The Ups and Downs of Lymphedema Care

I have found that patients with lymphedema of the lower extremities can be incredibly challenging but also very gratifying to take care of.  The challenges are:

  • managing those leaking legs
  • preventing cellulitis
  • reducing edema
  • encouraging compliance
  • getting those compression stockings on

I’ve seen patients who have baby diapers wrapped around their legs to catch the fluid leakage. I’ve seen their slippers so sopping wet that their feet look like they have been in water for days. My own mother had to keep plastic bags under her legs to protect her furniture.  The clear fluid just drips and drips. So the challenge is to contain the fluid while other treatments are being done to reduce the lymphedema. I’ve wrapped legs with thick dressings secured with a gauze wrap to absorb fluid. Most of the time the fluid won’t stop, won’t stop dripping all over the place until the treatments start working. In the meantime, there is the risk of infection.

Cellulitis is a common complication of lymphedema of the lower extremities. The moist skin is a perfect medium for infection. Many of these patients already have underlying diseases like peripheral vascular disease or diabetes that makes the risk of infection even greater. I had one patient who had a thick layer of pus across her grossly edematous legs. Only intravenous antibiotics will bring that kind of infection under control.

The biggest challenge is to reduce the edema. Some patients need to go to a wound care center for treatment of the open wounds that develop. The wound care specialist can direct the care. Since I work in the home, I carry out the doctors orders whether it be wound care or edema-reducing interventions. I’ll see the patient daily to wrap the legs, apply medicated dressings, assess the skin, and coach the patient to follow the instructions that will bring relief.

Some patients will do everything they can but I have had others who have a hard time complying. They just don’t get it especially the need to keep their legs up. Elevating the legs forces the fluid out of the legs and into the circulatory system. This is a crucial part of the treatment. Some patients don’t have nice recliners to get them into the right position. I’ll have to show them how to improvise. I had one woman who just couldn’t tolerate elevation. She said it hurt her so she kept her legs down and they got worse and worse. She ended up hospitalized.

The best and worst part of lymphedema care is the application of compression stockings. I don’t care if they are compression wraps, stockings, or a brace, they are all tough to get on. You have to be physical fit to do it! Many of my patients are elderly and find it beyond their strength or ability to do. That’s why I’m there. I get the compression treatment on…even if I have to pull, tug, and use all my strength to do it. It is the only way. And what a pleasure it is to see the legs begin to reduce in size day after day.

That is the gratifying part of lymphedema treatment. You first see a patient with enormous, dripping legs. They may have infection making the legs not only wet but red, warm, and painful. The medical team forms and a plan is made. The patient learns what they must do. The legs start to reduce in size. The wounds heal. The skin dries up. The wraps eventually become stockings. The patient is discharged. Sounds simplistic but it does happen and when it does it feels good to have helped someone like this.

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3 Comments on “The Ups and Downs of Lymphedema Care”

  1. Joe Zuther Says:

    I would like to thank you for the very informative blog site – the lymphedema community will certainly benefit from this information
    Joe Zuther

  2. nurse Talk Says:

    This is wonderful!!! Useful for my Job!


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