lymphnet.org / Lymphedema FAQs / Question Corner / January 1998

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LymphLink Question Corner

January 1998
Saskia R.J. Thiadens, R.N.

Q:  How can you tell if you have water edema, or lymphedema? What is the difference?

A:  There are a variety of things that cause edema. The word "edema" is actually a derivative of a Greek word meaning "swelling." In medicine, the word expresses an abnormal swelling in the body. Puffy eyes after a long night out or a meal with lots of sodium, or swollen ankles after standing or sitting for hours on a hot summer's day, are common forms of "water" edema and will subside rather quickly with elevation, rest and avoiding sodium. Swelling after a sprain, broken bone or surgery is also a common form of edema and is caused by broken capillaries (again, elevation, rest and a low sodium diet are helpful). Edema also is seen in patients after cardiac surgery or bypass, and in patients with venous insufficiency resulting from a cardiac/pulmonary condition. This type of edema usually responds well to elevation and compression stockings. Edema resulting from cancer surgery, lymphatic trauma or congenital lymphatic malformation will result in permanent (chronic) lymphedema (lymph fluid is a sticky, milky, high-protein substance much thicker than water and is not affected by the above methods of treatment).

Q:  I have great difficulty keeping my thigh-high stocking up, and my therapist told me that there is a glue to use. I am scared to use this since I have had many sudden infections in my leg. Please help me.

A:  I was sorry to hear of the many infections in your leg and understand your concerns regarding the use of the glue. Although I cannot speak for everyone's experience, I, personally, have not had any negative experiences with the glue in my practice. Many patients, including men (and women who do not shave their legs), are using it and really like it since this prevents having to wear a garter belt or the panty hose style. FYI: most stocking companies now provide the stockings with a silicone band that holds the stocking up. You might look into this as well. Most importantly, follow the "18Steps to Prevention" and see a podiatrist at least once a year who is well-versed in these types of infections (which could possibly be caused by a fungal infection, athlete's foot, etc). You also might try soaking your feet twice-a-week in 1/4 luke warm vinegar to 3/4 water which acts as a disinfectant.

Q:  I suffer from mitral valve prolapse (MVP) and must take antibiotics before and after invasive dental work. Failure to take this greatly increases the risk of developing a bacterial infection, a problem we LE sufferers need to avoid. Since most dental work is invasive, should all LE patients, whether they have a heart problem or not, take antibiotics before a dental visit?

A:  This is quite individual. Many LE patients see their dentist for both minor and major work and do fine without antibiotics. However, the person who develops frequent infections, especially with an unknown underlying cause, should take them pre/during/after as a prophylaxis. Some people easily bleed from the gums while brushing their teeth or when using dental floss. Washing your hands frequently and keeping your nails trimmed is a good idea if this is the case for you.

IN YOUR OPINION:

Attention Clinicians:  The following challenging question is in need of an answer. What is your opinion? Please send, fax or e-mail your input to: NLN, Latham Square, 1611 Telegraph Avenue, Suite 1111, Oakland, CA 94612-2138 or e-mail: nln@lymphnet.org.

Q1:  I have a four yr old daughter w/primary LE virtually throughout her body (both legs, genitals, buttocks, abdomen and chest, and one side of her face). Prior to receiving daily massage by a professional on a regular basis, we noticed she had a rather low energy level and would fatigue easily. Now since she receives regular treatment, we see a tremendous improvement in her energy level. Has anyone had similar "sluggishness /fatigue " problems without treatment? Is there any rationale/basis for the difference with and without treatment?

Q2:  In addition, in the last few months she has been complaining that her legs hurt (there is minimal swelling in her legs). We have been attributing the pain to "growing pains" as in other children, but we are concerned, however, that it may in fact be lymphedema-related and, thus, we should not dismiss her complaints as "growing pains." Any ideas or thoughts? (wchaite@aol.com)

Q3:  My daughter was born at 38 weeks gestation w/very apparent swelling of her left foot and some in her leg. We were told by the doctors that this was caused by her limb being "pinned" in-utero somehow. She had her first inocculation at four days old in one leg. No obvious reaction. She developed her first infection at age 20 months, followed by a second one six months later (good response w/Augmentin). Then had four weeks of CDP with a 40% reduction, and continued "self care "at home. Then four more serious infections over a period of four months. Prescribed prophylactic antibiotics and did well for a couple of months, but the infection again reoccurred. The last one in Sept 1997, the entire leg turned deep purple which has faded some but not entirely yet. As well-educated parents, we follow meticulous skin/nail care, as well as wearing of an Elvarex stocking.

Does anybody have experience with young children and recurrent infections? We are very worried since her leg has worsened, and are worried about what will happen when she grows older. No doctors understand these sudden onsets. Please help our beautiful daughter.

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Please address questions to: Editor c/o NLN, 116 New Montgomery Street, Suite 235, San Francisco, CA 94105 or e-mail: nln@lymphnet.org. Deadline for submissions is first day of the month prior to publication.

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