I am humming that song from the ‘80’s, “Just another manic Monday…” Another patient in profound heart failure with shortness of breath that prevents her from lying supine, who’s got edema from the abdomen down. Fluid is coming right through her skin (see the blisters forming in the photo).

I normally use skin perfusion pressure to find out if the perfusion of the legs is enough to allow us to use compression. I’ve seen patients with open arteries who have rest pain NOT from arterial disease, but because their heart just can’t pump enough blood down there.

Nearly 24% of my patients have heart failure. I am betting that skin breakdown of the legs is a major contributor to the cost of heart failure – but as far as I know, no one has looked at that. Cardiologists spend a lot of time making sure that lawmakers and payers understand the poor prognosis and huge cost of advanced heart failure. We keep telling lawmakers and payers that we heal everyone. We need to combine forces with the cardiologists and admit that skin breakdown is a symptom of this underlying problem, and that we can’t fix it. I got her open areas closed once before with the gentle compression she could tolerate, but I couldn’t control her edema and now she’s back again. Let’s hope the heart failure specialist can help. In the meantime, all we can do is gentle compression and nutritional support with protein and Juven or Arginaid. (I will tell you a story about that later.)

I wish it was Sunday… that’s my fun day…