

After all this time I learn something new all the time.

Marple · December 2011

I did a search on the site and came up with this thread again.

I'm having trouble with Juzo custom fit. Apparently my fitter was getting Juzo from Germany but now they are being made in Ohio and there has been a problem programming the machines correctly for the custom fits. My fitter suggested trying medi but (when they fit) I like Juzo and hate to start all over again with a different type sleeve. Does Medi have a seam or is it a circular knit.

Anyone else have any suggestions or info on Juzo?

Gentle hugs all.

Class II Custom Glove and Sleeve - Medi or Elvarex

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