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Julia Kizhner
Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience:  7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
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Julia Only....Hi Julia hope you are doing well. My aunt has

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Julia Only....Hi Julia hope you are doing well. My aunt has been having some issues. She has a habit of putting her hands between her legs. I try to put pillows in there, but she still does it. A few days ago she laid on her arm she has a habit of pulling it under her. The next morning I got her up & she cried out her arm was hurting. She stiffens them straight out so with the arthritis I can understand why it hurts. Anyway she has this bruise on top of the crease of her elbow & the side towards her body, which the nurse said caused edema in her hand. The water started leaking out of her hand out of a small skin tear, which has never ever happen before, it scared me too death. I knew it wasn't urine, cause it was in the place her hand was. The nurse said it was from laying on her arm. I don't know if she did in fact pinch her arm by laying on it I just assume. Is there a medical reason she could get a bruise there & cause this edema in her hand & now the leaking of water? I think it's a lot of water it soaked up a spot on her bed twice. The nurse said no. She said this all was normal. I try to keep her arm elevated, but she always seems to get it off during the night. Her hand is puffy today again so I am sure it will be leaking if she drops it down. Her feet & ankles always swell if they are down for just a half hour or so. Is this anything to worry about? I know this is a lot of info, but you are my go to girl
Submitted: 3 years ago.
Category: Health
Expert:  Julia Kizhner replied 3 years ago.

Hi Beth,

 

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?

 

Julia

Customer: replied 3 years ago.
Hey Julia,

The purple bruise is in the crease of her arm & on the side towards her body beside her elbow, sorry. No she hasn't had any blood work. No redness or warmth. The nurse said she had swelling in her hand from lying on her arm. But she nor I knows for sure if my aunt actually laid on her arm she is just assuming since my aunt has swelling in her hand, and my aunt has that habit of pulling her arm underneath plus sleeping with her hands between her knees. She said it's most likely from the compression. My aunt does have that osteoarthritis. Her hand is puffy it comes & goes, but it doesn't indent. When she lies down her feet go down & so does her hand puffiness after awhile.

Can you also tell me sometimes after my aunt eats or drinks she will cough it sounds crackly in her throat like the coughing is just in her throat. It lasts about 15 or 20 mins.

It's good to talk to you too! :)
Expert:  Julia Kizhner replied 3 years ago.

Hi again,

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.

Julia

Customer: replied 3 years ago.
Hi Julia,

The swelling is in the hand that is cripped from the parkinsons & arthritis. It's her knuckles & her fingers. The whole arm isn't swollen it's just the hand it comes & goes. There is no warmth or redness. The swelling usually doesn't go down when it's elevated. It usually goes down over night. But once she is up & it hangs down it swells up again. It has done this in the past many times the hand swells up. This time it was different, because she got the bruise on top of the crease in her arm & she has that small skin tear, which leaked all that fluid. Seems like it swells when we have rainy weather. There has been no more leaking since the other day, it's just a little spot on the bandage now.

Her coughing is more like clearing of the throat with some crackles. After a few minutes it stops.
Expert:  Julia Kizhner replied 3 years ago.

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.

Customer: replied 3 years ago.
My aunt has heart failure? I still think I have you confused, the bruising is in the crease of her arm the bruising includes part of her elbow. She hasn't had the swelling in her hand for awhile, but it did occur after the bruise. She then had the leaking of fluid with the skin tear. This all happen at the same time, which the nurse said it was because she laid on her arm, causing the swelling in her hand & the bruise.
Expert:  Julia Kizhner replied 3 years ago.

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.

Customer: replied 3 years ago.
You know I am the worry wart my heart started beating a mile a minute. Her legs have never swelled up it's usually her ankles & feet, and that one hand that is crippled. She is very alert most of the time, she tries to talk to me, but she can only sometimes get a few clear words, and sometimes a whole sentence. I think that makes me upset the most, I wish she could communicate with me. But I have noticed when she is really hurting she does tell me where. Her blister is about gone now on her foot, the place she had her stitches is healed, there is a scar, but it looks good.

Thanks for taking the time to come on an answer me, I know you are busy with guests!
Expert:  Julia Kizhner replied 3 years ago.

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 :)

Customer: replied 3 years ago.
lol no the bruise is in the crease of the arm, I should have never said she bruised her elbow. There is brusing that goes down to the elbow, but it's on top of her arm. She pulls her arm underneath her at times when she sleeps, so it gets more stiff & it already does from the arthritis. I just assumed she did that & pinched the arm since it was through the night. When I got her up she is always stiff, but she cried out about her arm, I noticed in the crease it was red, & during the day it turned purple & got pretty big. It is clearing up quickly the purple I was surprised. I called the nurse & she said that is most likely what happen she laid on her arm a long time, the edema happen in the hand from the compression of her body on her arm. Her hand does swell up when it rains, & it has been the last few days since that happen........cause it has been raining here. It just all happen at once. Since I can't ask her what happen we just have to guess. I know I have been upset, especially when I saw all that fluid it scared me too death. I just hate anything that happens to her. I tell her everyday I wish I could take her place.

I have been on asking questions, but usually it's usually after your off it just hit at those times, and I thought I could get a quick answer from someone else. You know I always come back to you, cause you are so patient, kind & sweet to me about my aunt, and all our problems.

I hope you had a wonderful 4th! My dog went crazy hearing the fireworks all weekend & Monday. He hates thunderstorms too! He was nervous & wouldn't even go out to pee.
Expert:  Julia Kizhner replied 3 years ago.

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).

Customer: replied 3 years ago.
Hi Julia,

Your trip sounds like it will be a lot of fun, enjoy & be safe! lol she didn't bruise her shoulder, she bruised the inside of her arm on the crease lol. We sound like the 2 stooges on this one! I give her an Aspirin every other night. The one nurse that was here told me to start breaking it in half & give her half every night. It is the low dose 81mg. A tiny pill. I didn't think you were suppose to break apart aspiin, because of it hurting the lining of your stomach? I give her the Aspirin, because of her laying so much, for fear of blood clots. The nurse said it was a good idea it keeps the flow of blood going. I know there is the good & the bad with all medicine, you just have to decide if it's going to benefit you more than then bad that comes along. My aunt never took much medicine her whole life, neither did my grandmother. They both had/have medication sensitivity, my grandmother she passed on years ago. I never take much meds myself, I don't like side effects. I know that sometimes we have to, but like them I have always tried to avoid them as much as possible.

Sometimes I wrap a cool wash cloth around my aunts hand, and that seems to help when she gets a flare up.

I just changed my aunt's bandage from that skin tear on top of her hand, & it is not healing as quickly as they usually do. Could it be because it was leaking all that fluid for a week almost? It's about half moon sized, and most of the time by the 2nd week it's closed. When I changed the gauze it lifts up the skin & opens it again. The nurse told me to put gauze on it to let it drain. it hasn't drained in a couple of days so just now I put on a big bandage band-aid instead. Can I leave the bandage on for a few days that seems to heal it faster then removing it everyday?
Expert:  Julia Kizhner replied 3 years ago.

Good evening,

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 :)

Talk soon,

Julia

Customer: replied 3 years ago.
Hi Julia,

Well the bruise wasn't under her arm it is on the crease of the arm. The bruise was really strange it's almost gone already. I have never seen her heal so quickly from a dark purple bruise. It went from red to purple now it's almost gone in 5 days. Could it be something else that could have caused the discoloration?

So the 81mg of Aspirin I give her every other night has no benefits from keeping her from getting blood clots? I have been giving her that for over a year. The nurse was the one that said to switch it to half every night of the 81mg.

I would leave the bandage off the skin tear, but I would be afraid she would hit it over & it wouldn't heal for a long time.

Sweet Dreams,
Beth
Expert:  Julia Kizhner replied 3 years ago.

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.

 

 

Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience: 7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
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