Complications Related to Chronic Weeping Edema of the Lower Extremities
What Is Edema?
It is simplest to say that it is the buildup of excess fluid from the blood—generally seen as swelling in the legs or arms—that leak from your blood vessels. However, many other medical problems can cause it as well (e.g. venous stasis—circulation problems in the veins of the lower legs that force fluids out of the veins). Edema is more than just swelling of the legs. Often, the patient has legs that are painful, itchy (pruritus), or burning, and the legs become so severely compromised that the patient is at risk of a severe infection.
Your vessels—both veins and arteries—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:
- Infection 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 ankles, and sometimes tops of the feet, are swollen.
- If you take your finger and push gently on the skin, it should feel like bread dough. The skin indents but is slow to bounce back.
- The legs and feet remain swollen, day and night.
- Pain. Remember, pain is your body's primary way to communicate trouble. If something is wrong in your body, you hear it loud and clear from your nerve endings!
- Difficulty walking. This is obvious; your legs will 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 open pores on your lower legs. This is when you should make an appointment to see your physician.
What Do I Have?
Some conditions that have can cause edema of the legs are:
- Congestive heart failure
- Pulmonary edema
- Liver failure
- Renal failure
Don't let the condition get out of hand! Your physician will take care of you, whatever you may have. Your job is to keep your legs as healthy as possible.
What to Do
- When the fluid starts building up, keep your legs elevated as much as possible to help bring the fluid back to the upper body.
- 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 and can cause fatigue, respiratory distress, and cough (especially at night). Your physician will decide your course of treatment, which may include diuretics, potassium supplementation, and perhaps medication to help your heart pump the blood around your body as efficiently as possible.
- Your physician may wish to test your lung capacity or assess your lab results, such as results for a basic metabolic panel that checks the overall function of your heart, lungs, and liver.
- You may need oxygen supplementation and, of course, wound care or skin care for both lower extremities if there are open, weeping sores.
Basic Wound Care
It is vital that you understand how important it is to use care and cleanliness at all times—not just with skin or wound care but for all areas 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 using supplies that are sterile.
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 the minimum amount of time it takes to kill any bacteria present on your hands.
As for wound care, 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 will 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 are there? 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 and a skin protectant on your open areas. Then, wrap your legs with rolled gauze. If the areas are draining fluid and the wound bed is pink, your physician may use an antibiotic ointment such as Bactroban and dress it with 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 no pain. Pain is actually the 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 generally caused by bacteria, possibly indicating infection. After thoroughly 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 will more than likely want you to come back 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 likely not go away by themselves. That is the hardest thing to accept. But, once you do, you should know you can handle it. 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. Always consult your physician 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.