Teamwork is required

In his office in Fürth, Dr. med Michael Kraus treats not only patients with phlebological problems, but also predominantly patients with lymphological problems. In his view, providing patients with flat-knitted compression stockings is a main pillar of treatment for lymphedema and lipo-lymphedema.

Bauerfeind life: How do lymph patients come to you – directly, or are they referred by their GP?

Dr. Kraus: 60 to 70 percent of my patients are referred. But they are not only referred by GPs; they are also referred by many colleagues in other specializations, such as orthopedics, gynecology, oncology and dermatology. Many patients are also sent by their therapists, medical supply retailers or even by their gym.

How can a patient with lymphedema or lipedema be treated properly?

Dr. Kraus: Treatment of lymphedema and lipedema primarily relies on the use of flat-knitted compression stockings that must be adjusted and tailored to the patient. The rest of treatment is different for the two illnesses. Lymphedema is a drainage disorder. Here, lymph drainage is required to release protein in the patient’s tissue and transport it to the lymph nodes. Lipedema involves an inflammation. As with all cases of inflammation, manual lymph drainage is contraindicated here. We offer sports classes for both illnesses.

Are general physicians allowed to prescribe themselves?

Dr. Kraus: Yes! However, they must ensure that all prescriptions for treatment and products are medically indicated and economically efficient. Even approval from the health insurance company does not release physicians from this obligation.
It is important for physicians not only to issue a prescription but also to thoroughly explain the treatment to the patients. This improves compliance with treatment for compression stockings, for example.

How frequently should the condition of the edema be monitored?

Dr. Kraus: The frequency of monitoring depends on the severity of the illness, of course. Severe edema may even need to be treated daily in extreme cases. As long as manual lymph drainage is being con-ducted, the results must be documented regularly. During the decongestion phase, compression bandages are helpful. Afterwards, flat-knitted compression stocking are indicated as mentioned.

“Many lymph patients are also sent by their therapists, medical supply retailers or even by their gym.”
(Dr. med. Michael Kraus)

What do you do if it is not possible to reduce the edema?

Dr. Kraus: This frequently occurs in patients after an oncological operation involving removal of the lymph nodes. In such cases, lymph drainage may not work properly anymore. Depending on the circumstances, transplants of lymph vessels or lymph nodes may be expedient then.

How well does interdisciplinary collaboration work in the field of lymphology?

Dr. Kraus: There is certainly room for improvement. Successful lymphological treatment always depends on teamwork. It requires intensive communication between physicians, therapists, medical supply retailers and the patient. If there is more feedback between these players, treatment will be more successful and patient quality of life will improve.

Images: ARTARCO Fotostudio, Bauerfeind