pitting edema

[HouAnswerGuy]

Hi everyone. I have a question about a client, and am wondering if you all could give me some feedback.

I have a client who is very overweight, who also has some pretty severe foot issues. She dislocated her 2nd toe years ago, and a podorothist just figured it out this year; she is scheduled for surgery this fall to reposition the toe.

In the meantime, she has a very hard time walking, which translates up through her body in a myriad of ways. I usually do a lot of work on her legs & hips to help with circulation & reduce TPs that cause her myofascial pain. But between her feet & her sedentary job, most of the help I provide dissipates btw our sessions.

This summer, it got very hot here. She was my first experience of pitting edema. oh! so THAT's what that looks like. wow. it really doesn't spring back at all.

So I told her that it is a CI. I am concerned about her body's ability to handle the extra fluid load. I have to change approaches, avoid deep & circulatory work. I told her I need her to see her MD. I even wrote a letter to her MD asking for his professional opinion. She had recently had a cardiology workup & everything was fine. But I am still concerned about her kidneys.

Well, she has been back twice now, w/o visiting the doc. I have continued to do mostly upper body work, MFR, etc. I have been avoiding her legs; I really want her MD to check out her kidneys, especially as she told me in the spring that she had had a kidney infection that she treated at home ( which I passed on to her MD).

However, the heat has passed. And during her last visit, her pitting edema had pretty much resolved. I feel like I still need to wait to hear from the doctor, but I can't make her go to see him. Since she is no longer presenting the pitting edema, does that mean I can work her lower extremities again? She really needs it; but at the same time, I really think she needs to have her kidney stuff checked out- especially before she heads in for surgery this autumn.


About a week after I first saw her pitting edema, I had another client present with it. She, however, had just seen her MD, who had told her that massage was excellent for her slow circulation, and that I should carry on with circulatory massage b/c her systems had checked out fine. So that has been in the back of my mind the whole time, as well.

Any feedback for me on this subject?

 

[VisualEcho]

pitting edema

She was my first experience of pitting edema. oh! so THAT's what that looks like. wow. it really doesn't spring back at all.

I told her I need her to see her MD. I even wrote a letter to her MD asking for his professional opinion. She had recently had a cardiology workup & everything was fine. But I am still concerned about her kidneys.

Well, she has been back twice now, w/o visiting the doc. I have continued to do mostly upper body work, MFR, etc. I have been avoiding her legs; I really want her MD to check out her kidneys, especially as she told me in the spring that she had had a kidney infection that she treated at home ( which I passed on to her MD).

However, the heat has passed. And during her last visit, her pitting edema had pretty much resolved. I feel like I still need to wait to hear from the doctor, but I can't make her go to see him. Since she is no longer presenting the pitting edema, does that mean I can work her lower extremities again? She really needs it; but at the same time, I really think she needs to have her kidney stuff checked out- especially before she heads in for surgery this autumn.

Any feedback for me on this subject?

My feedback would be that if you really feel she should have her MD see her, stick to your guns.

I can think of three ways this can go. The main thing is to be comfortable in your decision.

• She will see MD and you'll get a release (or not) - in which instance you will be happy for the information.
• She will go see someone else who will work on her legs/feet if you don't.
• She will just keep asking you to do the work, and not see the MD.

Thanks for such a well written out post with so much information. I am sorry I can't elaborate more on the situation than I have. Maybe someone else will respond with better feedback.

And, don't you love it when someone finally presents with something you've never seen before? A real life experience is worth so much more than a thousand words!

 

[Ian Loves Noel <3]

pitting edema

DEEP work w/ pitting edema is an absolute no-no. However, at school we were taught that mild stroking upwards would be of benefit to a client's circulatory health. Would I do this type of thing w/o consulting a doctor - depends on the client... the 4 that I have had in my practice for a long time had had long term battles with summertime pitting edema so we proceeded cautiously with stroking and drainage techniques to help "move things along". Never have done swedish work on their legs, but, then again, with the PE that would have been sheer misery for them so I never even considered it. Two of the clients keep their edema in check by doing upward stroking from just below the knee [where they are able to reach] to the groin at least once if not 2x a day.

It's up to you whether or not to get an MDs permission - around here the requests for information and/or permission are brushed aside as "foolishness" [quoted by the man's nurse to me] so I ask the clients what they want done, explain the risks, etc. and am guided by what they want and my common sense.

 

[Pompal 09.]

pitting edema

I agree that ideally it would be nice to get some feedback from her physician. But (and there is always that little word thrown in, yes??) I tend to proceed as Anastasia has in the past. My first thought while reading this was that it probably has nothing to do with her kidneys.
And if she is obese, then I would assume that her heart is over worked throughout the year and it just gets more difficult when the heat and humidity arrives for the summer.
If she is having foot pain on top of her other issues then she is probably sitting more than usual and the excess weight was pressing on the main areas that process the lymphatic flow from her feet and legs.
I bet you helped some of that blockage when you worked her upper body - creating a vacuum effect to help draw the fluid naturally out of her legs.
It sounds like you blended your training with your empathy and did some very good work on your client!!
If the edema returns to the extent of pitting and causing you to really have concerns maybe suggest she see someone trained in Lymphatic Drainage Therapy. Good luck!

 

[liamjlewis]

pitting edema

thanks so much for the feedback. I will be seeing her next week, and I am thinking that her edema will be cleared up. I am still curious to hear what her doc will say, but I think that light stroking will be advaneforum.xxxeous in the meanwhile. What she really needs is some TP work in her calves & feet, but I am going to keep pushing her to see her doc. I had her fill out a HIPAA release for me to talk to her doctor, but I didn't have her sign one that lets him talk with me. I think I will do that, and send him a followup letter. Maybe he will get back to me if I make it easy for him. But he may not have any information until she actually goes in to see him, so I may just have to wait until she does.

I am really glad to hear all of your points of view. It has been quite helpful.

 

[ukfan14]

pitting edema

A lot of over wieght people have Edema. There are water pills that the DR. can write a scpit for, but a lo of people don't like them bc they make you go pee all the time. I do light strokes pussing the fluid up and that seems to help. You can also suggest the your client lay on there back and put their feet in the air

This type of thing is a verious cycle bc it can be uncomfotable at times making it hard to workout or even be able to put on shoes. When the best thing for Edema is to try to loose wieght

 

[xo NavyGirl]

pitting edema

Her doctor was very grateful for my letter

He checked out her kidney function, which turned out to be fine, and ran some other tests as well. As expected, the pitting cleared up when the heat wave was over, but I am glad that I wrote my letter & kept her PCP in the know about my experience.

Thanks again to everyone for your feedback. This place can be such a treasure trove of info and support!

 

[Steel city]

pitting edema

Kudos to you for taking the initiative on your client's behalf!