Happy Valentine’s Day to my patients and my amazing nurses.
Watch the incredible video of this wound dripping lymphatic fluid:
This movie is of a man in his 70’s who has had prostate cancer with radiation to the pelvis and a DVT in that leg. He’s got lymphedema in addition to his venous stasis. Watch the lymphatic fluid dripping out of this wound in real time. Keeping his edema controlled is a full time job. He has a pneumatic pump he won’t use because he can’t get it on an off easily and he wants to sit at his computer all day with his feet dependent. Every time I try to transition him into a Velcro strap device (e.g. Juzo, Farrow, etc), it’s a disaster, largely because he just can’t or won’t get it snug enough. Within days he is back in the clinic with open ulcers to restart bandages. It seems clear to me that we will just have to keep bandaging him forever.
The role of the lymphatics is under appreciated. Here’s a venous ulcer patient whose lymphatics were imaged with Near Infrared imaging. You can see that the lymphatics are severely affected. We see this every day in patients with venous disease.
I saw this perfect heart shaped wound yesterday! No, I did not manipulate this in any way. A patient’s compression bandage slipped down and left this. She’s been suffering from terrible depression and it’s the first time I saw her laugh! We take our joy where we can find it. “Happy Valentine’s Day!” to all the wound care practitioners out there!