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Family Physician
Family Physician, Doctor (MD)
Category: Health
Satisfied Customers: 12816
Experience:  Emergency Medicine and Family Practice for over 26 years
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spine biffida and has been in a wheelchair her whole life

Resolved Question:

my sister in 42. she has spina biffida and has been in a wheelchair her whole life. she has always had some swelling but now it is terrible. one of her feet is so swollen up it looks like a latex glove blown up with air. she has no feeling from the waist down. she was told to wrap her legs but that is impossible for her to do herself. what should she do and what type of health care provider should she see? thanks.
Submitted: 6 years ago.
Category: Health
Expert:  Family Physician replied 6 years ago.
How long has she had this swelling?

What if any cause has been identified for this swelling?

Customer: replied 6 years ago.
THE SWELLING HAS BEEN REAL BAD, ESPECIALLY IN HER RIGHT FOOT FOR OVER A YEAR. I TOOK HER TO THE ER ABOUT THAT TIME. THE ONLY THING ANYONE SUGGESTS IN WRAPPING, WHICH FOR HER IS NEARLY IMPOSSIBLE AND COMPRESSION HOSE, WHICH ARE ALSO NOT REALLY AN OPTION. SHE DID SEE A DR AT THE UNIVERSITY MEDICAL CENTER IN TUCSON. THEY SUGGESTED SOME TYPE OF SURGERY TO DRAIN HER FOOT BUT SAID IT MIGHT OR MIGHT NOT WORK AND IT MIGHT ONLY LAST A WEEK OR TWO EVEN IF IT WORKED. SHE TAKES COUMIDIN AMONG OTHER DRUGS. SHE HAS A WHEELCHAIR WHEN HER LEG CAN BE OUT STRAIGHT AND SHE DOES PUT IT UP A LOT.
Expert:  Family Physician replied 6 years ago.
Based on the information that you have given, it sounds like she is suffering from lymphedema. There are a number of treatments including specialized physical therapy, wraps and special alternating pressure "boots" that pump the swelling out of the feet.
Expert:  Family Physician replied 6 years ago.
Here is an example of a insurance coverage policy on this type of equipment

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0354_coveragepositioncriteria_lymphedema_pumps_and_sleeves.pdf


Edited by Family Physician on 6/2/2010 at 3:16 AM EST
Customer: replied 6 years ago.
AS I STATED THE WRAP HAD BEEN SUGGESTED BUT SHE IS UNABLE TO DO THAT. WHERE WOULD ALL THAT FLUID GO FROM HER FOOT IF IT WAS PUMPED AWAY FROM HER FOOT ? IS THERE SOME UNDERLAYING REASON FOR THE SWELLING AND FLUID POOLING? CHF OR SOMETHING AN ENDOCRINOLOGIST COULD DIAGNOSE?
Expert:  Family Physician replied 6 years ago.
Her lack of mobility in the legs is the biggest contributing factor to this problem. The fluid reenters the circulation as it would with someone who does not have any problem. The normal action of muscles in walking pumps the fluid back from the feet.

This is not really an endocrinology issue. This is more of a physical medicine/rehabilitation issue or a vascular surgery issue.
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