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Suggest Treatment For Edema And Chronic Weeping Legs In An Elderly Person
Question: My Mom is 101 y/o. While she has nearly always had LLE, it has worsened in the past month or so. This morning her legs were close to normal, speaking about edema. There was one open sore, about 1/4" across; thin lines of lymph (?) buildup could be seen running along side the wound. That said, there was no evidence of infection. A bandaid was placed to protect the wound and light compression hose were donned. This evening I removed the hose and both legs were hugely edematous and leaking. The would had grown to about the size of a quarter. I cleaned the area and covered with a 'stick resistant' covering , held in place with paper tape. Her doctor has OK'd an additional furosemide 20 mg if the edema is in the morning, and I have instructed her to take that medication. However, I am wondering why the swelling is increasing so much during the day, although I know she is walking and standing for much of the day. What could I do to help her keep the swelling down... and why is the leg weeping even when the leg isn't huge with fluid retention? Should she continue to wear the light compression hose? Thank you!!
Brief Answer:
Information requested and suggestions
Detailed Answer:
Hello.
I am Dr Mittal.
I have read your message.
I will do my best to help you.
First, yes, light compression hose can be applied continuously.
You see, this will help her veins to keep pumping the blood back up.
And will help control the edema.
As for the lasix, please do give it for the edema, but be aware that lasix is known to reduce sodium. And in elderly, even a mild drop of sodium can cause problems (that are usually reversible, once sodium is replaced). However, since she needs it, do give the medicine as suggested. And no, do not increase her sodium intake in the meantime, because you cannot monitor the loss without blood tests, so you never know how much loss is happening and how much replacement is needed. Besides, in her case, I am sure the doctor has given the medicine for short term only.
As for the weeping of the skin, in the elderly, the skin is thinner than in younger people, because the amount of fat is less in them. So it is easy for them to have weeping even with little edema. Besides, in her case she has a wound too.
As for the swelling, you have guessed it correctly that the dependant position of the legs allows the fluids to accumulate in the legs. This can be taken care of by- compression bandage (the hose you are already using), diuretics (lasix), keeping the legs raised (by keeping 2-3 pillows below the feet when she is lying down or sitting), asking her to wriggle the toes (this keeps the leg muscle active, thereby helping the leg veins to drain the edema) and by increasing the protein intake in her food especially the albumin containing foods like egg whites (please do consult your dr before taking this step- if there is renal involvement, added protein may further deteriorate the situation).
I would suggest echocardiography and creatinine and albumin tests, after discussion with your doctor. Unfortunately, having done the tests, the treatment may largely stay the same. So do discuss the options of the tests with your treating doctor. A swab culture from the lesion may be a good idea though.
I have tried to make it as simple as possible. Please feel free to contact me for any related issues that you need to discuss.
Best of luck.
Dr Mittal
Information requested and suggestions
Detailed Answer:
Hello.
I am Dr Mittal.
I have read your message.
I will do my best to help you.
First, yes, light compression hose can be applied continuously.
You see, this will help her veins to keep pumping the blood back up.
And will help control the edema.
As for the lasix, please do give it for the edema, but be aware that lasix is known to reduce sodium. And in elderly, even a mild drop of sodium can cause problems (that are usually reversible, once sodium is replaced). However, since she needs it, do give the medicine as suggested. And no, do not increase her sodium intake in the meantime, because you cannot monitor the loss without blood tests, so you never know how much loss is happening and how much replacement is needed. Besides, in her case, I am sure the doctor has given the medicine for short term only.
As for the weeping of the skin, in the elderly, the skin is thinner than in younger people, because the amount of fat is less in them. So it is easy for them to have weeping even with little edema. Besides, in her case she has a wound too.
As for the swelling, you have guessed it correctly that the dependant position of the legs allows the fluids to accumulate in the legs. This can be taken care of by- compression bandage (the hose you are already using), diuretics (lasix), keeping the legs raised (by keeping 2-3 pillows below the feet when she is lying down or sitting), asking her to wriggle the toes (this keeps the leg muscle active, thereby helping the leg veins to drain the edema) and by increasing the protein intake in her food especially the albumin containing foods like egg whites (please do consult your dr before taking this step- if there is renal involvement, added protein may further deteriorate the situation).
I would suggest echocardiography and creatinine and albumin tests, after discussion with your doctor. Unfortunately, having done the tests, the treatment may largely stay the same. So do discuss the options of the tests with your treating doctor. A swab culture from the lesion may be a good idea though.
I have tried to make it as simple as possible. Please feel free to contact me for any related issues that you need to discuss.
Best of luck.
Dr Mittal
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Above answer was peer-reviewed by :
Dr. Nagamani Ng
Answered by
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