Abstract:
The present invention is directed to a device that provides thermal energy therapy, compression therapy and negative pressure therapy simultaneously and/or in conjunction with each therapy. The outcome of the present invention is that a patient&#39;s bodily fluids can be maintained, controlled, and/or adjusted with decreased medication dependence. Using these three therapies individually does not obtain these desired results of controlling, maintaining or adjusting the patient&#39;s bodily fluid. This combination of therapies is beneficial to the patient.

Description:
CLAIM OF PRIORITY 
     This application claims priority to U.S. provisional patent application Ser. No. 60/843,030 filed on Sep. 8, 2006. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates generally to a human body circulatory aid and/or thermal energy transfer. 
     BACKGROUND OF THE INVENTION 
     DVT Apparatuses 
     Gaymar Industries, Inc. is the assignee of this application and expired U.S. Pat. No. 4,597,384. The &#39;384 patent is incorporated herein by reference as disclosing a well-made deep vein thrombosis cuff. In the &#39;384 patent, Gaymar wrote, “[T]herapeutic and prophylactic devices for the alleviation of deep venous thrombosis by mechanical as opposed to chemical means. Deep venous thrombosis (DVT) is a condition in which clotting of venous blood occurs generally in the lower extremities due to lack of sufficient muscular activity in the lower extremities. Thus it is important that the velocity of blood flow in the patient&#39;s extremities be maintained at the requisite level in order to prevent pooling of blood in such extremities so that stasis of blood will not develop. This is particularly important since it is well known that stasis of blood is a significant cause leading to the formation of thrombi in the patient&#39;s extremities which could ultimately cause the death of the patient. 
     Devices are presently in use for the purpose of increasing blood velocity to prevent problems set forth above. Many of these devices comprise compression sleeves which fit over and around the limb requiring care. Fluid pressure producing means are provided for sequentially inflating the compression sleeve and allowing for a simultaneous deflation of all sleeve components. 
     Applicant&#39;s U.S. Pat. No. 4,453,538 which is entitled “Medical Apparatus” and issued on Jun. 12, 1984, is hereby and herewith incorporated for all of its disclosure into this application. Among other features this patent describes a flexible pad formed for external enwrappment about a patient&#39;s limb. The pad includes a plurality of relatively large individual fluid receiving cells adapted to receive and retain sufficient fluid to exert pressure upon the enwrapped limb for a specified period of time. More particularly, the cells are sequentially pressurized starting at the limb extremity and proceeding in the direction of the patient&#39;s heart. It is desirable that the sleeve compression pressure proceed smoothly and [progressively] along the patient&#39;s limb from the extremity heartward. Most pressure sleeves currently in use cannot do this. In fact most of them leave continuous pressure gaps between respective sleeve portions. Such results are undesirable. 
     In view of the foregoing it is an object of [the &#39;384 patent] to provide a compression sleeve for a patient&#39;s limb which will provide a smooth pressure flow with no pressure gaps extending completely around the patient&#39;s limb. 
     It is yet another object of [the &#39;384 patent] to provide a device for use in applying successive compressive pressures against a patient&#39;s limb to produce a smooth pumping action from the patient&#39;s limb extremity heartward. 
     It is a still further object of [the &#39;384 patent] to provide a sleeve for use in applying compressive pressures against a patient&#39;s limb wherein the sleeve comprises a plurality of laterally extending separate fluid pressure members arranged longitudinally along the sleeve from a lower portion of the encased limb to the upper portion thereof with the adjacent lateral edge portions of adjacent pressure members being curved upwardly and then downwardly in unison whereby the respective contiguous edges thereof follow each other so that when pressure is sequentially applied from the lowermost pressure members upward there will never be a continuous circumferential pressure gap on any lateral circular portion of the encased limb. 
     Another object of [the &#39;389 patent] is to provide a device of the type described in the proceeding object and further wherein the successive pressurization of each pressure member from the lowermost heartward produces a plurality of circumferential spaced radially inward maximum and minimum forces interdigitated with successive pressure members having similar maximum and minimum forces to produce a smooth gap free pressurization from start to finish.” 
     Gaymar&#39;s apparatus is just one of many types of deep vein thrombosis (DVT) apparatuses. There are numerous designs for such DVT apparatuses. Representative samples of such DVT apparatus designs are found, and hereby incorporated by reference, in the following U.S. Pat. No.: 2,531,074 to Miller, Nov. 21, 1950; U.S. Pat. No. 4,091,804 to Hasty, May 30, 1978; U.S. Pat. No. 4,269,175 to Dillon, May 26, 1981; U.S. Pat. No. 4,343,302 to Dillon, Aug. 10, 1982; U.S. Pat. No. 4,396,010 to Arkans, Aug. 2, 1983; U.S. Pat. No. 4,989,589 to Pekanmaki et al., Feb. 5, 1991; U.S. Pat. No. 4,311,135 to Brueckner et al., Jan. 19, 1982; U.S. Pat. No. 5,080,089 to Mason et al., Jan. 14, 1992; U.S. Pat. No. 5,186,163 to Dye, Feb. 16, 1993; U.S. Pat. No. 5,383,894 to Dye, Jan. 24, 1995; U.S. Pat. No. 5,554,103 to Zheng et al., Sep. 10, 1996; U.S. Pat. No. 5,591,200 to Cone et al., Jan. 7, 1997; U.S. Pat. No. 5,626,556 to Tobler et al., May 6, 1997; U.S. Pat. No. 5,795,312 to Dye, Aug. 18, 1998; U.S. Pat. No. 5,830,164 to Cone et al., Nov. 3, 1998; U.S. Pat. No. 5,876,359 to Bock et al., Mar. 2, 1999; U.S. Pat. No. 5,997,540 to Zheng et al., Dec. 7, 1999; and U.S. Pat. No. 6,176,869 to Mason et al., Jan. 23, 2001. 
     Some of the above-identified references disclose DVT apparatuses having a therapy pad with at least two chambers and each chamber receives, through a conduit, a fluid from a source (a “fundamental compression therapy pad design”). The fluid can (a) return to the source through a return conduit or the original conduit (“recirculation systems”), (b) be directed toward a receiving unit (not the source) through a return conduit (“receiving system”), or, alternatively, (c) permeate through apertures in the chambers (normally using air as the fluid and commonly referred to as a “low air-loss system”). The alternative method is preferred if the fluid is a gas; and the former methods are desired if the fluid is a liquid (like an aqueous fluid or a non-aqueous fluid) or a gas (like air). In any case, the fluid is pressurized. The fluid pressure in each chamber can be the same or different, depending on the desired result. For example, the fluid in:
         (a) chamber 1 is 50 mm Hg, chamber 2 is 50 mm Hg and so on; (Uniform pressure)   (b) chamber 1 is 80 mm Hg, chamber 2 is 40 mm Hg, and chamber 3 is 20 mm Hg; (Sequential downward pressure)   (c) chamber 1 is 60 mm Hg, chamber 2 is 40 mm Hg, chamber 3 is 60 mm Hg, and chamber 4 is 20 mm Hg; (Alternating Uniform/Sequential Downward Pressure)   (d) chamber 1 is 50 mm Hg, chamber 2 is 30 mm Hg, chamber 3 is 50 mm Hg, and chamber 4 is 30 mm Hg; (Alternating distinct uniform pressure) or   (e) combinations thereof.
 
The fluid can also have a desired temperature. As disclosed in U.S. Pat. No. 2,531,074 to Miller at col. 1, lines 50-56; DVT apparatus can control the fluid temperature. The fluid temperature, however in the cited references, is uniform in each chamber of the therapy pad.
       

     The fluid receiving cells can be made of a single material or a plurality of materials. Whatever number of materials are used, the material that contacts the patient&#39;s skin should be of a material or combination of materials that effectively transfers thermal energy to the patient or receives thermal energy from the patient (hereinafter “Transfer Material”). Examples of such transfer materials that have been used in the past include and are not limited to polymeric materials like polyethylene, polymeric materials with metallic materials (like rivets) positioned on and within the polymeric material, metallic-polymeric materials, and metallic materials. 
     All of the above variations of (a) fluid pressures, (b) recirculation systems, (c) constant fluid temperature in each chamber, (d) air-loss systems, (e) compression DVT systems, and (f) fundamental compression therapy pad designs, revert at least to the late 1970&#39;s. 
     Hypo/Hyperthermia Control Devices 
     In this application, we need to also discuss hypo/hyperthermia blankets. One type of hyper/hypothermia blankets are forced-air blankets. Those blankets have been litigated for many years. One such case is Augustine Medical, Inc. v. Gaymar Indus., Inc. (the assignee of this application), 181 F. 3d 1291, 50 USPQ2d 1900 (Fed. Cir. 1999). In that case, Judge Radar concluded that Gaymar&#39;s forced-air blankets did not infringe any of Augustine&#39;s patents at issue, and wrote, “Convective thermal blankets inflate to direct warm (or cool) air onto a person. Surgeons often use these blankets during and after an operation to prevent or treat hypothermia caused by surgical conditions. Hypothermia results when a patient&#39;s body temperature drops below a certain threshold. Surgery often presents the threat of hypothermia. A patient&#39;s body temperature may drop significantly during surgery because anesthesia prevents the patient&#39;s body from regulating its own temperature. Additionally, operating rooms—kept cool to accommodate the surgeon&#39;s working conditions and to reduce the spread of germs—can chill patients. Moreover, surgery often calls for administration of cool intravenous fluids at a time when the patient&#39;s body cavity is open. 
     A convective thermal blanket over the patient is thus necessary to prevent or treat hypothermia during and after surgery. Heated air from a warming unit inflates the blanket. Once inflated, the blanket directs heated air onto the patient through small holes (or “exit ports”) in the undersurface of the blanket. With careful use, a convective blanket regulates patient temperature and prevents hypothermia . . . . [Gaymar&#39;s blankets] feature an inflatable quilt-like structure [, . . . ] attach two sheets of the same amount of flexible, lightweight material around their periphery and at various spots along their surfaces. In operation, heated air flows onto a patient&#39;s body from holes in the undersurface of [Gaymar&#39;s blankets], but [Gaymar&#39;s blankets] do not form a self-supporting or Quonset hut-like structure. Instead, [Gaymar&#39;s blankets] lie flat when inflated on a flat surface and rest substantially on a patient when in use . . . . Gaymar began selling forced-air blankets in March 1992.” And one of those blankets is Gaymar&#39;s THERMACARE quilt. 
     Alternatively, other types of hypo/hyperthermia blankets are sold by Gaymar. An example of these blankets is Gaymar&#39;s DHP 600 hyper/hyperthermia blanket. That blanket operates differently from the forced-air blankets. Those blankets overlay a user and receive a fluid having a predetermined temperature. The fluid circulates through a cavity defined in the blanket that is to be positioned on a patient. The fluid (a) transfers its thermal energy to the patient and/or (b) receives the patient&#39;s thermal energy to control the patient&#39;s body core temperature. A description of those blankets is set forth in U.S. Pat. No. 6,375,673, which is hereby incorporated by reference in this application and which is licensed to the assignee of this application. 
     These blankets are extremely effective in altering the body core temperature of a patient. A problem with these devices is that some people claim those prior art hypo/hyperthermia blankets are bulky and difficult to use because those blankets cover too much of the patient. To address that problem, applicants have found a solution. The solution is set forth in the present application. 
     Negative Therapy Devices 
     Stanford University is the assignee of U.S. Pat. Nos. 5,683,438; 6,602,277; 6,673,099; 6,656,208; 6,966,922; 7,122,047; and 6,974,442. These patents disclose devices that create a negative pressure about a portion of a patient&#39;s body having a venous plexus. A venous plexus is a vascular network formed by numerous anastomoses between veins. The venous plexus is normally located at the patient&#39;s foot area and hand area. The negative pressure is applied, and simultaneously thermal energy (cold or warm) is applied to the venous plexus area that is subject to negative pressure. 
     Applying a negative pressure condition to a portion of the body (a) lowers the vasoconstriction temperature and/or (b) increases vasodilation in the body portion that is enclosed. The negative pressure conditions may be provided using any convenient protocol. In many embodiments, the negative pressure conditions are provided by enclosing a patient&#39;s venous plexus area in a sealed enclosure, where the pressure is then reduced in the sealed enclosure thereby providing the desired negative pressure. In many of the embodiments, the negative pressure is allowed to leak to the ambient environment through a seal so it does not create a tourniquet effect. A tourniquet effect is undesirable because it terminates the blood flow which is contrary to the intent of Stanford&#39;s negative pressure, thermal energy device. 
     Negative pressure includes conditions where a pressure is lower than ambient pressure under the particular conditions in which the method is applied, e.g., 1 ATM at sea level. The magnitude of the decrease in pressure from the ambient pressure under the negative pressure conditions in one example is at least about 20 mmHg, preferably at least 30 mmHg, and more preferably at least about 35 mmHg, where the magnitude of the decrease may be as great as 85 mmHg or greater, but preferably does not exceed about 60 mmHg, and more preferably does not exceed about 50 mmHg. When the method is performed at or about sea level, the pressure under the negative pressure conditions generally may range from about 740 to 675 mmHg, preferably from about 730 to 700 mmHg and more preferably from about 725 to 710 mmHg. 
     In practicing the exemplary methods, the negative pressure conditions during contact with the patient&#39;s skin may be static/constant or variable. Thus, in certain examples, the negative pressure is maintained at a constant value during contact of the surface with the low temperature medium. In yet other examples, the negative pressure value is varied during contact, e.g., oscillated. Where the negative pressure is varied or oscillated, the magnitude of the pressure change during a given period may be varied and may range from about 85 to 40 mmHg, and preferably from about 40 to 0 mmHg, with the periodicity of the oscillation ranging from about 0.25 sec to 10 min, and preferably from about 1 sec to 10 sec. 
     The negative pressure is applied to the certain venous plexus area to create vasodilation. That vasodilation results in the thermal energy (1) effectively transferring its thermal energy to the patient to warm the patient&#39;s body core temperature, or (2) effectively receiving the patient&#39;s thermal energy to cool the patient&#39;s body core temperature. 
     Stanford University disclosed that the thermal energy can be provided from outside the enclosure—for example a heat lamp—if the enclosure allows such thermal energy to penetrate through it or within the enclosure. Within the enclosure, the thermal energy can be provided by an electric thermal blanket or pad; or a conductive conduit or pad that allows a fluid having a desired temperature to flow through it. In both internal thermal energy providing embodiments and variations thereof, the patient&#39;s venous plexus is applied to the thermal energy providing device to transfer thermal energy to the patient and/or receive thermal energy from the patient. 
     “Third Space” in the Human Body 
     Current scientific literature reveals that inflammatory mediators initiate a biochemical chain of events that increase capillary permeability. These mediators include pharmacologically active amines such as histamine and 5-hydroxytryptamine, polypeptides such as bradykinin, kallikrein and leukotoxine, the prostaglandins, and various complements including derivatives thereof. These mediators act specifically on the junction of the endothelial cells of capillaries so that the junctions cannot contain colloids such as serum albumin within the vessel. The serum albumin escapes into the interstitium creating a nonfunctional “third space”, the volume of which increases proportionally to albumin leakage and the presence of cytokines as well as proteolytic enzyme activities within the matrix. This leakage further widens capillary membrane-mitochondrial distances creating problems of poor diffusion and transport between the circulatory system and the functional cells resulting in cellular anoxia, a cellular energy deficit, and acidosis, and possibly leading to sequential organ failure. 
     In the past, the problem of the creation of the third space has been approached through pharmacological means. The present invention approaches the problem by controlling the patient&#39;s temperature, applying compression therapy to the patient and/or applying pressure therapy to the patient. 
     SUMMARY OF THE INVENTION 
     The present invention is directed to a device that provides thermal energy therapy, compression therapy and negative pressure therapy simultaneously and/or in conjunction with each therapy. The outcome of the present invention is that a patient&#39;s bodily fluids can be maintained, controlled, and/or adjusted with decreased medication dependence. Using these three therapies individually does not obtain these desired results of controlling, maintaining or adjusting the patient&#39;s bodily fluid. This combination of therapies is beneficial to the patient. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         FIG. 1  illustrates a schematic drawing of a first embodiment of the present invention. 
         FIG. 2  illustrates an alternative embodiment of  FIG. 1 . 
         FIG. 3  illustrates a third alternative embodiment of  FIG. 1 . 
         FIG. 4  illustrates a fourth alternative embodiment of  FIG. 1 . 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The present invention is a combination of a compression therapy, thermal therapy and pressure therapy to operate in concert with each other to treat more than just deep vein thrombosis and body core temperature. The combination is designed to move bodily fluids in the lymphatic system, secondary venous system, and artery system in a controllable manner to obtain desired results. Desired results include and are not limited to controlling and/or manipulating the patient&#39;s blood pressure and bodily fluid volume. By controlling and/or manipulating the patient&#39;s blood pressure and bodily fluid, the present invention offers more medical assistance than expected. 
     Applying cold thermal energy therapy causes vasoconstriction and warm thermal energy therapy causes vasodilation. Compression therapy causes vasoconstriction and moves the blood in the direction of the compression therapy—normally toward the heart. Cold thermal energy therapy and compression therapy increases the patient&#39;s blood pressure. However, cold thermal energy therapy, compression therapy and negative pressure therapy reperfuses blood (and other bodily fluids) from the third space. Obviously, too much cold thermal energy therapy, compression therapy and negative pressure therapy is not good, therefore the present invention is able to provide the opposite therapy to obtain the desired balance for the desired results. This combination of therapies have never been incorporated together to control the bodily fluids, including an not limited to cardiac output control. Instead, medication in combination with one of these therapies has been standard bearer up to today. 
     As illustrated in  FIG. 1 , the present invention can be a conventional negative pressure, thermal energy device  400  and a conventional compression therapy device  410  interconnected to a controller  420  to operate both devices simultaneously and/or in conjunction with each other to obtain the desired results. An example of the conventional negative pressure, thermal energy device  400  is manufactured by AVACore&#39;s core control device (located in Ann Arbor, Mich.). An example of the conventional compression therapy device  410  is disclosed in Gaymar&#39;s U.S. Pat. No. 4,597,389.  FIG. 1  illustrates these devices  400  and  410  positioned about a patient&#39;s foot and leg, but  FIG. 1  is merely being used for illustrative purposes and it is understood that these devices, individually or collectively, can also be positioned on the foot, the leg, a hand, an arm, a hand and an arm, and combinations thereof. 
     The thermal energy provided to the conventional negative pressure, thermal energy device  400  and the conventional compression therapy device  410  can come from the same source or different sources  415 . The sources can be (a) fluid providers such as Gaymar&#39;s MEDI-THERM heating/cooling unit; Gaymar&#39;s THERMACARE device; electrical sources; and/or air or fluid pumps with coolers and/or heaters; (b) electrical providers (not applicable for the conventional compression therapy device  410 ); (c) irradiant heat devices like a heat lamp (not applicable for the conventional compression therapy device  410 ) or (d) combinations thereof. 
     Some of those sources can provide thermal energy at a single temperature. Other sources can provide thermal energy at various temperatures. And other sources can provide a fluid to (a) the conventional compression therapy device  410  at temperature T1 and (b) the conventional negative pressure, thermal energy device  400  at temperature T2, wherein T1 and T2 can be the same or different. Moreover, some sources can provide a fluid to (a) the conventional compression therapy device  410  at temperature T1 for a first fluid pressure member  411  and at temperature T2 for a second fluid pressure member  412  (as illustrated in  FIG. 2 ) and (b) the conventional negative pressure, thermal energy device  400  at temperature T2, wherein T1, T2, and T3 can be the same, different, or combinations thereof. 
     In addition to controlling the temperature of the fluid&#39;s thermal energy that enters the conventional compression therapy device  410 , the thermal energy source  415  controls the pressure of the fluid that enters the conventional compression therapy device  410  as illustrated in  FIG. 1 . Alternatively and as illustrated in  FIG. 2 , the thermal energy source  415  can provide a fluid having (a) a first pressure (P1) to the first fluid pressure member  411  and (b) a second pressure (P2) to the second fluid pressure member  412 , wherein P1 and P2 can be the same or different. 
     The compression therapy device  410  can offer static compression therapy, sequential compression therapy, or variations thereof. 
     Reverting to  FIG. 1 , the first fluid pressure member  411  is interconnected to the second fluid pressure member  412  through a conduit  413 . Depending on the shape and size of the conduit  413 , conduit  413  can maintain or adjust the fluid pressure that enters the second fluid pressure member  412  from the first fluid pressure member  411 . For example, if the conduit  413  tapers from the first fluid pressure member  411  to the second fluid pressure member  412  then the fluid pressure is greater in the second fluid pressure member  412  than the first fluid pressure member  411 . If the conduit  413  tapers in the opposite direction, then the fluid pressure in the first fluid pressure member  411  is greater than the fluid pressure in the second fluid pressure member  412 . 
     The negative pressure created in the conventional negative pressure, thermal energy device  400  is provided by a conventional negative pressure providing device  402 . The conventional negative pressure providing device  402  can be any system that creates negative pressure within the enclosure of the conventional negative pressure, thermal energy device  400 . The negative pressure is created in the enclosure of the conventional negative pressure, thermal energy device  400  at area  403 . 
     The controller  420  has an input system that allows a user to program (a) when to operate the thermal energy source(s)  415  and negative pressure providing device  402 , (b) how much (i) thermal energy is directed from the thermal energy source  415  to the conventional negative pressure, thermal energy device  400  and the conventional compression therapy device  410  and (ii) negative pressure to create in the conventional negative pressure, thermal energy device  400 , and (c) the temperature of the thermal energy directed to the conventional negative pressure, thermal energy device  400  and the conventional compression therapy device  410 . The controller  420  can be electrically interconnected to the conventional negative pressure, thermal energy device  400  and the conventional compression therapy device  410 , or alternatively, the user could manually operate each device separately. The former embodiment is preferred because it provides the opportunity to control the devices simultaneously and in conjunction with each other to obtain the desired results. 
       FIGS. 1 and 2  illustrated that the conventional negative pressure, thermal energy device  400  and the conventional compression therapy device  410  are separate devices.  FIG. 3  illustrates that the conventional negative pressure, thermal energy device  400  and the conventional compression therapy device  410  can be combined together to form a single unit device  500 . 
     The single unit device  500  encloses the patient&#39;s body part (hand, arm, hand and arm, leg, foot, or leg and foot). The single unit device  500  has a proximal end  503  and a distal end  504 . The distal end  504  is sealed. The proximal end  503  has an opening that allows a patient&#39;s body part to enter into the single unit device  500 . The proximal end  503  has a leaky seal  506 . 
     The leaky seal  506  allows the area  403  to have and maintain a negative pressure environment without creating a tourniquet effect to the patient. Area  403  is positioned between fluid pressure members  411 ,  412  and  417  and the patient&#39;s skin. 
     Third fluid pressure member  417  operates in the same way as fluid pressure members  411  and  412  as described above. That means fluid pressure member  417  receives a fluid from thermal energy source  415  at temperature T4 wherein T1, T2, T3 and T4 can be the same, different, or combinations thereof. Likewise, the fluid pressure in the third fluid pressure member  417  can be P3, wherein P1, P2 and P3 can be same, different or combinations thereof. 
     The thermal energy therapy is provided to the patient through the fluid pressure members  411 ,  412 , and  417 . Simultaneously or not, fluid pressure members  411 ,  412 , and  417  can be providing compression therapy to the patient. 
     Alternatively, the seal  506  can be positioned anywhere within fluid pressure members  411 ,  412  and  417 , not just at the proximal end  503 , as illustrated in  FIG. 4 . 
     Alternative Embodiments 
     The compression therapy unit  410  or the single unit device  500  can use a fluid recirculation system, a receiving system, or, a low air-loss system (only with a gaseous fluid). 
     As illustrated in  FIG. 2 , the thermal energy source  415  provides a first fluid having T1 and P1 to the first fluid pressure member  411  through conduit  555  and a second fluid (the second fluid and the first fluid can be the same fluid or different fluids) having T3 and P2 to the second fluid pressure member  412  through conduit  557 . Conduits  555  and  557  interconnect to the respective member  411 ,  412  and the fluid source  415  through a quick disconnect interconnection system (for example a Colder quick disconnect unit)  559   a - d . A quick disconnect interconnection system allows a user to disconnect the conduits from either the respective member  411 ,  412  and the fluid source  415  and connect the conduits to different members or different outlets of the fluid source. In other words, the older interconnection system or equivalent thereof allows the member  411  to originally have the first fluid, then the second fluid and then the first fluid again. 
     In another embodiment illustrated in  FIG. 4 , the first fluid pressure member  411  overlies at least a portion of the second fluid pressure member  412 . In each member  411 ,  412 , the pressure may or may not be the same. The temperature in each member  411 ,  412  can be the same or different. The fluid that enters each member  411 ,  412  can also be the same or different. This embodiment ensures that the desired pressure is applied and in some cases increased at the transition point between the fluid pressure members  411 ,  412 . 
     The conduit  413  can also be an orifice between two fluid pressure members. For example, the orifice can be an opening within heat sealed members that allows fluid to flow between the members. The orifice and the conduit  413  can also have check valves or membrane valves, not shown, that prevent the fluid from re-entering a particular fluid pressure member. Examples of membrane valves include and are not limited to tricuspids designs, bicuspids designs, poppet styles or flap designs. 
     Alternatively, the conduit  413  can have a thermal energy adjuster  558 . The thermal energy adjuster  558  has the capability to alter the temperature of the fluid going between two fluid pressure members. The thermal energy adjuster  558  is any conventional device that can alter a fluid&#39;s temperature. An example of a thermal energy adjuster  558  is thermal coil in, exterior to, or combinations thereof to the conduit  558 . Another example is a thermal blanket on the exterior surface of the conduit  558 . 
     The present invention is positioned on a patient and a medical person monitors the patient&#39;s blood pressure, body core temperature, heart rate, and heart rhythms. Depending on the patient&#39;s presentation, the medical person (or persons) alters the present invention&#39;s therapies (compression, thermal energy and negative pressure) to obtain the desired result. It has been confirmed this invention can control and/or manipulate the flow of the patient&#39;s blood (and other bodily fluids) without medication. Obviously, the present invention solves a problem by potentially decreasing the quantity of patient medication. 
     It is appreciated that various modifications to the inventive concepts described herein may be apparent to those of ordinary skill in the art without departing from the scope of the present invention as defined by the herein appended claims.