What to know 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.

Arranging this care in Madison County

Crossing the river for a lymphedema therapy appointment can take a large part of a day from Madison County, with the leg down for the whole ride. Many people would rather have wound care come to them. Before a visit is scheduled, Gateway confirms two things: the treating provider who serves your address, and how that provider works with your coverage, whether that is Medicare, an Illinois Medicaid plan or a commercial plan. Participation and benefits depend on the provider, the plan and the care needed.

Across Madison County you will find older houses on city lots, newer subdivisions, farmhouses and apartments, along with independent and assisted living, memory care, rehabilitation centers and skilled nursing facilities in the larger towns. Gateway arranges wound care and primary care visits with partner clinicians in each of these settings. The steps differ a little from one to the next. At home, we plan around the household and whoever helps with care. In a facility, we plan around the staff, the chart and the resident’s daily routine.

Care at home

Few people with lymphedema in the legs can manage the care alone. Reaching the feet, lifting a heavy limb and applying layers of wrap take flexibility and strength that the condition itself wears away. A spouse, an adult child or a paid caregiver often does the daily skin care, and the treating clinician may order home health nursing for dressing changes and compression.

Gateway shares the clinician’s orders with the home health agency and coordinates the schedule so everyone follows one plan. Caregivers are welcome at visits. It is the right time to ask what you are expected to do and what should be left to a nurse.

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

Compression should feel snug and supportive. It should not hurt. Report these problems to the treating clinician, and ask ahead of time what to do if one of them shows up at night or on a weekend:

  • Numbness, tingling or a pins-and-needles feeling below the wrap
  • Toes or fingers that look pale, blue or dusky, or feel cold
  • Pain that builds under the wrap instead of easing
  • A wrap that has slid down, bunched up or formed a tight band
  • Fluid soaking through the outer layer

Call 911 for chest pain, sudden shortness of breath, or a foot or hand that turns cold, white and severely painful.

Primary care and overall health

Because lymphedema lasts longer than any single wound, someone needs to hold the long view. A primary care clinician can track how often skin infections return, check the feet and toenails for the fungal problems that let bacteria in, and serve as the point of contact for the other specialists you see.

Gateway arranges wound care and primary care together for this reason. When the wound visits wind down, there is already a clinician who knows the history, the garments in use and what an early flare looks like for you. Questions such as who reorders garments, and how often the limb should be rechecked, have a place to go.

Primary care at home in Madison County →

Arranging wound care with lymphedema in Madison County

For a resident of a nursing home, assisted living or memory care community in Madison County, a request for wound care with lymphedema can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

Madison County patients are discharged from several hospitals: Anderson Hospital in Maryville, Alton Memorial Hospital, OSF Saint Anthony’s Health Center in Alton, Gateway Regional Medical Center in Granite City and HSHS St. Joseph’s Hospital in Highland. Gateway Wound Care is not affiliated with any of them, and follow-up can be requested no matter where the stay took place. A family member or discharge planner tells us where the patient is headed, whether home or a facility. We then obtain the discharge orders and arrange a visit with a partner clinician once availability for that location is confirmed.

  • County: Madison County, Illinois
  • ZIP codes: 62025, 62034, 62234, 62040, 62002, 62035
  • Nearby hospitals: Anderson Hospital in Maryville; Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton; Gateway Regional Medical Center in Granite City; HSHS St. Joseph's Hospital in Highland (not affiliated with Gateway)
  • Nearby communities: Edwardsville, Glen Carbon, Collinsville, Granite City, Alton, Godfrey, Illinois
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Madison County

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

Common questions

Do I need a referral to request lymphedema wound care in Madison County?

No. Patients, family members and caregivers can call Gateway directly at 314-325-0126 or send a callback request, with or without a referral. Some health plans have their own referral or authorization rules, and we ask about those when we confirm the treating provider. The web form asks only for a name and phone number, so please save medical details for the phone call.

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.

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.

Can I request primary care at home in Madison County if I do not have a wound?

Yes. Wound care and primary care can be arranged separately or together, depending on what the patient needs. A request can be for follow-up of ongoing conditions such as diabetes, heart disease or memory loss, or for follow-up after a hospital stay, with no wound involved. The treating clinician determines what care is appropriate, and availability is confirmed for your town and care setting.

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.