About wounds with lymphedema

People whose swelling has been present for a long time are the ones most likely to develop a lymphedema wound. That includes people who had lymph nodes removed or treated with radiation for cancer, people with long-standing vein disease in the legs, and people who have had skin infections in the same limb more than once. Severe obesity can overload the lymphatic system. So can spending most of the day seated with the legs down, which is common after a stroke, with advanced arthritis, or with heart and lung conditions that limit walking.

A smaller group is born with lymph vessels that did not form normally, and their swelling may begin in childhood or early adulthood. Older adults often have several of these causes at once.

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: Creve Coeur

Many people in Creve Coeur have lived in the same house for decades and have managed swollen legs on their own for nearly as long, often with worn stockings and a routine that worked until the skin opened. Older homes add their own difficulties: a tub to step over when legs need washing, a bathroom up the stairs, a favorite chair with no way to raise the feet. A treating clinician visiting at home can see these and suggest workable changes. Gateway coordinates the visit and any garments or supplies ordered.

The housing in Creve Coeur leans toward ranch homes and two-story houses on generous lots, joined by condominium complexes, apartments and a number of senior living communities. Independent living, assisted living, memory care and skilled nursing can all be found in or next to the city. Gateway arranges partner clinician visits wherever the patient lives. In a house, we plan around the family’s day. In a senior community, we find out whether the resident or the staff handles dressing changes between visits, so the treating clinician’s orders go to the right hands.

Care at home

A home visit lets the treating clinician see the limb in the place where the swelling actually builds. The chair you spend the day in, the height of your bed and whether you have any way to prop up your legs all affect how much fluid collects. Those details are hard to describe in an office and easy to see in a living room.

It also spares you the trip. Moving a heavy, wrapped, draining leg into a car and through a waiting room is exhausting, and some people put off care because of it. Gateway arranges visits with partner clinicians in private homes, with availability confirmed by location.

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

Changes in the swelling itself can point to something beyond the wound. Tell the treating clinician about:

  • Swelling that increases quickly over a day or two
  • Swelling that moves higher, into the thigh, groin or belly
  • Rapid weight gain, or shoes and garments that suddenly do not fit
  • Needing extra pillows to breathe comfortably at night

Sudden swelling and pain in one leg, often with warmth in the calf, needs urgent medical evaluation because it may be a blood clot. Call 911 for chest pain, trouble breathing, coughing up blood, fainting, or a racing heartbeat with lightheadedness.

Primary care and overall health

Not all of the fluid in a swollen leg comes from the lymphatic system. Heart failure, kidney disease and liver disease can each add to it, and long-standing swelling from any of them wears on the lymph vessels over time. A primary care clinician keeps track of these conditions through exams, weights and lab work.

That information matters to the wound plan. How firmly a limb can be compressed, and how fast, depends in part on how well the heart can handle fluid moving back into circulation. When Gateway arranges both wound care and primary care, each clinician can see what the other has found and ordered.

Primary care at home in Creve Coeur →

Arranging wound care with lymphedema in Creve Coeur

Before anything is scheduled, Gateway checks two things for every request for wound care with lymphedema in Creve Coeur: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.

Mercy Hospital St. Louis and Barnes-Jewish West County Hospital are both in Creve Coeur, and Missouri Baptist Medical Center in Town and Country is a short drive south. Gateway is not affiliated with these hospitals. A surgical or chronic wound often still needs attention after the patient goes home. Case managers can fax us a referral before discharge. Families can call with the hospital name and going-home date. Gateway requests the records, confirms the Creve Coeur address and setting, and arranges a follow-up visit with a treating clinician.

  • County: St. Louis County, Missouri
  • ZIP codes: 63141
  • Nearby hospitals: Mercy Hospital St. Louis in Creve Coeur; Barnes-Jewish West County Hospital in Creve Coeur; Missouri Baptist Medical Center in Town and Country (not affiliated with Gateway)
  • Nearby communities: Chesterfield, Maryland Heights, Chesterfield and West County, Ladue, Overland, Des Peres
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Creve Coeur

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

Common questions

Will Medicare or my health plan pay for lymphedema wound care in Creve Coeur?

It depends. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a provider participates, and what your benefits are, depends on the treating provider, your plan and the care the clinician orders. Visits, dressings, compression garments and pumps are often handled under different rules. We go over these questions with you before care starts.

My arm is swollen after breast cancer treatment and the skin has opened. Can Gateway help?

You can ask us about any lymphedema wound, including one on an arm or hand. Arm lymphedema after lymph node surgery or radiation carries the same infection risk as leg lymphedema, and a new opening in the skin should be reported promptly. Let your oncology team know as well. Gateway can arrange an assessment with a partner clinician and share the findings with the clinicians who managed your cancer care.

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 physician office in Creve Coeur refer a patient to Gateway?

Yes. Offices in Creve Coeur can refer by fax at 314-786-7966 or by phone at 314-325-0126. Include the patient’s contact details, the reason for referral and recent notes. Gateway checks availability for the patient’s home or facility and keeps the referring office informed after the visit. The patient does not have to live in Creve Coeur for a local office to refer.

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.