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Thread: Help please. Pulmonary Edema, pressure wounds with history of DVT

  1. #1

    Help please. Pulmonary Edema, pressure wounds with history of DVT

    My son, T-12 complete, injured at 17 yrs., now 21 is suffering from severe edema of both feet. History... injured 11/08, DVT 11/09, filter in groin, prescribed coumadin. He has had multiple pressure wounds with one case of severe osteomyelitis.

    To date, he is still on Coumadin and since January, his INR has been really low 1.4 - 1.5. INR tests every 2 weeks with adjustments, not much change as of last Monday, yet another change in dosage. Can't seem to get it regulated. Additionally, his protein level is 14, scheduling an appt with a nutritionist.

    He currently has one wound (right bumm), currently on wound vac. Unfortunately, he wore regular "footie socks" in late February resulting in pressure wounds on the front of his ankles. Since then, his feet are swelling tremendously and now has wounds on the back of ankles. All wounds are being treated by a wound care specialist.

    Last week, he saw his GP. We brought his attention to the foot swelling and he prescribed water pills and potassium and stated blood may be pooling in his feet. Since then, he's been taking the prescriptions as well as elevating his feet as high as we can get them during the night, however, we're seeing little to no change. He's also started utilizing his standing frame.

    Had an appt with the physiatrist last Friday and she stated to continue the current regemin as prescribed by the GP.

    Appt. with the wound care Dr. today and he stated the swollen feet is pulmonary edema. We must continue to elevate the feet at night and continue the standing frame. We've also eliminated shoes with heels, and have him in backless house shoes. But his feet are huge.

    Is there anything else we can do? I remembered back to the days after his accident they had electric compression boots. However, after reading many of the previous threads, I'm at a loss. Could there be clots in the feet, would compression boots (whatever they're called) cause a clot to break loose? He can't wear compression socks due to the pressure wounds? Ugh, this sucks. We're confident with the wound care Dr as he's been treating his wounds successfully for 3 years, the physiatrist is new, however, we really like her and she' affiliated with TIRR/Houston. The GP is good for normal things, e.g., UTI's, etc.. but ????

    Any/All help is greatly appreciated. ( my apologies for the length of detail)
    FAITH: Is not believing God can, but knowing he will.

  2. #2
    Has your son's heart been tested? Does he have alow salt diet? Heart failure can cause edema in the feet and abdomen.

  3. #3
    @ Craig: No, his heart has not been tested. He's usually very healthy despite the secondary SCI gifts (those gifts that keep on giving, occasional UTI's, Pressure wounds). Salt? Well, he could do a whole lot better. I cook with low salt, however, he'd prefer salty snacks over sweets. He also loves his carbonated beverages, but neither the salt or the soda intake has changed the past couple of months. With the exception he is drinking more water since all this.
    FAITH: Is not believing God can, but knowing he will.

  4. #4
    Senior Member lynnifer's Avatar
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    Soda pop will make his feet swell; they do mine. Enough until he is better. A lot of water or tea or fruit juice only.

    His feet should be elevated above his heart for half the day - 12hrs - if it's 'dependent edema.' I wouldn't do the standing frame until he's better or at least down to one wound.

    I have no experience with pulmonary edema but I suspect that doctor AND the one who prescribed the water pills may be wrong.

    I'm not a nurse though. I hope someone chimes in soon. I think you need to be in a better place that's used to seeing paralyzed people.

    How much is he up in his chair during the day? What does he sleep on? Cushion while in the chair?
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  5. #5
    My apologies... I was just corrected by my son, what the wound Dr. stated was that we have to get the swelling down as it could result in pulmonary edema. Regardless, we have to reduce the swelling and after reading many of the prior posts/threads, I'm reluctant to do anything else, e.g., massage, compression boots, etc... We've had a rough 2-3 years and we certainly don't want to any further damage.
    FAITH: Is not believing God can, but knowing he will.

  6. #6
    Lynnifer. The soda isn't good and he knows that. He is drinking a lot more water (thankfully) and he also drinks tea. He usually sleeps 12 hours (feet now elevated as high as we can get them without them falling off the props, if you know what I mean) and he's usually up 12 hours on a new quad chamber ROHO (recently prescribed for the wound on his bumm). He also has a ROHO low profile for his vehicle.

    We discussed the water pills/potassium with the wound dr. this afternoon and he was ok with them as they're only temporary and only to be used when he has extreme swelling.

    As far as a better place, his physiatrist is affiliated with TIRR in Houston which is a "Model" system for SCI. She spends an enormous amount of time there and is SCI literate/competent. She too, examined the wounds/swelling and was made aware of the medication. And she didn't make any changes nor did she offer any other recommendations.

    As far as sleeping, he has an electric /air-flow bed that circulates the air continuously.

    It's just so frustrating. And I despise SCI and all it's gifts that keep on giving. Thank you for your response!
    FAITH: Is not believing God can, but knowing he will.

  7. #7
    Senior Member lynnifer's Avatar
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    Well it sounds like you two are doing everything right.

    A couple Thursdays ago, I had swollen feet for three days. I never found the cause (though I suspect it was sodium and not moving around much). I stayed in bed for almost 2-3 days until it went down. Maybe try that? I know it sucks not to get up, but he's got you to help. I'm on my own. He could get up for a few minutes every few hours.

    I've done that before in the past when I had bad wounds on my feet. I just stayed in bed with them elevated on pillows higher than my heart.

    Good luck to you both. I hope he's not diabetic - has he been tested for any metabolic ailments?

    Sorry you're going through this. Some have it so easy while others have it so hard.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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