Case 139: Patient Has Long-Lasting Relief from Chronic Lymphedema with Eight Outpatient Treatments.

At age 74, this man was referred by his family doctor for boot therapy for bilateral chronic lymphedema. He had seen many doctors over 40 years. A recent CAT scan of the abdomen revealed no intra-abdominal obstructive pathology. His cardiologist provided no help. Noninvasive vascular arterial and venous studies were normal. His legs no longer diminished in size at night. He found support stockings (Suphose) too painful to wear. His past surgical procedures, which were not closely associated in time with his lymphedema, included prostatic surgery, a vasectomy and thyroid surgery. His medicines included Synthroid (L-levothyroxine), furosemide 40 mg daily, Hygroton 50 mg and 3-4 ounces of whiskey daily

The circumferences of his right leg were larger than those of his left: 13 1/8 vs 12 1/2 inches at the ankle, 18 vs 17 1/4 inches at the calf and 22 1/2 vs 22 inches at the thigh.

The circumference of both the right and left legs diminished after eight treatments given to the right leg only: 11 3/8 and 11 1/2 inches at the ankle; 16 1/4 and 16 1/8 inches at the calf, and 22 1/8 and 21 1/8 inches at the thigh respectively.

He returned for a few treatments in 1987 reporting that his legs were then just beginning to swell again.

Long-Boot treatments were only given to the right leg because it was larger and more symptomatic. After his course of therapy, he was referred to our physical therapy department for additional treatments with a Jobst Boot. We sought to ascertain if additional reduction in his leg size would result (it did not) and if he could benefit from the purchase of the less expensive Jobst home boot. He found the Circulator Boot had a massaging and softening action that the Jobst Boot did not have.

Comments: This case history, without photographs, was reported in the 1997 Angiology Supplement devoted to boot therapy. In reviewing his pictures for this rendition of his story, we were pleased to find we had made an error: it was five years between the first and last photograph, not the two years reported in Angiology. The approximate 25,600 compressions (8 treatments x 40 minutes per treatment x pulse rate of 80) his leg received apparently had altered the pathophysiology of his lymphedema. We hypothesized we had decreased an obstruction in his pelvic lymphatics.