Complications Related to Chronic Weeping Edema of the Lower Extremities
What is Edema?
The simplest way to explain edema is to say that edema is the left over fluid from the blood your heart pumps every day. This is erroneous because heart failure is just one diagnosis that can have the additional effect of swollen legs. Edema is more than just swelling of the legs. Often, the patient has legs that are painful, often weep fluid, are itching (pruritus) as well as burning and the legs become so severely compromised the patient is at risk of a severe infection. It is also incorrect because even with the heart pumping blood the patient may also have a diagnosis of venous stasis, where the fluid in the lower extremities is not properly balanced.
Balance? What Does that Have to do with Anything?
Your vessels, venous as well as arterial, maintain a balance by exchanging oxygen and nutrients through their vessel walls into the surrounding tissues. This keeps your tissue alive and functioning. However, if your circulatory system is unable to meet the demands of that exchange then your vessels cannot shift or move the proper amount of fluid, and the circulatory system becomes unbalanced. When that occurs, often the first sign is swelling in the legs or ankles, visible in the evening after you have been up for most of the day.
Why Would my Heart do This to Me?
Your heart is very selfish! It takes care of itself and the area surrounding it and that is it! Nothing else! Unfortunately, your legs are not in "its surrounding area," so it behooves you to keep your skin clean, dry and free of any open areas. Broken skin increases the risk of infection exponentially.
Worst case scenarios include:
- Cellulitis with staph or pseudomonas
- Open sores that will not heal
- Constant painful itching
- Constantly weeping fluid
- A systemic (whole-body) infection that will inevitably lead to hospitalization and intravenous antibiotics
Signs of Edema
- The first sign is that the ankles and sometimes tops of the feet are swollen.
- If you take your finger and push gently on the skin, it should be like bread dough. The skin indents but is slow to come back to the surface.
- The legs and feet remain swollen most of the day and night.
- Pain. Remember, pain is your body's number one way to communicate trouble. If something is wrong in your body, you hear it loud and clear from your nerve endings!
- You have difficulty walking. This is obvious; your legs resemble tree trunks and you can only stumble from bed to chair.
- Your legs turn reddish-blue.
- Eventually, clear, pink or yellow fluid will seep from every available open pore on your lower legs. This is when; finally, you must make an appointment to see your physician.
What Do I Have?
Some diseases that have edema of the legs as a "trait" or "symptom" are:
- Congestive heart failure
- Pulmonary edema
- Liver failure
- Renal kidney failure
Don't let the condition get out of hand! Your physician will take care of the disease, whatever it turns out to be. Your job will be to keep your legs as healthy as possible.
What to Do
- When the fluid starts building up, remember to keep your legs elevated as much as possible to help bring the fluid back to the upper torso.
- On the other hand, be sure that you do not just go to bed. While the majority of fluid overload may well be in your legs, it may also be in and around your lungs and heart. This makes it difficult to breathe, causes fatigue, respiratory distress, cough (especially at night). Your physician will be the one to best decide your course of treatment, which may include diuretics, potassium, and perhaps heart medication to help your heart pump the blood around your body as efficiently as possible.
- You physician may wish to test your lung capacity or assess your lab values, such as a basic metabolic panel that checks the overall function of your heart, lungs, and liver.
- You may or may not have oxygen added to your medication list and, of course, wound care or skin care for both lower extremities if there are open, weeping sores.
Basic Wound Care
Before any orders are given to you, concerning your skin care, it is imperative that you understand how vital it is that you use care and cleanliness at all times, not just with skin or wound care but for the rest of your life. Depending on the number of open sores on your legs, you may be unable to care for yourself at home. If so, your physician and or nurse will be the person to instruct you on skin care. They will stress the importance of strict hygiene, hand washing and the importance of using supplies that are sterile or at least very clean.
The easiest thing to remember is hand washing. If you have to think to yourself, "Should I wash my hands now?" it is already too late. Wash them! You will be glad you did!
While you wash your hands, if you sing the ABC song or the Happy Birthday song to yourself, you have washed your hands for fifteen to twenty seconds. This is exactly the amount of time it takes to kill any bacteria present on your hands.
As far as wound care is ocncerned, the following factors need to be considered:
- How much fluid is there? If there is an exorbitant amount of fluid, then a dressing that will wick the fluid away would be best. Be careful that you do not make the dressing so big that filling with drainage will cause it to slide down your leg, causing further harm. If the dressing becomes saturated, the action of sliding could well take several layers of skin with it.
- How many open sores? If there are less than half a dozen it will be manageable and should heal well and quickly. If there are more than six open sores, the risk for cellulitis increases and additional steps must be taken to keep you and your legs as healthy as possible.
- How deep are the sores and what color are their wound beds? If the areas are dry and red, without any heat around them then help them stay this way with a dry dressing, a skin protectant on your open areas, and then wrap your legs with rolled gauze. If the areas are draining fluid and the wound bed is pink, your physician may order an antibiotic ointment such as bactroban, then a non-adherent dressing such as a telfa pad and then a rolled gauze such as kerlix.
- Is there pain associated with skin care, cleaning, or walking? While your wound care may be uncomfortable it should not cause pain. Discomfort, yes, but hopefully not pain.Pain is actually your body's first sign of infection. Not redness, temperature, or even a foul odor. These signs usually come later. Pay attention to pain and inform your physician so an evaluation can be done and proper steps can then be taken to address the issue.
- Any surrounding redness? Again, this is a sign of infection. Call your doctor!
- Any odor? Odor is caused by bacteria, and possibly infection. All bacteria has odor; odor is what is produced when bacteria and oxygen meet for the first time. However, after cleaning the affected area, there should not be that much odor. A noticeable odor after cleansing is a sign of an infection or a complication that could slow or stop your healing process. Again, call your physician.
After two weeks your physician I'll more than likely want you to come back to the office for a follow up visit. If that appointment is not made on your first visit, call and make one yourself in 10-14 days, even if your legs look and feel better.
Unfortunately, edema and chronic weeping legs will probably not just go away by themselves. That is the hardest thing to accept. But, once you do, then you know you can handle it; because the condition will come and go, and now you have the information you need to take care of it any time it raises its ugly little head!
What is written here should not replace your physician’s advice and services. Consult your physician every time for all things medically related. If you feel you have any of the signs or symptoms above, contact your physician for a consultation as soon as possible.