About wounds with lymphedema

Several common beliefs about lymphedema wounds cause trouble. One is that a leaking leg should be left uncovered to dry out. In practice, uncontrolled drainage damages the skin around it, and the treating clinician will usually choose a dressing that manages the moisture. Another is that swelling is simply part of aging or weight and nothing can be done. Swelling has causes, and many of them can be managed.

People also assume that a tighter wrap works better, or that old stockings from a drawer will do. Compression that is wrong for the limb can injure it. And some think the work ends when the wound closes. The swelling remains, and so does the need for daily skin care.

What an assessment covers

Compression is the main tool for reducing lymphedema, but it is not right for every limb on every day. Before ordering it, the treating clinician checks blood flow to the foot or hand, sometimes with a simple circulation test, because squeezing a limb with poor arterial supply can do harm. Heart and kidney conditions are reviewed, since moving fluid out of the legs places extra load on the heart. Loss of feeling in the feet also matters. A person who cannot feel a wrap digging in cannot report it.

With that information the clinician decides whether to use compression, what kind, and how firm. The decision is revisited as the limb changes.

Local context: Alton and the Riverbend

For people in the Riverbend, lymphedema care often spans two states. Cancer treatment or vascular care may have happened at a St. Louis hospital, while primary care, home health and the health plan are based in Illinois. Records sit on both sides of the river. Gateway gathers them and confirms first which partner clinician can see you in Illinois. Illinois Medicaid and Missouri plans follow different rules, and benefits for compression garments, wraps and dressings vary, so coverage questions are raised before visits begin.

Each town in the Riverbend has its own housing. Wood River, Roxana, East Alton and Hartford have many compact one-story houses on a street grid, Bethalto and Godfrey have ranch homes and newer subdivisions with more land, and Alton has older houses on hills. Senior apartments, assisted living, and skilled nursing and rehabilitation centers are spread among the towns. Gateway arranges partner clinician visits in homes and facilities throughout the area, and when a patient moves from one town or setting to another, we carry the records, orders and schedule along.

When care happens at home

Supplies run out quickly when a lymphedema wound is draining. Absorbent dressings, padding and wrap materials may be changed several times a week, and going without them for even a day or two can set the limb back. Gateway coordinates supply orders with the treating clinician’s orders and follows up with the supplier on delivery to your home.

Tell us when you are getting low, well before the last box is opened. It also helps to mention practical problems, such as fluid soaking through to bedding or furniture, or dressings that will not stay in place overnight. The clinician can often change the dressing or the plan to deal with them.

Care in skilled nursing and assisted living

In a skilled nursing facility, a lymphedema plan succeeds or fails on consistency. A wrap put on firmly by the day shift and loosely by the evening shift does not control swelling, and gaps of a day or two let the limb refill. The treating clinician writes orders that are specific about the dressing, the compression and how often each is changed, and reviews them with the nurses who will carry them out.

Gateway coordinates the visit schedule with the facility and sends the orders and visit notes to the nursing team. Staff questions that come up between visits go back to the clinician.

Signs to tell the clinician about

Skin infection is the complication to watch most closely with lymphedema, because it can spread through a swollen limb quickly. Contact the treating clinician promptly if you notice:

  • Redness that is new or spreading, or red streaks running up the limb
  • Skin that feels hot or newly tender
  • Fever, chills or body aches
  • Drainage that turns cloudy, thick or foul smelling
  • Pain that is clearly worse than usual

Do not wait for the next scheduled visit to mention these. Call 911 if a person with these signs becomes confused, faint, very drowsy or short of breath.

Why primary care matters here

Medicines are part of the swelling picture. Some commonly prescribed drugs, including certain blood pressure, diabetes, pain and hormone medicines, can cause the legs to hold fluid. Water pills reduce some kinds of swelling and do little for others, and they can affect the kidneys and blood pressure along the way.

Sorting this out is a job for the prescriber. Do not stop or change a medicine on your own because of swelling. A primary care visit that includes a full medication review gives the prescriber and the wound clinician a shared, current list, and Gateway coordinates the records so both are working from it.

Primary care at home in the Riverbend →

Getting care arranged in the Riverbend

You may already have a surgeon, a wound clinic or a home health nurse and still want help with wound care with lymphedema closer to home in the Riverbend. That is a fine reason to call 314-325-0126. Tell us who is treating the wound now and what is not working, whether that is the travel, the gaps between appointments or unclear instructions. Gateway does not replace your current clinicians. We can arrange for a partner clinician to see the wound where you live and, with your permission, share notes with the offices already involved so the plans agree.

The two general hospitals in the Riverbend, Alton Memorial Hospital and OSF Saint Anthony’s Health Center, are both in Alton. Patients from Wood River, Bethalto and the other towns are commonly discharged from them, and Gateway has no affiliation with either. A discharge to a home a few towns away can leave a family unsure who checks the wound next. Families can call us with that question. Discharge planners can refer by phone at 314-325-0126 or fax at 314-786-7966, and we coordinate follow-up with a partner clinician and the regular doctor.

  • County: Madison County, Illinois
  • ZIP codes: 62002, 62035, 62024, 62095, 62010
  • Nearby hospitals: Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton (not affiliated with Gateway)
  • Nearby communities: Alton, Godfrey, Illinois, Edwardsville, Granite City
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in the Riverbend

Read the full guide to wounds with lymphedema, or see everything Gateway arranges on the mobile wound care in the Riverbend page.

Common questions

Can a wound care clinician come to a home in the Riverbend for a lymphedema wound?

Gateway arranges home visits with partner clinicians across Greater St. Louis and the Metro East, and availability in the Riverbend is confirmed by address and care setting. Call 314-325-0126 to ask. It helps to have a list of your medicines, the names of the clinicians you see and any wraps or garments you have tried. The treating clinician decides what care is needed after seeing the limb.

Why does the skin on my swollen leg look thick and bumpy?

When protein-rich lymph fluid sits in the tissue for months or years, the skin responds by thickening and hardening. It may form deep creases at the ankle or grow small wart-like bumps, especially on the feet and toes. These changes are a sign of long-standing lymphedema. They make skin harder to keep clean and more likely to crack, so point them out to the treating clinician.

What does a lymphedema therapist do, and would I still need wound care?

A lymphedema therapist is a physical or occupational therapist with added training in reducing lymphatic swelling through specialized massage, bandaging, exercise and garment fitting. A therapist does not replace the clinician who manages an open wound. The two often work on the same limb at different stages. The treating clinician decides whether and when a therapy referral makes sense, and Gateway can coordinate the referral paperwork.

Can a nursing or rehabilitation center in the Riverbend refer a resident for wound care?

Yes. Directors of nursing, wound nurses and social workers can refer residents by calling 314-325-0126 or faxing 314-786-7966. Gateway coordinates visit times with facility staff, and the treating clinician’s assessments and orders are shared with the nurses who provide daily care. Family members of a resident can also contact us to start the request.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.