Wound care with lymphedema in Webster Groves.

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

During the exam, the treating clinician looks at the wound and at all of the skin on the limb, since the next problem often starts a few inches from the current one. Typical points of attention include:

• Where the wound sits, its size and depth, and what the wound bed looks like
• How much it drains and what the fluid looks like
• Skin folds, including the base of each fold
• The spaces between the toes, where cracks and fungal infections hide
• Warmth, redness or tenderness that could mean infection

These findings guide the choice of dressing, how often it is changed, and whether an infection has to be dealt with before anything else.

Arranging this care in Webster Groves

Many people in Webster Groves 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.

Large frame and brick houses are common in Webster Groves, often with the bedrooms and the only full bathroom upstairs. There are also smaller bungalows, apartments and condominiums near the business districts, and senior living that includes independent apartments, assisted living and skilled nursing care in and around the city. Gateway arranges visits with partner clinicians in each of these settings. In a private home, the clinician can see where the patient actually sleeps, sits and bathes, which often matters for a wound. In a facility, we coordinate timing and orders with the staff.

When care happens 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.

In a facility

Memory care and assisted living bring their own challenges for lymphedema. A resident with dementia may pull at a wrap, unroll it or be unable to say that it hurts, so staff need to know what to watch for: toes changing color, a wrap bunched behind the knee, fluid soaking through. The treating clinician takes this into account when choosing the type of compression.

Assisted living staff are often not permitted to change dressings or apply wraps. In that case the clinician may order home health nursing to come to the apartment, and Gateway coordinates among the agency, the community and the family.

What to report and when to call 911

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.

Primary care and overall health

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 Webster Groves →

How to get started in Webster Groves

People asking about wound care with lymphedema in Webster Groves 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.

After a hospital stay, Webster Groves residents often come home from SSM Health St. Mary’s Hospital in Richmond Heights, St. Luke’s Des Peres Hospital or Mercy Hospital South. None of these hospitals is affiliated with Gateway. If the discharge plan includes wound care, or the patient needs primary care follow-up and cannot easily get out, the family or the hospital’s discharge planner can contact us. We collect the discharge summary and orders, coordinate with a partner clinician and arrange follow-up visits where the patient is recovering.

• County: St. Louis County, Missouri
• ZIP codes: 63119
• Nearby hospitals: SSM Health St. Mary's Hospital in Richmond Heights; St. Luke's Des Peres Hospital; Mercy Hospital South (not affiliated with Gateway)
• Nearby communities: Kirkwood, Shrewsbury, Maplewood, Brentwood, Crestwood, Affton
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Webster Groves

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

• Diabetic foot ulcers
• Venous leg ulcers
• Pressure injuries and bed sores
• Arterial and mixed wounds
• Non-healing wounds
• Post-surgical wounds
• Reopened (dehisced) surgical wounds
• Surgical site infections
• Skin tears and traumatic wounds
• Skin graft aftercare
• Wound VAC (NPWT) follow-up
• Wound care with lymphedema in Kirkwood
• Wound care with lymphedema in Affton

Common questions