Sunday, 27 August 2017

Where to Buy Fashionable Medical Grade Compression Stockings in Australia.

[Image: a woman's legs lie on some colourful velvet cushions. She wear yellow compression stockings (Kings Cross Yellow, last season's German Juzo colour range and deep red shoes with bow ties. In the distance a white chair and wall can be seen along with a plug, fairy lights and the edge of a couch.]


Here is the fair old land of Oz purchasing medical grade compression stockings, particularly fashionable compression stockings, can be a frustrating and difficult endeavour for a number of reasons.
  1. It can be incredibly expensive. Even the most basic of compression styles, particularly if you also want quality and a medium to high medical grade compression level, are going to put a large dent in your purse. 
  2. There are few places in Australia selling anything more than the basic beige, black and navy version. Fashionable options can take a lot of time and determination to find. 
  3. Compression socks in a range of styles can often be sourced but stockings either thigh high or waist high are not so easy to find.
  4. We often have purchase our compression stockings from overseas companies. 
  5. With exchange rates at present this can be incredibly expensive.
  6. Some companies postage rates are also prohibitive. 
  7. There are a number of companies selling compression stockings that are not medical grade compression eg Scholl. They are cheap and more easily accessible but in the end if you are purchasing on the advice of your Dysautonomia specialist you need a medical grade level of compression. (It is suggested that waist high 30-40mmHg are the preferred strength and length for Dysautonomia. However given that many patients also experience abdominal pain a lot of patients still find adequate relief from the use of maternity stockings which have less stomach compression and thigh high options. Additionally 30-40mmHg can be incredibly hard to put on if you have any hand weakness or joint instability and many, myself included, use 20-30mmHg with success.)
So what to do and where do you start?

Australian Companies:
(Please note that this is not an exhaustive list, just a starting point.)


Appliance and Limb Company (now part of Oapl): One of the few local companies selling Juzo compression wear (socks, thigh and waist high, maternity and also arm sleeves and gauntlets) in both the US and German colour series are Sydney rehabilitation company Appliance and Limb Company (now part of the Oapl group). Currently there isn't an option for online sales and you must either ring or email the company. There is also a requirement for a doctors prescription for compression stockings (including the grade of compression). I have used this company a couple of times and while the ordering process is somewhat cumbersome and frustrating at times, it does provide the one of the cheaper access routes to the German range of Juzo colours (see video below).




Sigvaris AustraliaSigvaris have an Melbourne-based shop front where you can both purchase and be fitted for compression stockings. Sigvaris have a selection of four colours currently available (see below) as well as the Allure range (see my review of the Allure here). They also have a listing of local distributors where you can also purchase these versions. Sigvaris also has a FB page and are reasonably responsive.




Compression Socks Shop: as the name suggests Compression Socks Shop stock a large range of compression socks in some amazing colours and patterns. If you are one of the lucky Dysautonomia patients who can get away with socks instead of stockings this company has a large and ever changing range from a number of different brands. They also have a limited range of lower grade (Class 1 or 18-22mmHg) colours (eg Bordeaux is a mulberry colour) and basic colours in a medium grade (Class 2 or 23-32mmHg) in compression stockings in waist high and maternity.

2XU
: Australian athletic company 2XU has a limited range of products which range up into the medium range of medical compression (around the 22-30mmHg range and some lower ranges). For those who prefer a more athletic look as opposed to the traditional medical compression stockings these can provide a nice alternative. Additional bonuses with 2XU are that they are easy to purchase both online and in multiple sporting outlets, and even better, they often have sales where you can pick up both socks and leggings at great prices.

Below are some 2XU options that fall in a Class/Grade II or Moderate compression range.
(NB: all of these are footless tights. Depending on how poor your peripheral perfusion is these may not be an option. Speaking as someone who ends up with purple sausage toes or feet from toeless compression stockings and compression tights it is important to consider this aspect of presentation when selecting compression options.)

Power Recovery Compression Tights (20-30mmHg - Firm)
Refresh Recovery Tights (20-25mmHg - Firm)
MCS Run Compression Tight (23-26mmHg - Firm)
Mid-rise Compression Tight (22-25mmHg - Moderate/Firm)
MCS Cross Training Compression Tights (23-26mmHg - Moderate/Firm)
Chemists: most local chemists will offer at least one brand of compression stockings (Jobst seems most popular and was what I was offered first up at my local chemist). Lower grade or non-medical compression can usually be bought off the shelf. However higher grade ones need to be ordered in. Some chemists will offer a fitting service and some will require a doctor's prescription. It's a case of going into your local chemist or giving them a ring to see what they offer. This can be a reasonable starting spot if you are new to compression stockings.

Private and Custom Fitting: there are a variety of companies that offer custom fitting. This can be a good option if your body proportions don't fit well with the structure of mass produced stockings or if you have a specific medical need. It is worth ringing your local OT or Physiotherapist to see what companies are available in your area. Some orthotics clinics can also offer this service. Just a heads up that custom fitting is usually quite expensive. (Oapl and Vennosan are two companies that come to mind for custom compression)



Other Australian-based companies that offer basic brand specific stocking options are:

Bauerfeind Australia:  Bauerfeind Australia offer free postage for the VenoTrain range of compression stockings. I did also find a Melbourne-based orthotics centre Melbourne Orthotics who are able to get Bauerfeind products in if you already know what you want/need.

Venosann


BSN Medical stock Jobst products.


International Companies:

The options to purchase compression stockings from overseas are too extensive to list completely here. Instead I'll list a couple of the main companies that are used by local patients. Currently US companies are a little cheaper than European companies due to the exchange rate.

Brightlife Direct: US based company Brightlife Direct offer a wide range of compressionwear including fashionable options from brands including Juzo, Rejuvahealth and Sigvaris. Brightlife Direct have a great social media presence and have been very supportive of the Dysautonomia community. Their blog is also a great source of information on topics such as the best sheers, to how to get the wrinkles out of your compression stockings. They have also been very receptive to Australian consumers concerns about issues such as the exchange rate and postage costs often offering up special codes to help with costs. I have purchased stockings through Brightlife Direct with no problems to date.

Compressionstockings.com: US based Compressionstockings.com also offers a wide range of compressionwear including similar fashionable options from brands including Juzo, Jobst and Sigvaris. I have purchased stockings through Compressionstockings.com with no issues however I have heard others in Australian patient groups who have experienced issues with the company. The main complaint has been in relation to communication. Given that we are in a different time zone getting in touch with the company if there are problems with delivery or product is generally through email and this has proven problematic according to some of the messages I have been sent.

Compressionsale: Similar to Brightlife Direct and Compressionstockings.com, US based Compressionsale also offers a wide range of stocking options. I haven't purchased from Compressionsale but have had favourable reports from other Australian patients who have.

Rejuvahealth: US based Rejuvahealth was one of the first companies next to Juzo that I discovered in my hunt for fashionable compression. Sadly their range of thigh high and waist high fashionable compression has shrunk in favour of an extensive compression sock range (in the photo below is their lovely floral pattern they used to stock. I reviewed them here). You can still sometimes pick up their lovely Black Sheer Dot pattern stockings on the site and on other end of line sites. The main prohibitive aspect of Rejuvahealth is that there postage is quite expensive compared to other similar companies.


Tramps Fashion Compression Hoisery: Tramps is a relative newby on the fashionable compression scene. I first wrote about them back in 2016 when they popped up in my searches with what often feels elusive, patterned compression stockings. While patterns and compression can be found in upperlimb brands like Lymphedivas or in compression socks, the compression stocking market has been very slow to adopt any printed options (Juzo do a tie-dyed(US) and batik (German) print, as well as some lover level compression leggings in their Signature range, Sigvaris offer the Allure and Jobst the Ultra Sheer Patterned, Rejuvahealth did for a time offer some great prints.).  Tramps offers the Bryanna Cheetah Jacquard in the 25-30mmHg range and Bryanna High Waist and Jocelynne Hip Hugger is some vibrant colours.

Zulily: US based retailer Zulily can be another source for end of line compression stockings. It's a bit of pot luck what turns up, but if you already have an account then it's easy to check out their compression stocking and compression sock sections.



That pesky thing called 'cost'.

Quality compressionwear is a significant financial investment. The more unique the item the more the cost. Items manufactured to specific individual measurements can be incredibly expensive. The financial burden of compressionwear continues to be a major factor for patients as not all insurance companies or government suppliers will pay for compression wear, or will only provide the most basic of styles. But there are a number of ways to cut costs.

Private Health Insurance: If you have Private Health Insurance get your doctor to write you a prescription for your stockings. Depending on your insurance provider and how you have structured your scheme, you can sometimes get all or at least part of the cost of the stockings back through your insurance company.

Sign up and First purchase discounts: A number of sites will offer buyers a discount on their first purchase. These discounts can range from 15-20% which can be a considerable benefit on a tight budget.

Coupons: There are a wide range of coupon sites offering discounts for various compressionwear websites and specific brands. Simply Google coupons and the brand or company you prefer and see what comes up. Most coupons are time limited so if you find a good one get on it pronto!

Sales: Most websites will have a sale section These can provide you with considerable savings (50-70% in some cases). For example at the time of writing, Rejuvahealth have some lower strength, 15-20mmHg, patterned pantyhose down to $30US score! Get on that people. End of season colours often come up in the sales a month or two after the change over. You sometimes have to put in the hard yards and search but if you have a colour or style you like for the last season pop it in Google and see who has any left. It can be pot luck as to sizes, styles and lengths available but I've scored some bargains over the years. If you're after a pair of stockings to wear under jeans or long skirts the world's your oyster with well known sites like Zulily having reputable brands at bargain basement prices.

Shop around for postage: Postage is the nemesis of anyone living in the Southern Hemisphere. Current rates can be highly prohibitive even if the stockings themselves are a bargain. Sometimes it is worth contacting a company to see if they will take pity on us poor folk down under and be willing to wave their postage or at the least provide a discount.

Shop local: Related to the postage issue is the currency exchange rate. Our piddly little AU$ is doing it tough when ordering from OS. However, sometimes local distributors can provide a cheaper option. For example here in Australia The Appliance and Limb Centre can source Juzo Softs from both Germany and the US at a much cheaper rate than using OS suppliers at present. Always keep an eye on exchange rates. Given the uncertainty of world events such as the recent Brexit, exchange rates can change rapidly. 

You get what you pay for: There are many companies selling compression stockings for next to nothing. I saw some fabulous Beetlejuice-style black and white ones out of China for $10US be still my heart! But alas, when I contacted the company it became clear that we differed on the definition of 'compression'. With cheaper versions it is often hard to find out the exact compression rate and if the compression is graduated. Many companies wont respond or respond with automated emails with little to no detail.

Whilst compression stockings can be fashionable they are first and foremost a medical device and like any medical device you shouldn't scrimp on quality. If the compression is poorly designed it may not perform properly and can lead to problems in how fluids are returned. Remember we are buying these stockings to help with a medical problem. It is better to save up and buy one good quality pair of stockings from a reputable brand, than to have five cheap, but dodgy, pairs.

Sizing.

Brightlife Direct now have a size/brand calculator the Brightlife Direct Size Calculator which I tried out the other day. It's a great option if you are just starting out looking at compression stockings and are feeling overwhelmed at what to buy. You simply put in your measurements and style you're after and it pumps out a list of brands that may suit. To give you an idea of how it works I popped in my measurements and usual length and compression. As you can see below it suggested a number of products that may work for me. I would always recommend double checking a brands individual sizing to be sure, simply because it can be such an expensive outlay, but this is a great starting point.




For more on compression wear 
check out:


Compressions Stockings from Beige to Brilliant Guide. My basic guide to selecting and buying compressionwear. I wrote this way back in 2012 and it's still one of my most popular posts.

Fashionable Compression stockings: 2016 Update Options and New Tips.

Metamorphosis: marketing Medical Compression as Fashionable and Transforming the Narrative around Disability.

Below are a few reviews for different brands I have purchased over the years and a bit of a tongue in cheek post about how I style my compression stockings.

Compression Stocking Review: Sigvaris 712N Allure 20-30mmHg patterned Thigh High Compression Stockings with Lace Silicon Border in Black.

Rejuvahealth Review.

Allegro, Microfibre 20-30mmHg Black Thigh High Compression Stocking Review

LympheDiva Gauntlet Review

Fashion blogging is not for the faint of heart

Go forth and good luck with your purchasing.

Michelle

I've been listening to the Waifs while writing so it only seems fair to have one of their songs as my musical accompaniment today. I love these lines every time I hear this particular song.


You say that I shouldn't be so

Vague, inattentive, a law to myself

I guess that I live in a world of my own

And all that I know now is all that I've known

Friday, 11 August 2017

We're getting there.

[Update: a merle Great Dane sits on frost burnt grass. She is wear a green t-shirt and has only one front leg. Behind her is a red garden chair and garden pots and plants. She looks alert but over it. Out of everything my old green t-shirt has been the best thing to cover her wounds and stop bandages from moving.]

This post is the follow up to my last (Filaments) which was the lead up to her surgery.


"Freyja's temperature is always low, so this represents a fever for her."

What is it about vets that they instinctively trust the animal and the readings before them? Try to explain something similar to a medical practitioner and you can see the internal eye roll before they hustle you out the door ignored and untreated. So many Dysautonomia patients often have internal thermostats set outside normal parameters. After years stuck at 38C my body now frequently inhabits the region of 35.2- 35.5C. A couple of my regular doctors believe me, but even as I described back when I was getting regular saline IV's, a nurse despite multiple forms of assessment refused to believe her instruments, or me. Mind you even when I told my pacemaker surgeon that I don't process sedation or local anaesthetics properly, it wasn't until I continually woke up mid procedure and in pain, that I was believed. And yet for Fryeja's vet it's not a stress. She simply believes and believes in, her patients.

It does give me confidence. Not all vets do well with giant breeds. I've seen towering men baulk at touching both Freyja and when he was still with us, Thor. Giant breeds always attract comments about their size ("You should put a saddle on that!"), and it can be off-putting, belying a gentle nature and a breed that still considers itself a lap dog. But practicalities of treating a large animal aside the vet is at ease and just gets on with the job. She walks in comforting and confident and Freyja just goes with the flow. And in turn I feel confident and comforted. I am grateful for that. We go back in today. Maybe I can convince her to give me a litre of fluids and a cortisone shot in my bursitis inflamed hip, when she's done with Freyja's stitches. There definitely seems to be a lot more practicality and in many ways compassion, in veterinary medicine that has been lost in human medicine where all too often the patient is seen as less than, an inconvenience, or even at times the enemy.



It's been two weeks since her surgery, nearly three from the time we walked in ignorant and free from the worry and stress that has permeated so much of days since. And I am tired.

So so tired. But we're getting there.

It's been a rough few weeks and chronically ill bodies don't tend to react well to stress. Life hasn't stopped so we could focus on the one stressful issue. Instead it kept throwing things our way including the sudden loss of my uncle. He was a tough guy. Three bouts of cancer, a heart attack, broken bones and a 70s rock and roll lifestyle that he never really shook. He was a guy who always lived life by his own rules and never mellowed with age. And sitting in front of his casket and listening to his singing and bass playing, quintessential Oz Rock, it felt and continues to feel unreal. And I am still processing. But we're getting there.

We're getting there
We're getting there
We're getting there

I keep reminding myself.
Slow and steady wins the race, right?



Standing in the vet's consulting room going through the procedure for the surgery I was simultaneously trying not to throw up from worry and fighting back tears at the prospect of what lay ahead for her. She didn't know. We were leaving her with strangers to have a life changing operation. We couldn't explain to her. Sucking up the responsibilities of pet ownership is tough when it comes to decisions like these. Realising how much you love the trusting, furry, stink ball in front of you at the same time as you have to watch her go out through the door after signing the paperwork, is even tougher.

Perceptions of time vary depending on the circumstances in which we are living and the stress of waiting for the phone call felt like an eternity. When the vet finally called it was late. It went longer than expected. She did really well. The scans were clear and the procedure straight forward except for the complications of her size.Would we mind if she went home and had dinner before we came in to see her? Of course. Well not really. Emotional brain wanted to scream no and run straight to the clinic and break down the door. While logical brain knew it was already 7pm, that the vet was also on call and working hideously long hours over an incredibly long working week. We could wait, Freyja could wait, and perhaps more importantly, the vet could go home, see her family and have a breather before the emergency after hours consults started to roll in.

Thankfully calm and rational Mr Grumpy was in charge of phone calls on the day.

8:30 pm Freyja was tucked up under a blanket surrounded by hot water bottles and blissfully unaware thanks to the slow steady drip of morphine into her veins. The relief of seeing her was overwhelming. To touch her paw and stroke her muzzle. To have that tangible connection. Then and only then did the vets words seem to take on form. It went well. She was okay. She was in good hands. I went home exhausted but slightly less anxious. Slightly.

Great Danes aren't supposed to be in tiny country vet clinics. Her 58kgs and long limbs meant only just fitting on the fully extended operating table and a room all to herself for recovery. Similarly the next day she was perched on blankets in the middle of the main surgery room. Allowing her company and after a quick look around at the other inhabitants, clear acknowledgement that her bulk would not fit into even the largest of their cages. A small excited whine, thumping tail and waves of relief. Who knew you could be so excited to hear your dog had peed? Who knew as I write nearly two weeks since the surgery, seeing her pee and poo would continue to excite me. This is much of what the last to weeks have involved.



Bringing her home has been both nerve wracking and a relief. I have slept on the couch next to her and also jumped out of bed when I've heard her cry out or stumbling around in the lounge. I watch her and clean up after her. We've wrapped meter upon meter of bandages around her torso. And my bum and legs have gone numb from sitting on the floor next to her bed. I am continuously covered in her hair and slobber. And changing her blankets sometimes multiple times a day due to incontinence. I am tired. She is tired.

But we're getting there.

I find myself speaking in high pitched excited tones. And soft low comforting notes.

Every unsteady pee and poo is celebrated. Ever hop/step applauded.
Every moment of discomfort soothed. Ever stress comforted.

She lays before me in the loungeroom in one of my green t-shirts trying to keep a dressing on her infected drain. We continue to ply her with antibiotics and cuddles and take calls from our vet checking on her progress. She is quieter than normal. In our multiple trips to the vet since the surgery her nervous energy, especially in the presence of other dogs, is gone. I don't know if she's more settled or more over it. Only time will tell. Today we go in again to check the infection and hopefully remove the stitches from the two large wounds that occupy the space left from her now amputated shoulder and leg.

"All I want is to do is go inside and rest and this annoying woman keeps trying to make me walk." * * Freyja is still not feeling great and pretty meh about the world but we have to keep her up and moving if only in short bursts with much rest in between. It's all a bit slowly slowly but we're getting there. Hopefully the antibiotics are kicking the infection in the wound and she'll pick up again soon. We're both tired but hopeful. She's been my companion for 8 1/2 of the last 11 years I've been ill so I just want my energetic, slobbery pup back. * * [Image: a short video of Freyja a merle great dane wearing a green t-shirt walking a little in the back yard on our Winter frost burnt grass. More a hop walk as she continues to learn how to get around on three legs. At the end she flops tired to ground to look longingly at the back door where her warm bed resides.] * * #greatdane #merle #ilovemygreatdane #tshirt #amputeedog #recovery #tired #exhausted
A post shared by Michelle Roger (@michelle_roger) on

 We're all tired.

But

We're getting there.

Michelle

Thank you to everyone who has sent me and Freyja lovely messages. I keep thinking I'll catch up with them but I realise now it's unlikely. I have read them all but the fatigue and stress has meant all my spare energy has been focused on taking care of her. If you want to keep up to date with how she goes I'll be updating over on Instagram.