What you don't know about Edema

Good day, guys. It has really been a while! Yeah, I'm now in my final year at the University of Nigeria, Enugu Campus, also doing my clinical postings at UNTH

Recently, something caught my attention that I couldn’t shake off and I have decided to share it with you all.

https://www.flickr.com/photos/unicefethiopia/32326118822

Lately, my grandmother, who had been managing diabetes for well over fifteen years, suddenly started showing swelling around her ankles. At first, we all brushed it off. “Na old age,” someone said. You know how it goes when someone elderly complains about body changes, it’s easy to wave it off. But over a few days, her legs became so swollen that her skin looked stretched, almost shiny. It looks like the feet do no longer belong to her. And I remember thinking, “How did I miss this?”

I can recall vividly that I covered edema as a topic in my Pathophysiology classes, yes, but it was always abstract. Some words like “interstitial fluid accumulation” and “oncotic pressure” are all found in my notes, but they never quite sank in until I saw my grandma struggling to put on her slippers. And this got my attention.

That was the first time I started noticing edema not just in pictures from textbooks, but in real life. I begin to pay closer attention to patients with edema during my rotations at UNTH. From my observation , Patients with diabetes had puffy feet. Those with heart failure spoke about a kind of heaviness in their legs that made walking difficult. Also, kidney patients had this indisputable puffiness around their eyes, legs, even the abdomen sometimes.

Today, I thought back to one of our lecturers by the name Professor Okafor, mentioning how situations like diabetes, heart failure, and kidney disease can all contribute to swelling. But back then, should I say I was too focused on passing the exam to really understand what he was trying to teach us. Hence, I failed to understand the concept of the matter, and I now see that life has an amusing way of teaching the same lessons again, just louder. Smile

So I ran back to my notes and textbooks to see if I could connect the dots. What I found humbled me because this was what I ought to have known so far.

Obviously, under normal circumstances, our bodies filter about 20 liters of fluid into tissues every blessed day. About 17 liters get reabsorbed into the bloodstream. The remaining 3? The lymphatic system comes in by collecting and returning it quietly to the circulation system. But when things go wrong, let's say when the heart’s weak, or the kidneys are failing, or when our blood vessels get too leaky from long-standing diabetes, this whole delicate system just crashes and becomes impaired.

One of the most eye-opening cases I saw was a woman named Mrs. Adaeze, during my clinical posting. She had chronic lymphedema after surviving breast cancer. Her arm was so swollen that she had to custom-make her blouses. But it wasn’t the physical swelling that got to me, it was the emotional toll. One afternoon, when we were helping her with compression wraps, she whispered something to us, “I used to love wearing bangles but now, I can’t even wear my wedding ring.” Her words touched me personally.
And that’s the part no textbook really prepares you for.

As a physiotherapy student, I began to see how our profession fits into this puzzle. Things like Movement, massage, compression may actually sound simple, but they’re powerful when done in the right way. I learned that something as basic as ankle pumps, that is moving the ankle up and down, and leg elevation can actually help push lymph fluid back to the drainage system. I even got to practice manual lymphatic drainage which we call efflurage, a gentle, rhythmic technique that feels more like flowing with the body than forcing it.

Interestingly, I got to discovered that some medications we routinely prescribe can worsen swelling. One of the patients I saw was on insulin and pioglitazone. His legs had ballooned over just a few weeks. Turns out, there’s such a thing as insulin-induced edema. Who would have thought?

All of this made me think about how we often separate the body into parts, treating “heart failure” here and “diabetes” there. But in real life it doesn't work that way. In most patients, it’s everything working (or failing) together. Diabetes affects the vessels and the affected vessels impair the kidneys. The kidneys affect fluid balance in the body. And before you know it a “simple” swelling becomes a sign of a much deeper problem.

Even with my grandma, it wasn’t just the swelling that worried us rather it was the way she slowed down with her movements, even, avoided her evening walks which she normally used to do, and lost confidence in her body. Already , we started helping her manage her fluid intake, reduced her salt, used compression stockings, and encouraged her to move more. With time and care, she improved and not just physically, but emotionally. And so did I.

I guess what I’m taking on is: that experience changed the way I view medicine and care.

My experience taught me that healing is not just about drugs or surgery rather about connecting the little things which matter..

Now, I look forward to my graduation and the next chapter of my journey, maybe abroad, maybe here. I’m more confident than ever that healthcare has to be approached holistically. We can't just go on treating the body like a machine with separate parts. Everything should connect. And sometimes, a simple swelling is the indication that opens the door to deeper healing and understanding.

So guys, I'm here again, back on Hive, after what feels like a long time of personal and academic demands.

If you've caught a glimpse of or experienced anything similar,be it with a parent, a patient, or even yourself, I'd love to hear your own story.

Thanks for hanging around till the end of this article. See you as soon as I get another free time to write!!

References

[1] Physiology, Edema - StatPearls - NCBI Bookshelf
[2] Pathophysiology of Edema Formation - Capillary Fluid Exchange
[3] Control of Lower Extremity Edema in Patients with Diabetes
[4] Heart Failure Signs and Symptoms | American Heart Association
[5] Chronic Kidney Disease, Fluid Overload and Diuretics
[6] Lymphatic Dysfunction (Lymphedema): Symptoms and Treatments
[7] Lymphedema: Practice Essentials, Background, Pathophysiology
[8] Insulin oedema in type 2 diabetes mellitus: A case report - PMC
[9] Manual Lymphatic Drainage - Physiopedia
[10] Effectiveness of edema management techniques for subacute hand
[11] Compression therapy for treatment of venous disease