From the Editor: Issue 1 of a 2 Part Compression Continuum

  “If you don’t have a wound then I can’t help you. I run a wound center.” I actually said this to a woman who called my office about 13 years ago seeking help with her post-mastectomy upper extremity lymphedema. But women are so darn persistent when they want something (I know this since I am one). I thought (foolishly, it turned out), “I know a lot about leg edema, how hard can this lymphedema thing be?” So I went to my first National Lymphedema Network (NLN) Meeting, and read the one textbook that was on the market at the time. It is ironic that I am writing this editorial now, while I am actually attending the 2010 NLN meeting. I have faithfully attended these conferences for the past 12 years because it turns out that I knew nearly nothing about edema management until I met these people. I started our lymphedema clinic with a part time therapist, and despite the fact that my hospital did absolutely no marketing of our fledgling lymphedema service, at the end of a year, I needed 6 full time therapists to meet the demand created by word of mouth from patients. Thanks to the NLN, its dynamic Director Saskia Thiaddens, and my own wonderful therapists, I managed to learn what I needed to know about the management of cancer related lymphedema, as well as the challenge of treating children as young as 6 months of age with primary lymphedema.

  I also learned why some venous ulcer patients with secondary lymphedema do not heal with the bandage systems we use for venous insufficiency. Soon I was turning over patients with difficult wounds and secondary lymphedema to the manual lymphatic drainage (MLD) therapists for treatment. I now wonder how I ever thought I could run a wound center without MLD therapists.

  Wound care clinics face trying times. Frankly, lymphedema services greatly expanded our referral base and provided a new direction for my clinic. Clinicians from cardiology to orthopedics are so frustrated with edema in their practices! They want us to fix it. But even for experts, long-term management is difficult. Meghan Hegarty writes about compression as an engineering problem. Her enlightening article covers compression bandages, compression hosiery, pneumatic compression systems, vascular mechanics and the challenges of providing the right products for these patients.

  In the more than 10 years I have been involved in lymphology, the field has undergone a quiet revolution. Initially, pneumatic compression devices (PCDs) were relatively unsophisticated and debate raged regarding whether their use was even harmful. Although all patients do not need one, I now find them a valuable adjunct in the management of difficult patients, particularly those with truncal or genital swelling, massive localized lymphedema and venous ulcers with secondary lymphedema. Dr. Cecilia Cervantes and Sharon Orphey provide one the best articles I have ever read the association between lymphedema and delayed venous ulcer healing, the mechanism of action of PCDs, their classification and clinical use.

  I now see venous disease and lymphedema as a sort of continuum. You will find that the October issue and the upcoming December issue are a continuum of information. They will both contain articles pertaining to venous ulcer management and lymphedema treatment because we understand these diseases are often treated together and the tools you need may apply to both. In answer to the question I asked 12 years ago, “How hard can this be?” It isn’t hard with the right information.