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I am happy to hear from you. Its been a while since we talked :)
Ok, so from what I understood your aunt has a bruise on her elbow, swelling in her hand and leaking of fluid from a skin tear in the hand?
I have a few questions. Does she have swelling in her forearm as well or just in the hand? Any swelling in the elbow? Any redness or warmth in that entire area?
Have they recently done any blood work using that arm? When you press on the swelling, does it stay indented?
We have guests from out of town so I have not been able to be logged in. Sorry for taking this long to answer you.
The purple bruise is most likely from some kind of trauma, bruises are usually from broken blood vessels under the skin. Because your aunt's skin is very frail, even light trauma can cause a bruise. She could have hit her elbow in the middle of the night without noticing and woke up with the bruise.
I don't think the bruise is of any concern.
If the swelling in the hand was caused by laying down on the arm, it would have resolved relatively quickly and should not have reoccured.
I am not sure why she has swelling in only one arm but it definitely is not normal. The reason she has fluid coming out from a tear in the skin is because of the swelling. Usually when there is a lot of swelling, the fluid escapes into "third space" which is the space outside the blood vessels. So if there is a tear in the skin, that's where the fluid goes.
If the swelling is persistent and is only present in one hand and the swelling is relatively new, it would probably be something that should be looked at by her doctor. Maybe she needs an ultrasound on her arm to make sure there is no blood clot in a vein which can cause some swelling (usually a blood clot is accompanied by some pain and redness but not always).
The swelling from osteoarthritis will usually cause swelling over the knuckles not through entire hand and the pain would be constant, it wouldn't go away after laying down.
In terms of cough, it is probably because she is choking on little pieces of food and are irritating her throat. I remember this has been an issue a while back (you were worried that she might get pneumonia). There is not much you can do about her choking other then to give her pureed foods. At some point in time her swallowing may deteriorate and she would need to be transferred to pureed foods. Also she can have a swallowing evaluation to see why she is choking, if there are any specific foods that make her cough more, where do they go and why. It would be very useful.
I hope I answered all your questions. Sorry for being so lengthy and for not getting back to you sooner. I should be on line on and off today so let me know if you have any other questions.
Ok, then I must have misunderstood what you described. I thought the swelling was new and the leaking was coming from the hand, not the tear in her elbow.
So she must have bruised her elbow somehow, got the bruise and caused additional swelling. If there was a tear in the skin, it is not unusual for the fluid to come out.
The swelling in the knuckles and fingers from arthritis is common, that usually does get worse with rainy weather, some days will be better than others in terms of swelling in pain, some days will be worse. Ice always helps to decrease pain and swelling from arthritis.
Your aunt has swelling in her feet/legs because she is not mobile, also she probably has some component of heart failure and. Swelling in your aunt's case is not unusual and should not be of significant concern. Of course, giving her water pills will help get rid of some of the fluid but it can also dehydrate her and I don't think it would be worse it.
I still think your aunt is choking a bit when she eats, something just goes does the wrong pipe (even if it saliva) and she has to clear it.
She probably has a slight form of diastolic dysfunction which often causes swelling in the legs. But this is really not anything to worry about, it is common and usually does not lead to anything other then swelling in the legs (and maybe shortness of breath if your aunt was mobile).
But is is also quite possible that her swelling is simply due to immobility. I am sorry I made you worry, it is really nothing to worry about. My grandmother is 87 years old and has had diastolic dysfunction for years. She is also very stationary (she sits all day in one place) and she has a lot of swelling from her knees down. I don't think you need to subject your aunt to any testing for this. As long as the swelling goes down after she lays down, it is nothing to worry about.
I am sorry, I spent some additional time re-reading your question.
Ok, let me re-explain. I think I understand better.
The swelling in the arm is from the bruise. The way I understood it is that she had a bruise on elbow and the swelling down in the hand. It is normal to have swelling from a bruise. I doubt that she bruised her elbow from laying on it but it is possible. More likely she hit it on something during her sleep. If there is a tear in the skin, the fluid from the swelling will leak out. Do not worry about the arm.
I take back about what I said about heart failure. I take it back, don't worry :) If the swelling is in the feet and ankles only, it is from sitting down. The fluid will gravitate down due to immobility. Once she is horizontal, the fluid comes back to the heart and starts re-circulating and the swelling goes down.
Yes, the fact that your aunt cannot communicate is very frusturating. This disease is harder on the family members then patients themselves. I am happy to hear the scar healed. It healed very fast considering everything so the doctors did a good job stitching it and you did a good job taking care of it :)
Good morning Beth,
My parent's dog also was not a happy camper during the 4th and was hiding under my grandma's legs (she lives with my parents) the entire night. He acts the same way during thunderstorms. I have 2 cats and they can care less :)
Thank you for your compliment. I enjoy working with you. I know I am not as often online as some other people but I am usually on at least once a day. We are taking our family hiking to Yellowstone National Park next week but I am taking my laptop with (just in case) :)
Ok, you explained it much better now about your aunt's arm.
Somehow she must have bruised her shoulder in the middle of the night. In her case, even light trauma can cause a bruise (does she take any Aspirin?) because she is frail as it is. If she did pinch her arm by laying on it during the night (and if it fell asleep), it definitely could have hurt her when you got her up. As long as the swelling got better, there is nothing to worry about.
When her hand puffs up from arthritis, put a bag of frozen vegetables on it. That will really help decrease the swelling (make sure you put a paper town on the skin first).
Yes, you are right. We do sound like the stooges. All anatomy parts of the arm got mixed up :)
Irregardless, I don't think the bruise was caused by her laying down on her arm (although possible). Do you or your uncle pick her up under her arms? If yes, it is possible that slight pressure could have caused her a bruise. Being on Aspirin, even if every other day, thins her blood so she is even more likely to bruise (plus, she is so frail).
Yes, Aspirin should be given to someone who is not mobile to prevent blood clots. If you are giving her 81 mg every other day, that will probably be fine but if you are giving her 1/2 of 81 mg, that will not do anything anyway (that dose has no heart protective benefits and does not thin blood enough to prevent clots) so might as well not give her any. If you are giving her 1/2 of 325 mg, it would probably be good to just switch her to 81 mg every other day or even 81 mg ever day.
I don't like to take medications either and understand people who don't want to. If I can avoid giving someone medicine, I always will but, unfortunately, it is not always feasible. Some people are dependent on medications, others are blessed with great genes :) I hope I will fall into the latter half :)
Try to put an ice pack, not just a cold wash cloth. That will help even more. Just put a towel or a couple of sheets of paper towel under the ice pack. Ice is one of the greatest anti-inflammatories. It always works. People underestimate how useful it is.
If the skin tear is no longer draining, you don't even need to put a bandage on (as long as your aunt will not pick at the skin). Open skin wound will heal quicker with nothing on it. In my personal experience, leaving a bandage on for a day or longer makes the wound even wetter but if that's not your experience, you can definitely leave the band aid on and see what happens.
I will be logging off for the night but will check my email the first thing in the morning in case you write back.
Sorry for this lengthy answers and for getting all confused on the body parts :)
When I was referring to the crease in her arm, I was thinking it was where the arm pit is. We got each other so confused with this :)
Bruises can resolve pretty quickly, usually within a week most go away which is what happened with your aunt.
See, I didn't know what dose of Aspirin you were giving her. Giving her half of 81 mg will not protect her from clots so I don't agree with what the nurse recommended. If you were giving her 325 mg, that would be a different story. I think Aspirin 81 mg every other day is good to give and it does have the protection. I was saying half of 81 mg every night wouldn't.
You can put A&D ointment on the teat and put bandage over it. A&D will help the bandage not to stick to the skin and not to tear it off.