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.

How the care plan is built

A first assessment usually starts with the story of the swelling. The treating clinician asks when it began, whether it affects one limb or both, and whether it goes down overnight. A history of cancer treatment, leg surgery, injuries, blood clots or repeated skin infections matters, and so does the list of current medicines.

This history points to the cause, or more often the mix of causes, and that shapes the care plan. Swelling driven mostly by the lymphatic system is handled differently from swelling driven by the heart, the kidneys or the veins. The clinician may want records or test results from other offices, and Gateway gathers those ahead of the visit when it can.

Local context: Granite City

Crossing the river for a lymphedema therapy appointment can take a large part of a day from Granite City, 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.

Much of Granite City is made up of modest frame and brick houses on small lots, some with steps up to the front door. Apartments, senior housing, assisted living, and skilled nursing and rehabilitation facilities are found in the area too. Gateway arranges visits in all of these settings with partner clinicians. If steps, a narrow doorway or a second-floor unit make leaving home hard, say so when you call, because that is the situation home visits are meant for. In facilities, we coordinate with staff about the visit time, the resident’s chart and current orders.

Care 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

Small changes in the skin of a limb with lymphedema are worth reporting early, while they are easier to deal with. Let the treating clinician know about:

  • A wound that is getting larger or deeper
  • A clear increase in leaking, or dressings that soak through faster than before
  • New blisters, raw patches or cracks, especially in skin folds
  • Skin around the wound that turns white, soggy or sore
  • Itching, scaling or splits between the toes
  • A new or stronger odor

Call 911 for heavy bleeding that does not stop with firm pressure, or if the person becomes confused or hard to wake.

Primary care and overall health

Lymph flow in the legs gets much of its push from the calf and foot muscles squeezing with each step, so anything that limits walking tends to worsen swelling. Primary care can look at what is holding a person back, whether that is joint pain, breathlessness, weakness or fear of falling, and whether therapy would help.

General health affects the wound as well. Healing draws on protein and calories, high blood sugar slows repair and raises infection risk, and extra body weight adds pressure on lymph vessels in the groin and legs. These are long-term concerns that a primary care clinician follows alongside the wound visits.

Primary care at home in Granite City →

How to get started in Granite City

People asking about wound care with lymphedema in Granite City usually want to know what the first visit involves. Before it, Gateway collects the records the treating clinician asks for and confirms the time and place with you. During it, the clinician looks at the wound and the skin around it, measures it, asks about your health and medications and explains what they recommend. Afterward, the orders go to whoever does the daily care, supplies are requested and a follow-up is planned. Our guide to how mobile wound care visits work has more. To begin, call 314-325-0126. Whether a visit can be arranged is confirmed for your location.

Gateway Regional Medical Center in Granite City is the local hospital, and Anderson Hospital in Maryville is a drive to the east. Despite the similar name, Gateway Wound Care is a separate company and is not affiliated with either hospital. After a stay at one of them, or at a hospital in St. Louis, a relative or a discharge planner can ask us to arrange follow-up. We request the discharge orders, find out whether the patient is going home or to a facility, and set up a visit with a partner clinician once availability for that location is confirmed.

More wound care in Granite City

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

Common questions

Can Gateway arrange lymphedema wound care in a nursing home or assisted living community in Granite City?

Yes, we arrange visits in skilled nursing, assisted living, memory care and rehabilitation settings, subject to availability for that location. A facility nurse, social worker or attending physician can refer, and so can a family member. The treating clinician coordinates with facility staff on dressing changes and compression, and Gateway handles scheduling and paperwork between the facility and the clinician.

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.

Will Medicare or my health plan pay for lymphedema wound care in Granite City?

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 specialists are in St. Louis, but I live in Granite City. Can Gateway still arrange care at home?

Yes. Gateway works on both sides of the river, in Greater St. Louis and the Metro East. Give us the names of your specialists and we will coordinate records and orders with their offices so the treating clinician knows the existing plan. Whether a given insurance plan applies in your case depends on the treating provider, the plan and the care needed, and you can ask when you call.

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.