Case Details

General Medicine Cardio Thoracic and Vascular Surgery Vascular Surgery

Indian Doctors Network posted a case

almost 2 years ago

Elephantiasis and Directed Occupational Rehabilitation

Courtesy: Jose Maria Pereira de Godoy,Henrique Jose Pereira de Godoy,et al

A 66-year-old female patient with a history of bilateral lower limb lymphedema reported the aggravation of the condition over the years, reaching stage III (elephantiasis). The patient was sent to the Godoy Clinic and reported having undergone several treatments throughout her life as well as several episodes of erysipelas. She did not marry due to the lymphedema and complained of the frequent occurrence of strangers staring at her leg, which upset her. The physical examination confirmed elephantiasis. The circumference of the left lower limb was 106 cm. Her body weight was 106 kilograms, height was 160 cm, and the body mass index (BMI) was 41.6 kg/m2 .

The patient was submitted to intensive treatment for three weeks, which led to a 21 kg reduction in weight and 66 cm reduction in leg circumference .

Intensive treatment with the Godoy Method consisted of eight hours per day of mechanical lymphatic drainage, 15 minutes of simultaneous cervical lymphatic therapy, and hand-crafted compression stockings made from grosgrain fabric. Mechanical lymphatic therapy consisted of an electromechanical device that performs plantar flexion and extension. After three weeks of intensive therapy, the patient continued treatment at home using the compression stockings. At the follow-up evaluation, the patient was submitted to electrical bioimpedance analysis as well as circumference measurements and volumetry. The bioimpedance analysis revealed a pattern of normality, with the reduction in lymphedema. Ten years after treatment, the patient has maintained the results with the compression stockings. In occupational therapy throughout this period, the patient has been encouraged to perform activities that she has always wanted to do to improve her wellbeing. She took up belly dancing, followed by tap dancing. She reports that these activities changed her life and she is very happy for being able to realize her dream of dancing, which is an activity that she began at the age of 76 years. The study was approving Ethical Committee of Medicine School of Sao Jose do Rio Preto# 2.929.115.

The present study demonstrates that elephantiasis can be cured, as the patient has been without this condition for ten years. She continues to have lymphedema, which ranges from subclinical to stages I and II, varying at different times in her life. She was orientated to improve her quality of life by performing the activities that she had always wanted to do. A certain flexibility in treatment is possible and she is able to forego the use of the stockings on some occasions, such as going to the beach and spending a week without the stockings with little edema. This flexibility enables a better quality of life. After these periods, she returns to correct treatment with the use of the compression stockings.

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