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Thread: Edema

  1. #1
    Senior Member mike's Avatar
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    Edema

    I recently went to a lymphadema specialist who suggested that I might need a pump to treat my edema. I was told that my Medicare would not cover the cost of a pump that would run about $160 per month to rent. Has anyone used one of these pumps and found a way to get it covered by insurance.
    mike

  2. #2
    The following is the Aetna policy regarding coverage of lymphedema pumps:

    http://www.aetna.com/cpb/data/CPBA0069.html
    Policy

    Complex Decongestive Physiotherapy:

    Aetna considers a course of complex decongestive physiotherapy (CDP), also called manual lymphoid drainage, medically necessary when both of the following criteria are met:

    1. The member has any of the following conditions:

    * Intractable lymphedema of the extremities, unrelieved by elevation; or
    * One or more previous admissions to treat complications of intractable lymphedema (i.e., cellulitis, ulceration); or
    * Evidence of ulceration due to lymphedema; and

    # The member has shown a past record of compliance and the member or his/her caregiver is capable of following the instructions associated with CDP.

    Lymphedema Pumps:

    Aetna considers lymphedema pumps (pneumatic compression devices) medically necessary durable medical equipment (DME) for home use for the treatment of lymphedema if the member has undergone a four-week trial of conservative therapy and the treating doctor determines that there has been no significant improvement or if significant symptoms remain after the trial. The trial of conservative therapy must include use of an appropriate compression bandage system or compression garment, exercise, and elevation of the limb. The garment may be prefabricated or custom-fabricated but must provide adequate graduated compression.

    Note: For members without DME benefits, lymphedema pumps are only covered for members with arm lymphedema due to mastectomy for breast cancer who meet the criteria for a lymphedema pump stated above.*

    When medical necessity criteria for a pneumatic compression device are met, a non-segmented device or segmented device without manual control of the pressure in each chamber is generally considered medically necessary to meet the clinical needs of the member. A segmented device with manual control of the pressure in each chamber is considered medically necessary only if there is clear documentation of medical necessity in the individual case. A segmented device with manual control of the pressure in each chamber is considered medically necessary only when there is documentation that the individual has unique characteristics that prevent satisfactory pneumatic compression treatment using a non-segmented device with a segmented appliance/sleeve or a segmented device without manual control of the pressure in each chamber.

    There is insufficient evidence in the peer-reviewed published medical literature that a 2-phase lymph preparation and drainage therapy device (Flexitouch Device, Tactile Systems Technology, Minneapolis, MN) provides superior outcomes to standard segmented pneumatic compression devices. According to the manufacturer, the 2-phase lymph preparation and drainage therapy device consists of an electronic controller unit and garments, worn on the trunk and upper and lower affected extremities and connected to the controller unit by tubing harnesses. The garment consists of 32 inflatable chambers that sequentially inflate and deflate and deflate at 1 to 3 second intervals, according to one of the 13 preprogrammed treatment patterns selected. Chamber pressure and treatment times can be adjusted. The manufacturer states that device's sequential action evacuates lymph from the trunk and extremities and drains it into the venous system. The garments are made from stretch material and are fitted with Velcro enclosures, so custom fitting of garments is not required. There are no published studies comparing the effectiveness of this 2-phase lymph preparation and drainage therapy device to standard segmented pneumatic compression devices.

    For Aetna's clinical policy on pneumatic compression devices for chronic venous insufficiency, see CPB 500 - Intermittent Pneumatic Compression Devices for the Legs.

    Note: Although the literature suggests that the use of lymphedema pumps is commonly initiated in the hospital, there is no medical necessity for this practice unless the member has other complications of lymphedema (i.e., cellulitis) that would require hospitalization. The use of lymphedema pumps can be initiated in the clinic or in the home setting.

  3. #3
    Senior Member alan's Avatar
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    Mike,

    Is your edema a side effect of a med you're taking, or solely an aspect of your injury? The anti-convulsants (neurontin, lyrica, trileptal, et al) all can cause edema, as can other classes of meds. Trileptal caused major edema of my legs - I was afraid they'd never get back to normal size. Fortunately, they did, after much time spent with my legs elevated way up.
    Alan

    Proofread carefully to see if you any words out.

  4. #4
    Senior Member mike's Avatar
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    Alan, I think the edema is caused by both, the Neurontin I take and the weight I have gained since my accident. Unfortunately, reducing the Neurontin I take is difficult as it is the only drug that I get any pain relief from.
    mike

  5. #5
    Senior Member lynnifer's Avatar
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    Check out ebay for cheap ones - they sell them all the time.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  6. #6

    Edema & Neurontin

    Quote Originally Posted by mike View Post
    Alan, I think the edema is caused by both, the Neurontin I take and the weight I have gained since my accident. Unfortunately, reducing the Neurontin I take is difficult as it is the only drug that I get any pain relief from.
    I didn't realize that Neurontin contributed to edema. I just had a spill two weeks ago in my garage. Fast forward a week and my left leg is swollen nearly rock hard. (...and I just had both legs down to pre-para size!)

    I've got a pair of the pneumatic "moon boots" that I wear a night. Could I speed up my recovering if I wore them during the day while working?

    (I hate this!)

  7. #7
    Did you have that leg checked for a fracture? If not, I encourage you to do so. I find that the summer heat increases my foot/leg edema. However, I am able to control it by elevating my feet with a pillow when going to bed at night. By morning, they are usually back to normal.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

  8. #8
    Quote Originally Posted by SCIfor55yrs. View Post
    Did you have that leg checked for a fracture? If not, I encourage you to do so. I find that the summer heat increases my foot/leg edema. However, I am able to control it by elevating my feet with a pillow when going to bed at night. By morning, they are usually back to normal.
    I didn't have an X-ray since it's my modus operandi way of falling, transferring from one chair to my tennis wheelchair. I know that it might be broken, but using past experience as a future indicator, I've experienced this same type of edema, in the very same leg, twice in the past.

    Are there additional ways for accelerating the healing time?
    -I've got a compression stocking on.
    -I use the FlowTron Boots at night.
    -I alleviate my feet while all day at my desk (although, truth in advertising, it's not above my heart).

    Thanks Senior member.

  9. #9
    Diuretics are sometimes used, but that is something you would have to check out with your doc. The doc would have to look for contributing factors and determine if a trial is justified.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

  10. #10
    I just have the urge to call you Sarge in that hat...(which is not a bad thing!)

    Yup, I'm already on the Lasix.

    I'm now in bed with my FlowTron boots on my leg elevated up close to my ears (...I knew a young lady who...)

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