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Monday, July 28, 2014

Lymphedema services return at Cox Rehab

Wednesday, July 20, 2011

(Photo)
Outpatient lymphedema therapy services began at Cox Monett Rehabilitation in May 2011. Kay Bequette, of Marionville, at left, developed lymphedemia following surgery during her radiation treatments. Dr. Mindy Having, at right, is currently the only therapist at the Monett location. She is pictured above applying a glove and compression bandage to the right arm of Bequette. [Times Photo by Lisa Craft]
Outpatient Lymphedema Therapy Services have returned to Monett at Cox Rehabilitation and Sports Medicine.

According to Dr. Darren Bass, director of rehab, the service was offered over 10 years ago at the previous location on the north side of the hospital in Monett. The therapist left and was never replaced.

"Since then, we have heard constantly about the need," said Bass, "but it is very cost prohibitive for a small hospital to certify and train a therapist. The business model just didn't make sense for a small hospital.

"In March 2011, Dr. Mindy Having approached me identifying the need in the community and surrounding area," Bass continued. "I like to be progressive and look at new programs, so we talked and agreed to put Mindy on staff, since she was already certified and trained. She is rapidly making a great influence and dent on the need in this community."

Details on lymphedema are not widely known. It is a condition resulting in swelling of one or more limbs and often the corresponding quadrant of the trunk, caused by the disruption of the lymphatic system. It is a chronic, often progressive disorder that places one at risk for a grossly enlarged limb and skin infections.

The condition may occur following some surgeries, trauma, disease or radiation therapy, which results in damage to the lymphatic system. Occasionally, it is due to congenital absence or malformation of the lymphatic system.

Kay Bequette, of Marionville, developed breast cancer and underwent surgery. She had chemotherapy and is in the process of radiation treatments. During her treatments, Bequette developed lymphedema.

"When I had my surgery," said Bequette, "the pamphlet on lymphedema was included, and they told me it could appear up to 15 to 17 years after the surgery. Mine developed fairly quickly."

Dr. Having worked at the Meyer Clinic with Cox Health Systems in Springfield, and she was asked if she would be interested in training for this field. After observing for a few days, she decided to become a part of the lymphedema clinic.

"True lymphedema is a permanent condition," said Dr. Having. "A person might get a little better or it may get a little worse, but it never completely goes away."

A highly effective treatment is known as complete decongestive therapy (CDT). This state-of-the-art treatment, recommended by 1the International Society of Lymphology, often includes two to four weeks of treatment and the independent use of compression garments at home.

"Therapy consists of compression bandaging and light massage that consists of lymphatic drainage," said Dr. Having. "It targets the lymph nodes that we know are intact and working helps move the fluid. Eventually, the fluid will move to the kidneys causing the patient to go to the bathroom.

"Then massage progresses throughout the affected area, helping to move the fluid to areas of intact lymph nodes. When the edema is decongested, compression garments are considered to help control the swelling in normal daily life," Dr. Having explained. "That is an everyday thing, on during the day and off at night. Once the system is injured, it is always injured."

According to Dr. Having, if lymphedema goes untreated it will continue to swell and eventually lead to ulcerations as far as a wound.

"The fluid has to get out somewhere," said Dr. Having.

At that point lymphedema is a lot harder to treat and can develop into an infection and then the patient would have to be hospitalized. It can cause cellulitis, which would require a hospital visit, IV antibiotics plus going home with antibiotics.

"This condition can result from any kind of trauma to the body," said Dr. Having. "It depends on the level of trauma and on the person. We are also concentrating on educating the doctors. Not everyone knows what the condition is."

The swelling cannot be drained with a needle. It is located in the lymph system in a vast network, not a confined space.

"It has been a blessing for Cox Rehab to have Mindy," said Bass. "She is the only therapist at the Monett location. This is a program that we are looking for growth, and she is looking at opening more time so more patients can be served.

"Our goal at Cox Monett is to provide as many services locally as possible," Bass said. "We love Cox in Springfield and are closely tied. With that being said, if we can provide more services here for the Monett community, as well as the surrounding community, that is what we are here to do."



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