By Bob Osborn, RN
One of the most common problems that affects people with motor neuron diseases is called dependent edema. This is swelling of the hands and feet which gradually extends upwards into the arms and legs. This is caused because veins depend on muscle movement to return blood and fluid to the heart. Without the muscle movement, fluid pools in the veins which become overloaded. The fluid then starts to seep out of the veins into the surrounding tissue.
The swelling that follows cannot be reduced by diuretic medications (“water pills”). Elevating the legs or arms to a level higher than the heart is most helpful. This can be accomplished with positioning in a power wheelchair (tilt and recline and elevating leg rests), or in a bed by adjusting the leg position or placing pillows under the legs. Gentle massage with a lotion of preference can also help. Use the lotion to protect and moisturize the skin, which can be fragile if there is swelling. Massage from the toes or fingers always going upward toward the heart. This will help shift the excess fluid back into the veins and gravity will help the vein return the fluid to the heart in a more normal way. The massage motion is similar to the action of slowly working toothpaste from the bottom of the tube to the top.
One thing that can help prevent the swelling to begin with is compression stockings. Rather than get the kind usually used in hospitals, I usually recommend that people go to a travel website (TravelSmith, Magellan, etc) and order airline socks. They work just as well, are easier to get on and off, and are about 1/3 the price.
Should the skin become reddened and warm, medical attention should be sought as this could be cellulitis. Also, should the limb become very swollen, cold and/or numb seek medical attention immediately as this could be an indication of a blood clot blocking circulation.