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A surgery that occurred over seven years ago may have been the beginning of lymphedema, a condition that Ron now lives with.

Immediately after his surgery to repair a large abdominal aortic aneurism (a bulge in the aorta in the abdomen), Ron noticed a difference in the size of his legs, with some swelling in the right leg. It was not clear at that time, or even later, what the swelling was coming from. Gradually it got worse, and eventually Ron also noticed tightness in his legs. He was admitted briefly as an inpatient at GMHC in March of 2021 for cellulitis (a bacterial skin infection).

A few months later, in September, Ron developed cellulitis again, along with venous stasis ulcers on his legs, which are open wounds that “leak” excess protein-rich fluid from the body. After working to control the swelling and sores with Unna boots to promote healing of his venous stasis ulcers for several months, Ron’s primary care provider, Dr. McCaw, decided to refer him to a wound care specialist for more extensive treatment; however, there was a two month wait to be seen. Because GMHC’s Physical Therapist Kimberly Franzen, PT, DPT, CLT, had been recently certified to treat lymphedema, Dr. McCaw decided to refer Ron to her. That decision has been life-changing for Ron.

Lymphedema can occur as an abnormality at birth, primary lymphedema, or secondary lymphedema that develops after an injury, surgery or radiation treatment. Lymphedema is a protein-rich fluid buildup in the arm(s) or leg(s) that causes swelling, discomfort or achiness in the extremity and decreased mobility of the joints that can make it very hard to move your limbs to complete daily activities. Lymphedema symptoms include increased tightness and size of the arm or leg, skin changes including texture and color and increased difficulty with use of the arm or leg with daily cares such as dressing. Lymphedema increases the chances of recurring infection. At GMHC, we treat lymphedema to help reduce the size of the arm or leg, heal wounds, improve health of the skin and improve the patient’s quality of life. Because there is no cure for lymphedema, it is very important to treat it and learn to manage the symptoms.

Franzen began therapy with Ron in December of 2021 and treated both of his legs. She used all the techniques learned during her certification in Complete Decongestive Therapy for lymphedema, including manual lymph drainage, to aid in his healing. The results were amazing—the wounds were almost gone in three days! To maintain these results, and further decrease the lymphedema, intensive treatment began at 5 times per week for two weeks, and then tapered to 2-3 times per week for the remainder of his treatment. Franzen used multi-layer short stretch bandages to wrap Ron’s legs, which provided greater compression to reduce the lymphedema.

Each case of lymphedema is very different, and so is the individual treatment plan. Usually, the course of treatment is from 1-2 months. In Ron’s case, he experienced a few setbacks, and needed just over two months of intensive therapy. During this time, he also learned some valuable lessons in the precautions he needed to take to ensure his health. Franzen reported that during his therapy, Ron was mobile and doing all that he could to care for himself.

Franzen’s certification consisted of learning the full CDT (Complete Decongestive Therapy), which includes not only performing manual lymph drainage (MLD) to reduce the amount of fluid build-up, but teaching/ educating the patient how to apply compression bandages or garments, exercise, nail & skin care, and other self-cares to assist with overall management of their condition. The successful treatment of lymphedema includes a lifetime commitment to control and manage the symptoms.

Ron described the difference it made for him to have the swelling more controlled in his legs, “Before, when I was using the exercise bike, my legs could only go for about 7 minutes, but after my course of treatment, I was able to go for about 20 minutes,” and, “now when we are walking around while shopping, my legs don’t really get tired, just a little heavy—so I stop to rest my legs for a few minutes and I’m ready to go.”

Following the intensive therapy, Ron received instruction on transitioning to self-care, where he would monitor his own situation and only need to receive treatment if conditions would get worse again. Ron said that after living with this condition, he now knows what signs to watch for that would require a visit to his health care provider.

Franzen taught Ron and his wife how to bandage his legs on the days he didn’t have treatment. Because the course of treatment was effective in controlling the lymphedema, an accurate measurement was taken for custom compression socks, which he will regularly wear during the day, along with a custom-fit Velcro garment at night. 

When asked what he looks forward to being able to do again, Ron replied, “I hope to walk the course when I go golfing again. It will also be nice to wear dress pants instead of sweatpants, and regular shoes instead of extra-wide ones!”

Guttenberg Municipal Hospital & Clinics was recently named one of the top 20 critical access hospitals (CAHs) for Best Practice—Patient Satisfaction in the country. 

The top 20 CAHs, including GMHC, scored best among CAHs as determined by the Chartis Center for Rural Health for Patient Satisfaction. The rankings were recently announced by the National Rural Health Association (NRHA). An awards ceremony will be held during NRHA’s Critical Access Hospital Conference in September in Kansas City, MO. 

The top 20 CAHs have achieved success in overall performance based on a composite rating from eight indices of strength:  inpatient market share, outpatient market share, quality, outcomes, patient perspective, cost, charge and finance. This group was selected from the Chartis Center for Rural Health’s 2022 top 100 CAH list, which was released earlier this year. 

The top 20 CAH best practice recipients have achieved success in one of two key areas of performance:  

Quality index:  A rating of hospital performance based on the percentile rank across rural-relevant process of care measures.

Patient perspective index:  A rating of hospital performance based on the percentile rank across all 10 HCAHPS domains. 

“GMHC is proud of the efforts of the physicians and staff who have contributed to our hospital achieving this designation,” says Timothy Ahlers, CEO. “We are incredibly proud of our staff. We are blessed to have a team of professionals with high standards who care deeply about each and every patient and our entire community.”

“Our results as a top Best Practice Recipient in Patient Satisfaction means our community can count on us to deliver the services they need now and in the future,” said Ahlers.

About NRHA

NRHA is a nonprofit organization working to improve the health and well-being of rural Americans and provide leadership on rural health issues through advocacy, communications, education and research. NRHA’s membership is made up of diverse individuals and organizations from across the country, all of whom share the common bond of an interest in rural health. 

About the Chartis Group

The Chartis Group provides comprehensive advisory services and analytics to the health care industry. With unparalleled depth of expertise in strategic planning, performance excellence, health analytics, informatics and technology, digital and emerging technologies, clinical quality and operations, and strategic communications, Chartis helps leading academic medical centers, integrated delivery networks, children’s hospitals, and health care service organizations achieve transformative results and build a healthier world. For more information, visit www.chartis.com.

By Dr. Michele Dikkers, Physician at Cornerstone Family Practice and GMHC, Chair of Clayton County Board of Health

Growing up we had to be about dead before we went to the doctor.  Slap a bandage on it, put menthol vapor rub on your chest or put an ice bag on it.  A runny nose, sniffles or a cough was no reason to stay home.

Then we learned about COVID.  Now we stop and wonder.  Could it be a cold? Influenza? Strep throat? Mono? COVID?  Oh my.

Since COVID-19, the guidelines have changed.  If you are sick, stay home.  Get tested.  Wait until you are well, then return to the world.  Like any habit, it is difficult to make change.  But there are good reasons for the changes in our thought process.

Symptoms can be similar initially, but the outcomes can be very different.  They can all start with cough, body aches, fever, headache and sore throat.  But influenza and COVID may have a more serious end result.

Incubation time (time from exposure until symptoms start) is typically 1-4 days, unless it is COVID, then it can be 2-14 days.

With most of these illnesses, you can be contagious for 2 days prior to illness and for 3-5 days after illness starts.  With COVID, you may be contagious from 2 days prior to illness and up to 10 days after illness onset (up to 14-21 if with persistent symptoms or severe illness).

Symptoms last for 3-7 days, with the exception of COVID.  Symptoms of COVID, on average, last 1-6 weeks.  There can be long term symptoms that may last months after the acute illness is over.

When it comes to hospitalizations, 2% of those diagnosed with influenza will be hospitalized for 4-7 days, compared to 19% of the COVID diagnosis’ needing hospitalizations for 2-3 weeks.

Fatality rate of influenza is 0.1%, while the fatality rate of COVID-19 is nearly 3%.

Treatments for these illnesses vary.  There are antivirals for influenza, antibiotics for strep throat, monoclonal antibodies for COVID and, coming soon, the new oral medication recently developed to help decrease hospitalizations and deaths from COVID.  All depend on starting treatment sooner than later.  Treatment for influenza should be started within the first 72 hours.  Treatment for COVID-19 should be within the first 7 -10 days.  Treatment for influenza and COVID are to decrease severity of symptoms and won’t cure it but can significantly reduce need for hospitalizations and death as an outcome.

So, rethinking how we think about cold symptoms, the new recommendations are to stay home if you have any symptoms.   Be seen by your medical provider and get tested.  Getting tested allows for the best treatment options to be offered and improve outcomes.

Continue to be vigilant and continue to avoid getting sick.  Stay home if you are sick, continue with good hand washing, cover your nose and mouth when you cough and sneeze, wear a mask when you are in public places and update your vaccines.

Stay safe, be well and be kind to each other.

We congratulate Physical Therapist Kimberly Franzen, PT, DPT, CLT on her recent certification as a Certified Lymphedema Therapist (CLT). 

Kim’s certification included 135 hours total with 75 hours of online work and 60 hours of in-person class and hands-on work. Kim was in Minneapolis for the class from October 13th to the 20th for the in-person class, but all online class work was completed prior to attending. Both a written test and hands-on practical was passed for the certification. 

What is Lymphedema? Lymphedema is known as an abnormal accumulation of protein rich fluid that can occur gradually over time with increasing complaints of tightness or heaviness. Lymphedema increases one’s risk of infection or cellulitis. Typically lymphedema affects only one arm or leg, but can affect both as more commonly seen in the legs.

The certification consisted of learning the full CDT (Complete Decongestive Therapy) which includes not only performing manual lymph drainage (MLD) to reduce the amount of fluid accumulation, but performing and teaching/educating the patient on application of compression bandages or garments, exercise, nail & skin care, and other self-cares to assist with overall management of their condition.

Kim is now able to treat our patients who have lymphedema, lipidemia, or lymphedema which can occur due to other medial issues such as obesity, chronic venous insufficiency, lipo-lymphedema, or after a trauma or orthopedic surgery.

“Most people have not heard of or know much about lymphedema until they have been diagnosed with it,” said Kim. “I’m pleased to be able to offer this service to our patients who are diagnosed with this condition.”

Stay close to home, and receive your therapy and rehabilitation services with the experts at GMHC. For more information call 563-252-1121.

Guttenberg Municipal Hospital & Clinics is pleased to announce a collaboration with WELL Health Inc. to implement automated appointment reminders through secure two-way, multilingual messaging in the patient’s preferred communications channel: texting or telephone.

If GMHC has your cell phone or home phone in its system, patients will receive automated appointment reminders seven days, two days and one day before their appointments. Patients have an opportunity to respond or to opt-out of this service.

“It is our hopes that this two-way communication will help improve our patient’s experience throughout their care at GMHC,” said Danelle Krapfl, Lab and Imaging Manager.

This new service will begin on October 5, 2021.

 

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