Q. I’m 26 years old, a T4 complete para for eight years. My thighs are skinny due to muscle atrophy, but my lower legs are fairly “normal” looking. Last month I had to spend seven days in bed letting a small scrape heal. During bed rest my legs and feet got super skinny, and I noticed they were about half their usual weight. When the “normal” look of my lower legs returned after my first full day in a chair, I realized it was due to swelling. Is this something I should be concerned about? And if so, is there anything I can do about it?
A. Kristi, chronic swelling of the lower legs is usually referred to as dependent edema, and yes, it is something you should be concerned about. It can lead to serious problems, including pressure ulcers and soft tissue infections like cellulitis. Dependent edema is common in people with SCI and other neurological conditions that affect the muscles. Left unchecked it can get progressively worse. Fortunately, there are ways to reduce and manage edema — the sooner you take steps to control it the better.
Cherisse Tebben, family nurse practitioner and certified wound care nurse at Craig Hospital, explains that when leg muscles flex, they help pump blood back to the heart. When leg muscles aren’t flexing because of SCI or other neurological problems, blood and fluid start to pool in the veins and tissues of the lower leg and cause edema.
Chronic edema puts tension on the skin, causing it to become more fragile and prone to splitting and cracking. Edema also creates pressure that reduces blood flow, which slows delivery of antibodies and healing agents needed to fight infection and heal a wound. This creates an environment where a minor incident such as a scratch or bug bite could lead to cellulitis, or progress into a pressure ulcer.
Tebben cautions that any new swelling — especially if it is in just one leg — or swelling associated with redness, should be immediately evaluated by a doctor to rule out a blood clot, fracture or infection.
To control edema, avoid adding extra salt to food — sodium causes the body to retain fluid. Also be sure to stay properly hydrated to help flush the system. Dehydration causes the body to hold on to fluid and will make edema worse.
Other things that can make edema worse are hot tubs, hot baths and sunburn because they cause a local stress response.
Xiomara Acosta, a registered nurse at Craig Hospital’s outpatien