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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 is this balance thing?

Your vessels, venous as well as arterial, maintain a balance by exchanging oxygen and nutrients through the walls of these vessels 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 visible in the evening, after you have been up most of the day.

First sign?

The first sign is that the ankle bones and sometimes tops of the feet are swollen. If you take your finger and push gently on the skin, it would be like bread dough; the skin indents but is slow to come back to the surface. Eventually, if nothing is done, and often it is indeed overlooked, the legs and feet remain swollen most of the day and night.

Second sign?

The next thing you will notice is pain. Remember, pain is your body's number way of communication. If something is wrong within your body, you are going to hear about it loud and clear from your nerve endings! It is an efficient way of communication as well, right? It gets your attention all right!

Third sign?

Next, you will have difficulty walking. This is obvious, your legs resemble tree trunks and you can only stumble from bed to chair. Finally, your legs begin to turn reddish blue and clear, pink or yellow fluid will begin to seep from every available open pore on your lower legs. This is when; finally, you make an appointment to see your physician. There are several reasons why you may have edema in your lower extremities. This is because swelling of the limbs, or edema is not the disease; it is a condition or a sign and symptom of a disease.

If edema isn't the disease why do you have it?

Some diseases that have edema of the legs as a "trait" or "symptom" are: Congestive Heart Failure,

Pulmonary Edema,

Liver Failure,

Renal or Kidney Failure,

Hypothyroidism,

Cancer, Pregnancy

Malnutrition.

The important thing to remember is not to 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!

Why would your heart do this to you?

Why? Because your heart is very selfish! Your heart will take care of itself and its surrounding areas and that is it! Nothing else! Unfortunately, your legs are NOT in "its surrounding area" so it behooves you to get your skin clean, dry and free of any and all open areas. If not, the risk of infection increases exponentially. Worst case scenarios include infection, cellulitis with staph and or psuedomonas, open sores that will not heal, constant painful itching, constantly weeping fluid with odor, and finally a systemic (one involving your whole body) infection that will inevitably lead to hospitalization and intravenous antibiotics.

Of course, hospitals are soooo nice; everyone wants to be a patient in a hospital right? After all, hospital food is TASTY! Ha

What can you do now?

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 basic metabolic panel that checks the overall function of your heath, lungs, 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.

What kind of wound care?

Before any orders are given to you, the patient, on 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 able to care or yourself at home. If so, your physician and or their nurse will be the person to instruct you on the physicians order for skin care. The physician and their nurse will stress to you the importance of strict hygiene, hand washing and using supplies that are sterile and or very clean.

The easiest thing to remember about hand washing is to DO IT! If you have to think to yourself, "Self should wash my hands now?" it is already too late...GO WASH! LAVE LOS MANOS! You will be glad you did! Besides, hand washing is the perfect time to exercise your vocal cords! Really!

While you wash your hands, if you sing the ABC or the Happy Birthday song to yourself you have washed your hands for fifteen to twenty seconds, which is exactly the amount of time it takes to kill the bacteria present on your hands!

As for wound care, it really depends on

1) How much fluid?

If there is an exorbitant amount of fluid then a dressing that will wick it away would be best, but be careful that you do not make the dressing so big that when it fills with drainage the dressing will slide down the leg, causing further harm

2) How many open sores?

If there are less than half dozen it will be manageable and should heal well, and quickly

If there are multiple open sores the risk for cellulitis increases and additional steps must be taken to keep you and your legs as healthy as possible

3) How deep are the sores that are open and what color are those wound beds?

If the areas are dry and red, without any heat around them then let it stay this way, dry dressing, skin propectant such as skin prep and open to air

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 and wrapped gauze such as kerlix.

4) Is there pain associated with skin care or cleaning or walking?

Pain is actually the body's first sign of any infection! Not redness, temperature, odor...these come later; but pain...so pay attention! Inform your physician so evaluation will be done and proper steps taken to address this issue

5) Any surrounding redness?

Again, signs of infection...notify your doctor!

6) Any odor?

Bacteria are what causes odor, infections; all bacteria has odor; this is what happens when bacteria and oxygen meet for the first time. However, after cleansing the area or areas there should not be that much odor. If there is a noticeable odor after cleansing that is a sign of an infection or a complication so what should you do?

Oh you guys are soooo smart already! Absolutely! Notify your physician.

7) Finally, after two weeks your physician will probably see you for a follow up, if that appointment is not made on your first visit, call and make one yourself; even if your legs look and feel better.

Unfortunately, edema and chronic weeping legs means it will probably not "just go away by itself" 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!

Please check out the links below for any other information and I will be posting an article on how to perform a clean technique for any type of wound care in the near future