Conway McLean, DPM

As a youth, Roger had been quite interested in athletics, unlike his parents. They were immigrants, having come over from Europe, and had no association with nor interest in sports. When Roger’s father was young, helping out around the house, running their small farm, doing chores, these were important activities and kept him very busy. Roger played baseball and football as a youngster, and though he was not a star, he enjoyed the competition. In high school, he restricted his sporting activities to baseball since he didn’t have the size or the speed to play football. He enjoyed the camaraderie, but had no aspirations of playing any further.

After school, Roger went into restaurant work, which was demanding but, thankfully, did not require more schooling. He worked his way up from being a pizza delivery driver to being a waiter, but eventually was hired as an assistant manager of a small but successful pizza shop. The pay was decent, although the work, and especially the hours, took a toll. He had little interest in exercising after a long day’s work, but did play some sports with his friends on weekends, the prototypical weekend warrior. He figured this was providing plenty of exercise. Until he hurt his knee playing basketball with his buddies. He never got it fully evaluated though it bothered him for many years after.

Marriage and kids didn’t really change anything as far as his general health status, at least initially. But the kid’s food preferences and a busy schedule led to a change in his diet, and not for the better. His dietary intake had never been particularly good, but then, Roger believed he could eat whatever he wanted without repercussions. A pizza was always close at hand, of course, and it was one of his favorite foods. Roger certainly enjoyed eating, and availed himself freely of whatever foods were handy.

Time passed, as it will, and Roger got comfortable with the routine, the daily grind. Wake up, go to work, grab some dinner, play with the kids, fall asleep on the couch. In no time, he had an expanding waistline and seemed able to do little about it. He’d try an occasional diet but could never stick with it. He tried going to the gym more regularly but, again, life would get in the way. It was about this time the swelling in his legs began, although it was not painful, just a little uncomfortable.

Working on his feet as he did, the swelling in his legs gradually worsened, surreptitiously and without fanfare. He found a vague, dull ache would develop during his typical workday. Elevating would relieve it, but Roger was far too busy to spend any significant time with his legs up. He had work to do, customers to feed, kids to care for. His family doctor, who he saw for his (high) blood pressure, didn’t have much to recommend other than support socks. The doc mentioned a water pill, which sounded distinctly unpleasant, so he sided with the socks.

Compression stockings, as they were more accurately called, were subsequently purchased, and their use attempted. They were torture! Getting them on was tremendously difficult, and if he could manage this intimidating task, wearing them was painful, like his legs were caught in a vice by the end of the day. He gave it the “old college try” but could stick with it for barely a week before the routine was broken and he never donned them again.

As years passed, the swelling became his constant companion, never resolving. It used to go down overnight, his legs being nearly normal when he woke. These days, it would be better in the morning, but not all better. Then the skin changes started, with the lower legs becoming shiny and tense. The skin was stiffened, almost hard.

The real ordeal started the day Roger bumped his shin on the coffee table. He suffered a reddish bruise, which was not particularly concerning until, that is, it became a nasty open wound, draining abundant watery liquid. His health care provider wrote for an antibiotic, which Roger found curious, but he took it. No change was seen in the appearance of the ulcer, which, by this time, was feeling distinctly uncomfortable, even vaguely painful.

Roger learned how to dress it and clean it from a nurse at his doctor’s office, although he didn’t see how triple antibiotic ointment would heal it. He found by applying more gauze squares over the sore, he could keep the dressing from becoming completely saturated and draining into his sock during the day. Eventually, he stopped examining the wound so regularly and it became just a normal part of life.

When he scratched his other leg and it evolved into another open sore (he had an itch!), he knew something had to be done, something different. A friend encouraged him to seek out a podiatrist who was board certified in wound care. This visit was enlightening, providing abundant information about how all the water in the tissues of his legs prevented normal blood flow. Additionally, all the fluids caused fibrosis, meaning a type of scarring process. This explained the stiffness of the skin and soft tissues.

The podiatrist prescribed the weekly application of a wrap to both of his legs, which, though awfully inconvenient, actually felt much better. Much to his amazement, the wounds got smaller, as well. Even more desirable, the swelling resolved, slowly, gradually, each week more and more. When both wounds healed completely, Roger was prescribed a sleeve device with velcro tabs attached to bungee cords. The device allowed him to set the level of compression but, more importantly, was incredibly easy to apply. And it kept the swelling from building up again.

Does everyone with chronic swelling develop open sores? No, but everyone with edema is carrying many pounds of extra weight with them, whether the cause is lymphedema or some other. And determining the underlying reason for chronic edema can be difficult, since it is often multifactorial. High blood pressure, poor kidney function, diabetes, and so many others, all are factors leading to some type of chronic lower leg edema. As with Roger, too often it goes untreated.

This is frequently because of its insidious onset, meaning it is sneaky, and worsens only slowly. Humanity, as a species, is so good at adapting. We can adapt to the harshest conditions, even lower legs twice the size of normal. A more informed perspective will enlighten the sufferer to what is going on and why. They would learn that definitive action, taken early in the process, can prevent many of the complications that come from chronic edema, be it from lymphedema, post-surgical, cardiac issues (especially congestive heart failure), or whatever the underlying root of the water balance problem. Many are chronic conditions that won’t be healed, only controlled. Similarly, edema, whatever the cause, is something you hope to control, but a cure is often impossible.

Chronic wounds of the lower leg are a condition many physicians encounter, but few are experienced at treating. Sometimes seeing a specialist is the way to go, to get the most definitive treatment options. If you have chronic or recurrent swelling of the lower legs, don’t wait, thinking its going to get better on its own. Being educated about the problem, and which treatments are appropriate, is a really good start. But be careful……Dr. Google has much to say about everything, but is certain of very little!

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.