Leg Discoloration may be Hemosiderin Staining

Skin discoloration can happen for any number of reasons from rashes to allergies to eczema. However, if you have a family history of vein complications and notice skin discoloration around your feet, ankles, or legs, the cause may be more serious. You may have hemosiderin staining. Hemosiderin staining is caused by dysfunctional vein valves that force red blood cells out of the vein. These dead red blood cells release iron that gets stored in the tissue and causes discoloration.[1]

A few years ago, a co-worker of mine said her brother had of a brownish-reddish color around his ankles. Because he was young and healthy, he hadn’t considered that the discoloration might be a vein problem. It occurred to me that many people may not know much about hemosiderin staining, or that it can be a precursor to chronic wounds later in life.

Hemosiderin staining
Does this reddish-brown discoloration on the ankle look familiar? It may be hemosiderin staining, which can progress to a chronic, non-healing wound.
How is hemosiderin staining related to vein issues?

Venous insufficiency is the clinical term to describe poor blood flow from the feet and legs to the heart. The condition often causes varicose veins, swelling, and venous ulcers. When veins become damaged and don’t allow the blood to successfully flow back to the heart, the blood can pool in the lower extremities. This can cause a progressive loss of skin integrity known as chronic dermal disruption-type ulceration. Similar to a stage 1 decubitus ulcer, in the early stages of chronic dermal disruption, the skin is not broken, but without treatment, it often progresses to a chronic, non-healing open sore.

How do I identify early signs of venous insufficiency?

The clinicians I work with often say they see venous insufficiency in their patients who also suffer from obesity and diabetes. We refer to this as the “triangle diagnosis”.

In the first stages of venous insufficiency, the following may be present:

  • Swelling (edema) is often present in the ankles and feet.
  • Hemosiderin staining (also known as stasis dermatitis) may follow. It usually starts in the ankle area and over time, it may encompass the entire shin area circumferentially. This is one example of chronic dermal disruption-type ulceration.
  • As the disease progresses, you may also see other changes such as fibrosis or a “tree trunk” look to the legs. This is another example of chronic dermal disruption-type ulceration that can occur in the later stages of venous insufficiency.
How is venous insufficiency treated?

There are many ways to treat or manage venous insufficiency, but you should talk to your doctor about what is right for you. Here are a few ways to treat venous insufficiency:

  • compression stockings
  • regular exercise
  • elevating legs when resting
  • regularly clean and moisturize your skin
  • avoid sitting or standing for long periods of time[2]
  • pneumatic compression

I have spent many years specializing in pneumatic compression for patients who chronic venous insufficiency, non-healing wounds, and other circulatory conditions. And I have seen many of my patients have remarkable outcomes as a result of using their NormaTec PCD regularly. The PCD massages their limbs, which decongests engorged tissues and improves microcirculation in the extremities; this resolves symptoms that could otherwise progress to an open wound. If an open wound exists, improving circulation by using the NormaTec PCD will speed healing. Pneumatic compression is especially effective when combined with proper skin hygiene, exercise, and a healthy diet.

To learn more about how the NormaTec Pneumatic Compression Device might be the right option for you, click the button below to get some helpful information that you can share with your doctor.

Your NormaTec nurse,
Susan Rajotte, RN

Please note: The content contained in this post is not a substitute for medical advice, diagnosis, or treatment from your physician.

Understanding Your Circulatory System

To understand why you may have circulation problems, it is helpful to know how your circulatory system works. I have outlined some basic circulation information to help you get a better idea of how your circulatory system works – all the way from your veins, lymphatics, and arteries, down to your tiniest vessels.

Illustration of capillaries
Illustration of capillaries

Circulation is found in your arteries, veins, and lymphatic system. Arteries carry oxygen-rich blood away from the heart to the cells. Veins carry the blood back to the heart. The lymph system flushes away dead cells and cell debris, and it helps the body fight infections.

In each of these three systems, you will find various sizes of channels. Imagine a city in which you have three major highways. You exit one highway and get onto a main street that is still very busy. You turn off onto a quieter neighborhood side street, and then you take a shortcut through a back road that only you and a few others have found. This busy, winding network of transportation is like your circulatory system. Each of the three systems (highways) that create the entire circulatory system has a network of large units (main streets) and small units (back roads) that connect and work together.

  • Arterial system: the aorta is the body’s largest artery and arterioles are smallest arteries.[1]
  • Venous system: the vena cava are biggest veins and the venules are the smallest.[2]
  • Transporting blood between the veins and arteries are small blood vessels called capillaries.[3]
  • Lymphatic system: small lymphatic capillaries join together to create larger lymphatic vessels. These vessels expand into the lymphatic ducts.[4]
Disruption in Circulation:

Now, imagine that you are driving down Main Street and there is an accident up ahead. Traffic is horrible and you can’t get to a side road. You’re stuck in the middle of all of the other vehicles trying to get through. This blockage is like a clot. Clots can happen in the large veins or arteries or in the smaller ones. A similar disruption in the lymphatic channels is lymphedema. When left untreated, blood clots and lymphedema can get worse, causing further health complications.

Non-healing wounds and infection are other complications that can arise from circulation disruptions. Think of a bad stretch of road full of pot holes. The city can’t afford to fix it, traffic gets slower, and potholes get bigger. In your body, this is like blood flow that can’t efficiently get through an injured or damaged area, which can cause wounds that won’t heal, infection, or mobility issues.

Sometimes, these disruptions occur on those back roads rather than the main streets. While this may seem like less of a problem since it is a smaller channel, it actually poses a different type of threat. For example, if a major vein isn’t functioning properly, one option is to place a stent inside of it to open up the pathway. However, lymphatic channels, for example, are such tiny, hair-like structures that this kind of operation is impossible.

Treating Circulation Problems:

There isn’t one simple solution for treating these complex circulation issues. What works for some people may not work for others. Compression stockings or hose, bandages, exercise, elevation, Unna Boots, total contact casting, manual lymph drainage, stenting, and anti-coagulant medications are just some of the options to help those with circulation problems. These treatments are all different methods of trying to mobilize the blood or lymph back into healthy circulation. Your doctor will help determine what the best treatment option is for you.

At NormaTec, we specialize in micro-circulation issues from venous insufficiency to lymphedema treatment, and chronic wound healing to other peripheral vascular disease treatments. The NormaTec Pneumatic Compression Device mobilizes fluid by using air-filled boots that massage your arms or legs. It is an easy, effective treatment option that you can do in the comfort of your own home. If you have questions about your circulation problems, feel free to call us and speak to one of our nurses who specialize in these conditions.

Here’s to your health!

Your NormaTec nurse,
Susan Rajotte, RN

Please note: The content contained in this post is not a substitute for medical advice, diagnosis, or treatment from your physician.

Dr. Mark Hinkes: When Unna Boots Don’t Work

Article contributed by Dr. Mark Hinkes, DPM, one of America’s leading authorities on diabetic foot health, foot care, and amputation prevention.

“Hi, I’m here for my Unna Boot,” said a smiling, slightly heavyset new patient of mine. He was a Vietnam Veteran who had sustained injuries to both legs in the war. I could sense his good nature and great attitude about his injury. “Doc, it was a Bouncing Betty that got me, and we have been taking care of my legs with Unna Boots.” A Bouncing Betty was a particularly vicious type of land mine that, once triggered, jumped up in the air about two to three feet and then sprayed shrapnel in all directions resulting in terrible injuries to the legs and lower torso of anyone close to it.

Dr. Mark Hinkes, DPM “Yes, I have been getting the Unna Boots applied to my legs for the past six years, and they work great, except that I need to come in every week to have them replaced,” he said. An Unna Boot, sometimes referred to as a “soft cast”, is a static type compression dressing that is wrapped around a leg to control swelling. It is typically made of a roll of gauze that has zinc oxide or calamine lotion in it.

Looking down at his legs he shared with me, “I do miss my swimming. You see, I can’t swim due to the ulcers on my legs and the yellow fluid that constantly drips from them.” I could see his problem; the dressings on his legs were soaked in that fluid. “We see and have successfully treated many types of wounds,” I reassured him, “so let’s take a look at your legs.”

Once the dressings on his legs were removed, I pursed my lips and shook my head when I saw the results of the Bouncing Betty trauma and Unna Boot treatment. His legs were swollen on either side of the Unna Boot dressing and looked like an outboard engine propeller had chewed them up. Huge areas of muscle were just gone, leaving deep invaginations of tissue. There were thick layers of dead skin on the surface of his legs and thick scars were seen where the shrapnel was surgically removed from his legs. There were at least a dozen superficial venous leg ulcers that gently and silently began to ooze yellow lymphatic fluid down his legs. The skin of the legs was macerated and infected due to the chronic moisture.

When I asked the patient about the condition of his skin, he replied, “This is pretty good for me.” I looked him straight in the eye and told him, “I am sorry; I don’t put Unna Boots on wounds like this. I prefer to heal them.

Confused and shocked he said, “Doc, no one else has ever told me my wounds could be healed. Are you saying you can heal my wounds and stop the dripping? Are you telling me I will be able to go swimming again?”

“Yes, I have healed similar wounds like yours. I believe we can heal your wounds AND you will be able to swim again.” He began to cry when he realized there was a chance to heal his ulcers and cure the infection. Then he abruptly stopped and said, “How do we do it?”

“The plan I have successfully used for many other patients with similar wounds involves us being partners. “I will do my part and you will be responsible for your part.” He agreed and asked, “When can we start?” I shared my plan with him and we started his healing that day.

    • First, we ordered a venous Doppler exam (a non-invasive and painless test) to be sure he did not have any blood clots in the veins in his legs. This was a necessary precaution in advance of using a NormaTec PCD to control and remove the chronic fluid overload in his legs that was the cause of the ulcers, yellow dripping fluid, and resultant infections.

 

    • Then, we started a process of removing the excess, thick, unhealthy tissue from his legs by manually scrubbing the skin with wound cleanser and a scrub brush, and applied white petroleum jelly to hydrate the skin. The ulcers were debrided to remove infected tissue from his wounds, thus reducing the bioburden on them and accelerating their healing. Tissue samples from the infected wounds were sent for Culture and Sensitivity and appropriate oral antibiotics, topical enzymatic debriding medications, and local wound care treatments were prescribed.

 

  • A NormaTec PCD was ordered and the patient used it religiously every day, starting at 15 minutes per treatment and reaching his goal of four hours every day. The plan of using the PCD to eliminate the fluid overload in the legs combined with meticulous wound care including periodic debridment, resulted in resolution of the infection, closing the ulcers. Moisturizing of the skin resulted in total closure of all ulcers and no further dripping of yellow lymphatic fluid.

It has been two years since the ulcers have healed. The patient continues to use the PCD four hours every day and stops by my office to chat. With his warm smile and happy aura, he shares stories about how delighted he is that his wounds are healed and he can finally swim again.

Contributed by Dr. Mark Hinkes. To learn more about Dr. Hinkes’ work, read about his book Healthy Feet for People with Diabetes at www.dr-mark.net.

Please note: The content contained in this post is not a substitute for medical advice, diagnosis, or treatment from your physician.

Chronic Wound Management

Managing chronic wounds can feel like a daunting task. Wounds are often painful, wearing certain clothing becomes difficult, and the odor and appearance of the wound causes many people to be embarrassed and withdrawn from others.[1] Chronic wounds are common among people who have severe diabetes, a history of chronic venous insufficiency, tumors, or pressure ulcers caused by other mobility issues.[2] Here are some tips to help you take control.

Simple Steps for Caring for Chronic Wounds

Dr. Laura Jacobs, NormaTec’s founder, often shared this process to help manage chronic wounds:

Step One: Clean
  • Keep your wounds clean by removing all wound dressings and taking a warm (not hot) shower.
  • Gently wash your wound(s) with liquid hand soap and a paper towel.
  • Thoroughly rinse off the soap from the wound(s). Pat the wound(s) dry with a fresh paper towel.
Step Two: Moisturize
  • Once you are done cleaning the wound, be sure to moisturize your skin. Dry, cracked skin easily gets infected so it is important to keep your skin appropriately moisturized.
  • After showering and throughout the day, if needed, apply lotion to your skin (plain petroleum jelly works well).
  • Massage the lotion into both legs, from the knees down, including your toes and the bottoms of your feet. Do not apply the lotion in or near the wound(s).
Step Three: Dress
  • Once you have cleaned and moisturized, apply new wound dressings.
  • Remember, it’s important to keep your dressings dry, so change them as often as needed.
Motivation

Many patients endure anxiety and depression due to the loss of toes, limbs, and mobility, making management more difficult than the daily maintenance of cleaning, moisturizing, and dressing the wound. Having a strong social network will help give you the support you need. Senior centers, families, churches, or support groups, whether in-person or online, are a few ways to connect.

Also, never underestimate the importance of learning, growing, and having a variety of interests. Whether it’s knitting, reading, exercising, playing a musical instrument, watching a good weekly serial, playing cards, or learning about quantum-physics (who knows?), having diverse interests helps give everyone things to look forward to.[3] Setting goals within these tasks will help even further. For example, rather than simply listening to music, try identifying particular notes, patterns, or themes in the music, or try picking out musical lines on a piano or guitar.[4]

Keep on Moving

With winter approaching, use the autumn weather as motivation to get started with exercises. Try walking outside to see the beautiful fall colors, stretching on the lawn during warm afternoons, or doing some simple strength training outside to enjoy the aroma of the autumn air. Even if you’re bed-ridden, you can still benefit from exercise. Here are some examples from Arizona’s Healthy Living:

  • Flex and Point – The flex-and-point exercise works the tibialis anterior muscle located at your shin or the front of your lower leg. Perform this exercise while lying on your back. Point your right foot, then flex your left foot at the same time. Slowly alternate pointing and flexing your toes to feel the stretch on the front of your legs and your calf muscles. You also can point and flex your toes at the same time, as a variation.
  • Leg Lifts – Leg lifts involve working your quadriceps or the front of your thighs. Lie on your back with your right leg extended and your left foot flat on the bed for support. Slowly lift your right leg off the ground, focusing on using your thigh to lift your leg. You do not have to lift your leg too high off the bed — just a 3 to 6 inches will do. Return your foot to your starting position and repeat the exercise five to 10 times as you are able. Repeat the exercise to work your left leg.
  • Side Leg Lifts – Side leg lifts help to strengthen your leg and hip muscles. Lie on your back with your feet flexed and less than shoulder-width apart. You can place your hands under your buttocks for support and stability. Slowly spread your legs out to make a Y shape. Hold this position for one to two seconds, then bring your legs in to return to your starting position. Repeat this exercise five to 10 times and as desired throughout the day.
  • Reverse Lifts – Reverse leg lifts work the back of your legs or your hamstring muscles. Lie on your stomach with your head supported in your hands, knees touching the bed. Slowly lift your right leg, bringing it toward your buttocks. Only lift to a height as you are able — do not lift your heels to the point of pain. Lower your leg toward the bed and repeat five to 10 times. Switch legs to work your opposite leg.[5]

If you’re one of our patients, you can always call us. Our nurses have been helping patients just like you for many years, so we understand what you’re going through. We can also offer tips on how to use your NormaTec Pneumatic Compression Device more effectively. If you’re not a patient of ours, call us to see if we can help at 800.335.0960. We may be able to find a doctor in your area who prescribes the NormaTec PCD or help your current doctor order a pump for your peripheral vascular disease treatment.

Your NormaTec nurse,
Lea Cassetta, RN

Please note: The content contained in this post is not a substitute for medical advice, diagnosis, or treatment from your physician.

References:
[1]http://www.internurse.com/cgi-bin/go.pl/library/article.cgi?uid=21237
[2]http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_218.htm [3]http://www.nursingtimes.net/psychological-aspects-of-wound-healing/200564.article
[4]http://healthyliving.msn.com/diseases/rheumatoid-arthritis/natural-pain-remedies#2
[5]http://healthyliving.azcentral.com/senior-leg-exercise-done-bed-12792.html

 

Pneumatic Compression Device for Post-Operative Recovery

This story is brought to you by one of our patients who recently underwent surgery for a total left knee replacement. Since she was already using the NormaTec PCD for venous insufficiency, she continued her treatment and discovered it greatly helped in her post-op recovery.

NT: What led to your total knee replacement surgery?

When I was 12 years old, my doctor discovered I had scoliosis. I also have a one inch difference between my left and right leg. This set up the development of osteoarthritis in my knees that I have had for many years, my left worse than my right due to scoliosis. A few weeks ago, these conditions led to total knee replacement surgery.

Left knee illustration
Illustration of left knee-joint from behind, showing interior ligaments—from Gray’s Anatomy.

NT: What is the typical recovery time and therapy like for a total knee replacement?

I was told that the typical recovery time is three to six months with a great deal of swelling to the entire leg and especially the surgical site. Physical therapy is started in the hospital to determine what your needs are and to assist with roadblocks such as walking up a flight of stairs, rugs in the home, and teaching you how to walk with crutches. They estimated I would be out of work for three months.

NT: Has your recovery been different from the norm?

My recovery time has been very different than the norm. My doctor allowed me to take my NormaTec PCD with me to the hospital and for the first three days after surgery, I pumped at level 1 [lowest pressure] for a minimum of two hours a day. This made a big difference in my recovery and I was able to work with my physical therapist and occupational therapist for longer periods of time. As a result, I have no swelling in my feet, ankles, or shins. I do have residual edema to my knee, but it has not impeded my physical therapy program (home visits three times a week). I do three sets of exercises each day to keep the knee supple and prevent scar tissue from forming. Because I’ve had no edema, I was able to go back to working from home two weeks after my surgery, my wound is healed, and my knee rotation is 110 degrees (normal knee rotation is 120 degrees).

NT: Did your therapist or doctor support using a pneumatic compression device?

My doctor was open to using the NormaTec PCD since he had a patient who had one for his total knee replacement and did very well. Everyone including the nurses, therapists, and Physician Assistants all wanted to know what I was using and exclaimed at how it made a difference in my post-op course. I required very little pain medication, which made it easier to get up and do the exercises.

NT: How do you feel now?

As Billy Crystal says, “I feel marvelous.” I have very little pain during the day; I am able to get up and do my exercises three times a day; I have no problems with my daily activities. I have graduated to one crutch in and out of the home and, with practice, my gait is getting back to normal.

NT: What kind of feedback has your therapist or doctor given you?

I have not seen my doctor yet since my surgery, but I have an appointment in two weeks. My physical therapist continues to be amazed at how fast I have come along in such a short period of time. She continually says, “Do as much as your body can tolerate, then stop.” I’m finding I can do a lot!

NT: Have you had any surgeries similar to this in the past and how does this recovery process compare?

I have never had surgery of this type before so I have nothing to judge it by, but I have spoken to many people who have had total knee replacements who said it is incredible how far I have come so quickly. One man told me he was out of work for two months and it took him six months before he really started to be able to use his knee normally. I thank God for the NormaTec. It has made the experience of having a total knee replacement not something to be feared, but something to rejoice about because before the surgery I was in constant pain with poor mobility and things like walking my dog each night were impossible. We are both looking forward to that in the near future!

All of us at NormaTec hope to make edema, peripheral vascular disease treatment, chronic wound management, and lymphedema treatment simpler and better for anyone experiencing pain and discomfort in their daily lives.
Your NormaTec nurse,
Michelle Morais, RN

Please note: The content contained in this post is not a substitute for medical advice, diagnosis, or treatment from your physician.

Lymphedema Foods to Eat

You’ve been maintaining your daily lymphedema treatment and now you’re looking for diet and nutrition tips to keep your body functioning properly. Luckily, there are a number of choices that are both nutritious and tasty.
lymphedema diet tips

A good diet is important for many reasons, including maintaining a healthy weight to help decrease your swelling. Today, we’re going to focus on lean proteins, healthy fats, and vitamins.[1] And rather than simply giving you food recommendations, we have come up with a meal (tried and true recipes from our team) for you to try at home!

Remember, our tips and recommendations (and even our recipes) are general guidelines for conditions. You should always listen to your doctor’s recommendations, maintain any nutritional restrictions that have been prescribed, and ask to be medically cleared before changing your diet, lymphedema treatment, or starting an exercise program.

Lean Protein

Lean proteins repair skin and strengthen connective tissues. Lean proteins include:

  • quinoa (a healthy seed prepared much like whole grains such as rice or barley)
  • oatmeal
  • soy
  • egg whites
  • black beans
  • white meat chicken (no skin)
  • fish
  • seeds
  • nuts[2]
Healthy fats

Monounsaturated, Polyunsaturated, and Omega-3 fats are good for your health and can decrease cholesterol, reduce your chances of getting heart disease, manage your weight, and help your brain function, among other benefits. Healthy fats include:

  • oils – olive, canola, sunflower, peanut, sesame, soybean, corn, safflower
  • avocados
  • olives
  • nuts- almonds, peanuts, walnuts, macadamia nuts, hazelnuts, pecans, cashews
  • seeds – sunflower, sesame, pumpkin, flaxseed
  • fatty fish – salmon, tuna, mackerel, herring, trout, sardines
  • soymilk
  • tofu[3]
Vitamins A & C

Vitamin A can boost cell development and Vitamin C increases the formation of collagen.[4]

Vitamin A

  • carrots
  • sweet potatoes
  • pumpkins
  • spinach
  • collards
  • kale
  • turnip and beet greens
  • winter squash[5]
Vitamin C

  • red and green bell peppers
  • brussel sprouts
  • oranges
  • guava
  • kiwi
  • grapefruit
  • strawberries
  • cantaloupe[6]
Hydrate Yourself

Remember, hydration is key for all of your body’s functions. Drinking plenty of water, avoiding too much salt, and eating foods that have a high water content, like many fruits and vegetables, will help you stay hydrated throughout the day.[7] The Institute of Medicine reports that 20% of hydration comes from food and the other 80% is from beverages,so get plenty of both[8].

With these tips in mind, I’m happy to share a menu from the NormaTec team. These are recipes we know and love and we hope you will too!

Fresh Vegetable Salad with Quinoa and Black Beans
Feel free to add your favorite vegetables and enjoy!
  • 1 red bell pepper
  • 1 green bell pepper
  • 1 can of black beans
  • 1/2 red onion
  • 1 avocado
  • 1 lime or lemon
  • 1-2 Tbsp olive oil
  • 1 cup quinoa (Cook 1 cup of quinoa as recommended on the package. Try a low-sodium vegetable broth, a splash of olive oil, and salt and pepper for flavor.)
  1. While the quinoa simmers, slice up the red onion. TIP: for less pungency, soak the chopped onion in vinegar for 10-15 minutes.
  2. Chop the peppers and the avocado in the method of your choosing and add them to a large mixing bowl.
  3. Drain and rinse the black beans, then add them to the bowl.
  4. Add in the red onion if you have not done so.
  5. Allow the quinoa to cool and then add it into the bowl with the vegetables.
  6. Squeeze the lime (or lemon), add 1 tablespoon of olive oil, and salt and pepper to taste.
  7. Try Fresh parsley, cilantro, or basil for a burst of flavor
  8. Stir and serve!
Chicken Cutlets with Caper Sauce (adapted from Simply Recipes)[9]
I love this entrée from Simply Recipes, but suggest using spinach in place of the arugula for extra vitamin A.
  • 2 Tbsp olive oil, divided
  • 2 skinless chicken breast halves, pounded very thin, and then cut in half, so that you have 4 thin cutlets
  • Salt
  • 1 large shallot, minced, about 2 Tbsp
  • 2 garlic cloves, minced
  • 1/2 cup white wine or chicken stock
  • 1/2 teaspoon red pepper flakes
  • 1 Tbsp capers, drained
  • 2-3 cups spinach, torn into bite-sized pieces
  • 1/2 fennel bulb, shaved thin
  • 16-24 paper thin shavings of parmesan cheese
  1. Heat 1 tablespoon olive oil in a stick-free sauté pan over medium-high heat until almost smoking, about 1-2 minutes. Sprinkle salt over the pounded chicken breasts and sear them for 2-3 minutes per side in the hot pan, working in batches so that you do not crowd the pan. Remove the chicken breasts and cover with foil to keep them warm.
  2. Add the other tablespoon of olive oil to the pan. Add the shallots and cook 1 minute, stirring often. Do not let them burn, and if they begin to brown rapidly, turn the heat down. Add the garlic and cook another 45 seconds to 1 minute, stirring often.
  3. Add the white wine and scrape any browned bits off the bottom of the pan with a wooden spoon. Add the capers and red pepper flakes and boil until the wine is almost gone, about 2-4 minutes
  4. To serve, mix the spinach and shaved fennel and put some on each plate. Arrange some shaved parmesan over them. Lay a piece of chicken on each salad, then top with a little of the sauce. Serve hot.
Black Bean Brownies
If you have a sweet tooth that can’t be stopped, try a healthier approach to your normal recipes. These brownies are delicious and use black beans in place of flour. You can even make more substitutions for a healthier brownie.
  • 2 1-ounce squares unsweetened chocolate
  • 1/4 cup butter
  • 1 16-ounce can of black beans
  • 2 eggs
  • 2 egg whites
  • 1 Tbsp Stevia (a natural plant-derived sweetener)
  • 1/2 cup unsweetened applesauce
  • 1/2 cup fiber fill (such as Benefiber)
  • 1/2 tsp baking powder
  • 2 Tbsp dark corn syrup
  1. Preheat oven to 350°. Grease or coat with vegetable cooking spray a 9” square baking pan.
  2. In the top of a double boiler, cook chocolate and butter over simmering water until melted.
  3. Empty beans into colander and rinse well. Drain.
  4. Transfer beans to bowl of food processor fitted with a steel blade. Add eggs and egg white and puree.
  5. In a large mixing bowl, combine Stevia, applesauce, fiber fill, flour, and baking powder. Add bean mixture and corn syrup. Beat at low speed until mixed. Stir in chocolate mixture.
  6. Bake 30 minutes.

For those of you living with lymphedema, patients using the NormaTec PCD in the comfort of their home have reported a sustained decrease in their limb swelling since beginning pneumatic compression device treatments. To find out more about the benefits of the NormaTec PCD, check out our website www.normatecusa.com

Bon appétit!

Your NormaTec nurse,
Lea Cassetta, RN

Please note: The content contained in this post is not a substitute for medical advice, diagnosis, or treatment from your physician.

References:
[1]http://healthyheartsnutrition.com/2012/04/lymphedema-nutrition/
[2]http://www.foxnews.com/health/2011/04/26/10-lean-proteins/
[3]http://www.helpguide.org/life/healthy_diet_fats.htm
[4]http://healthyheartsnutrition.com/2012/04/lymphedema-nutrition/
[5]http://www.thedailygreen.com/healthy-eating/eat-safe/vitamin-a-44010609
[6]http://www.thedailygreen.com/healthy-eating/eat-safe/top-sources-vitamin-C-44102808#slide-1
[7]http://www.mskcc.org/videos/diet-and-lymphedema
[8]http://www.iom.edu/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx 
[9]http://www.simplyrecipes.com/recipes/chicken_cutlets_with_caper_sauce/.php

 

Coping with Venous Insufficiency & DVT when Traveling

Are you at risk for “Economy Class Syndrome”? If you have a history of DVT (deep vein thrombosis, i.e., blood clot) or chronic venous insufficiency (CVI), you should take precautions before traveling long distances. Whether you are traveling in an airplane, car, train, or bus, it is important to know how your circulatory system works so you can decrease your risk of developing DVT.[1]

How Healthy Circulation Works

The body’s circulation is found in three areas: the veins, arteries, and lymph system. Each area has a specific, important function:

  • Arteries bring oxygen-rich blood from the heart to all organs of the body
  • Veins bring the blood back to the heart
  • The lymph system flushes away dead cells and cell debris, and helps fight infection

In a healthy venous system, one-way valve action in combination with muscle contraction and relaxation and the effects of blood pressure on your vessels are mechanisms that aid in moving blood against gravity. When muscles contract and the valves open, the force on the blood vessels along with the tension in the vein walls themselves helps move blood back toward the heart countering the effect of gravity. When the muscles relax and the valves close, it prevents a reflux of blood (blood moving backward) and allows arterial flow to enter the venous system and repeat the process.

Poor Circulation and CVI

CVI happens when there is poor blood flow from the feet and legs to the heart, which often causes varicose veins, swelling, and venous ulcers. The one-way valves can become damaged and fail to close when the calf muscle relaxes, causing a backflow and pooling of the blood or the veins lose elasticity and become ineffective in assisting with blood return. When you are at rest in a sitting position, there is a significant decrease in muscle action. Pressure from the seat cushion on the back of the knees can also impact blood flow. The lack of muscle action, the compression caused by the seat cushion and the force of gravity can cause pooling of the blood in the vein that over an extended period can lead to clotting. Because those with CVI have impaired venous circulation to begin with, they are at greater risk for DVT in situations that prevent movement over long periods of time.

Signs and symptoms of CVI include:

  • swollen legs (edema)
  • varicose veins
  • wounds that won’t heal (i.e., diabetic foot ulcers)
  • cellulitis (skin infection)
  • skin firmness (referred to as induration)
  • pain and soreness
  • decreased range of motion in the lower legs
  • brown or red discoloration of the legs or feet that usually starts around the ankles (hyper-pigmentation)

You may experience CVI if you have the following conditions:

  • history of DVT
  • diabetes
  • operations or trauma
  • obesity
  • phlebitis
  • family history of varicose veins
  • pregnancy
  • insufficient exercise
  • smoking
  • advanced age[2]
Managing CVI & Preventing DVT when Traveling:

Unfortunately, concrete evidence is difficult to come by because research is limited and there are a great number of variables. However, Stop the Clot points to several reasons why the risk may be greater on airplanes:

  • Knee position – putting pressure on the popliteal vein
  • Dehydrating effects on the blood caused by low oxygen, cabin pressure, and humidity, as well as the consumption of alcohol, coffee, or tea
  • Sitting for long periods of time[3]

By all means, enjoy your trip, but don’t abandon the healthy lifestyle you have been maintaining at home. Remember to drink lots of water, choose healthy snacks, and to get up and move around frequently. Use your compression wraps or pneumatic compression device before and after your trip, or during travel if you are able. Choose an aisle seat if you’re on a plane so you have more room to move around and easier access to stand and walk around. If you’re in a car, walk around and stretch when you stop for gas or a bathroom break before getting back on the road. You can also try these airplane exercises from Boston Magazine:

When the “Fasten Seatbelt” sign is lit:
  1. Neck Rolls – Sit up tall and place your hands on your knees. Nod your chin down, then roll your head to the right, then back and to the left until you’ve completed a full circle. Do 8 to 10 neck rolls in each direction.
  2. Upper Trap Stretch – In your seat, place the back of your right hand on the small of your back. Then, turn your head to the left, and look down. You will feel a deep stretch on the right side of your neck. Hold for 10 to 15 seconds and then repeat on the other side. Do up to three to five reps on each side.
  3. Seated Cat-Cow – Begin in a tall seated position with your hands on your knees. Bring your upper body towards your lap, rounding your back, shoulders, and neck and hold for one to three seconds. Then lift your chest and your neck, arch your back and hold. Repeat this 8 to 10 times.
  4. Quad Pulses – In your seat, hold your mid-thigh so that your thumbs are against your inner leg. Squeeze your legs so that you can feel them press against your hands, hold for three to five seconds and then release. Repeat this 8 to 10 times.
Get more travel exercises at Exercises You Can Do On An Airplane[4]

Here’s to safe and happy traveling!

Your NormaTec nurse,
Lea Cassetta, RN

Please note: The content contained in this post is not a substitute for medical advice, diagnosis, or treatment from your physician.

References:
[1]http://www.dr-bull.com/information_travel.htm
[2]http://www.vascularweb.org/vascularhealth/pages/chronic-venous-insufficiency.aspx [3]http://www.stoptheclot.org/news/article125.htm
[4]http://www.bostonmagazine.com/health/blog/2012/12/20/airplane-exercises-stretches/

Nutrition Tips for Restoring Healthy Circulation

Nurse-SusanDiet is important to your overall health and management of your chronic circulatory condition. But despite attempts to cut those calories and fat, sometimes it can feel impractical or unmanageable. I’m always looking for new, reliable research not only on HOW to manage weight, but WHY certain methods are reliable while others are simply fads. Here is some current research on weight management and nutrition that offers some very practical advice that you can incorporate into your daily nutrition plan.

Why to Cut Down on Sugar

Sugar proves to be a problem even at commonly consumed levels. In a recent study, mice ate the equivalent of what is considered a typical ‘safe’ human diet – healthy, no-sugar-added, plus three cans of soda per day. What happened? They didn’t become obese, but the female mice died at a rate 2x higher than normal and the male mice were less likely to reproduce. Americans now consume 50% more sugar than we did in the ‘70s according to Professor Wayne Potts, the study’s senior author.[1]

Sugar is linked to weight gain, diabetes, belly fat, cancer, and heart disease, among many other problems.[2] For diabetics, blood sugar levels are especially important to keep in check since diabetes can lead to problems like diabetic foot ulcers and neuropathy. If you’re like me, nixing sugar isn’t easy. So, how can we help ourselves?

You might find that filling up on other, healthy food items when you’re hungry will curb your desire for quick, easily-accessible sugary foods. Also, drinking 6 to 8 glasses of water per day will also help curb your appetite. The grocery store can be a dangerous place to go without eating first. Make and stick to a list. Substitute complex sugar items with fruits and vegetables that will add more fiber to your diet, which, in turn, will make you feel fuller. Another method to try? Get more sleep! Keep reading to see why.

The Link Between Sleep & Junk Food

If you’ve had a sleepless night, you may find yourself craving doughnuts and pizza the next day. Researchers at UC Berkeley found that brain functions are decreased in the frontal lobe and increased in deeper parts of the brain when sleep-deprived. What does this mean? The frontal lobe is responsible for planning, reasoning, and impulse control, among other functions.[3]

The parts of the brain they discovered that have increased activity are more primal and respond to rewards. And what’s more rewarding than a double cheeseburger with a chocolate shake? The study looked at 23 healthy young adults and compared their brain scans and responses after a night of normal sleep and a night without sleep.[4] As a Weight Watcher myself, I came across similar information that recommends 7-8 hours a night for weight management. I tried the tip recently and found that it really did work for me.

If you have pain from lymphedema, chronic venous insufficiency, or non-healing wounds, sleep may not always be so easy to achieve. Many NormaTec patients, who have had years of chronic pain preventing adequate sleep, tell us that since obtaining their NormaTec PCD, they are now able to fall asleep during their treatments. Because it relaxes their muscles and eases their pain, it allows them to stay asleep as well. Though not the purpose of pneumatic compression device treatments, it is a nice bonus that extends into other health benefits that a good night’s sleep provides.

Why to Eat More at Breakfast & Less at Dinner

If you love breakfast, you’re really going to love this study. Simply changing WHEN you eat can make a big difference in your health. In a recent study, 93 obese women were fed the same, moderate fat and carbohydrate 1400 calorie per day diet. The difference was when they ate the allotted calories. One group ate 700 calories for breakfast, 500 for lunch, and 200 for dinner. The other group ate 200 calories for breakfast, 500 for lunch, and 700 for dinner.

The results? Those with the big breakfast lost more weight (17.8 pounds average), inches from their waist-lines (3 inches average) than did the big dinner group (7.3 pounds and 1.4 inches average). Insulin, glucose, and triglycerides were lower in the big breakfast group and they didn’t have high spikes in blood sugar. The researchers found that a ghrelin, a hormone that controls hunger, was lower in the big breakfast group, which could account for the group being less likely to snack during the day.[5]

A big breakfast should include protein (a good source would be eggs or cheese), whole wheat grains (like high fiber breads or English muffins), and either fruits or vegetables. An idea for a meal would be an omelet containing an egg, low fat cheese, vegetables, and a half cup of low fat milk. Then, add two slices of high fiber wheat toast with fruit served on the side, and the remaining half cup of milk. Voila! A low fat, high fiber breakfast.

Hopefully, these tips will help all of us make some practical changes to schedules and meal choices. Remember, exercise is also very important as well. It will help you burn calories, maintain healthy circulation, and get the most out of your peripheral vascular disease treatment.

Your NormaTec nurse,
Susan Rajotte, RN

Please note: The content contained in this post is not a substitute for medical advice, diagnosis, or treatment from your physician.

References:
[1]http://www.sciencedaily.com/releases/2013/08/130813111722.htm
[2]http://www.huffingtonpost.com/kristin-kirkpatrick-ms-rd-ld/dangers-of-sugar_b_3658061.html
[3]http://biology.about.com/od/anatomy/p/Frontal-Lobes.htm
[4]http://www.sciencedaily.com/releases/2013/08/130806145542.htm
[5]http://www.sciencedaily.com/releases/2013/08/130805131011.htm

 

Coping with Lymphedema’s Emotional Aspects

“Cancer is something you can get over; lymphedema is with you for the rest of your life.”[1]

At Eternity's Gate
Vincent van Gogh, At Eternity’s Gate

The word ‘chronic’ can be overwhelming. How can you possibly cope with something that will affect you for the rest of your life? Through our years of helping patients who live with chronic conditions such as venous insufficiency, non-healing wounds, and lymphedema, we have noticed they often feel that hope is lost. They’ve lived with their condition for years and no peripheral vascular disease treatment has really worked, so what’s the point? However, we also hear stories of people who cope miraculously well despite life-altering diagnoses. No matter which camp you’re currently in, you are not alone. Your feelings are valid and your concerns are shared. Sometimes, simply knowing you’re not alone in your thoughts and experiences can help you find the courage to move forward.

Psycho-Social Research:

If you are stifled by anger, fear, or hopelessness, you’re absolutely not alone. A study that took place from 2003-2009 measured the symptoms and quality of life for breast cancer survivors. They found that the psycho-social effects of lymphedema are real and very common:

  • An interrupted daily life
  • Fear of infection and injury
  • Feelings of abandonment and anger towards healthcare professionals
  • Feelings of guilt
  • Body image and confidence issues, embarrassment
  • Trouble sleeping
  • Decreased activity
  • Intimacy problems
  • Financial worries
  • An overall decreased quality of life

Because so many cancer survivors shared these concerns, the researchers suggested that healthcare professionals need to take a more active role in helping patients who are dealing with lymphedema. This may include longer appointments so that patients and their doctors can address emotional concerns, treatment options, and possible referrals to mental health professionals, physical therapists, and nutritionists.[2]

A New Approach to Long-Term Care:

Julie Silver is cancer survivor who is also a Harvard Professor and a doctor. After her cancer treatment, she also felt alone – and she was in a position to make some changes. Her Survivorship, Training and Rehab program (STAR) is an innovative way to help coordinate cancer care and rehabilitation among all types of healthcare providers including hospitals, doctors, nurses, therapists, social workers, and many more. It starts at diagnosis and follows the patient all the way through treatment and rehab.[3] You can find help for comprehensive treatment options here.[4]

The Importance of a Support System:

Depression is common and can be detrimental to your overall health. Let your family, friends, and caregivers know what you’re going through and don’t be afraid to ask for help if you need it. There are also many lymphedema support groups available. Listings for support groups by state can be found here. If you can’t find a nearby group or you are unable to leave your home, an online support group like Lymphedema People[5] can be extremely helpful. You can share your experiences, learn coping strategies, get information on treatments, and much more.

If you’re using the NormaTec PCD for lymphedema treatment, our customer service team loves to keep in touch with you. Through the years, we’ve had many patients who call to let us know how they’re doing. Sometimes, they ask about how we can help them get more out of their daily pneumatic compression device treatments, and sometimes we get to hear amazing stories of how their lives have changed since incorporating the NormaTec PCD into daily treatment regimen because they can wear normal shoes, skinny jeans, or just get up and walk around again.

Suggested Coping Methods:

Create a support system if you don’t have one – Whether you reach out to close friends and family, a nearby support group, or an online community, you’ll be happy you have someone with whom you can share your experiences.

Reach out for help when you need it – Everybody needs help from time to time. Don’t be afraid to ask. If you think you may need a therapist, talk to your doctor about a referral.

Exercise daily and maintain good nutrition – A healthy body will lessen your lymphedema symptoms. It will also help you feel better about yourself.

Stick to your daily treatment regimen – For our patients, using your NormaTec PCD for an hour each day will give you the best results. Skipping treatments is not recommended even when you feel your swelling is under control. Prevention is key!

Communicate with your doctor – There are many facets to your overall health and it is important for your primary care provider to understand what you’re going through physically and emotionally.
Lea Cassetta, RN

Here’s to your health!

Your NormaTec nurse,
Lea Cassetta, RN

Please note: The content contained in this post is not a substitute for medical advice, diagnosis, or treatment from your physician.

References:
[1][2]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904185/
[3]http://www.oncologyrehabpartners.com/star-certifications/star-clinician/
[4]http://articles.washingtonpost.com/2013-07-29/national/40887801_1_cancer-rehabilitation-clinical-oncology-breast-cancer 
[5]http://www.lymphedemapeople.com

Those Little Buggers: Mosquito Bites and Cellulitis Prevention

Mosquitoes are always unwelcome summer guests. When they bite, most of us experience a mild reaction of itching or stinging and mild swelling that disappears on its own in one or two days. You can often aid this recovery by simply treating with hydrocortisone, calamine lotion, or antihistamines.[1] However, sometimes the bites can lead to an infection known as cellulitis.

Cellulitis is an infection that involves the deeper layers of the skin. It is most often caused by bacteria (generally staph or strep) that enters through a break in the skin. However, cellulitis can also develop even without a break in the skin due to certain health complications. Cellulitis infection is treated with antibiotics. If left untreated, cellulitis can lead to serious complications. We’ll look at how to prevent mosquito bites and how to protect yourself from serious infection.

How can mosquito bites cause cellulitis?
Mosquito
Mosquito

Only female mosquitoes bite. They need the protein in our blood to aid in egg production. The saliva from her bite contains proteins (anticoagulants) that prevent our blood from clotting while she draws it out. Some of this saliva remains in the wound and these proteins can cause an immune response in our bodies that commonly cause the bumps and itching associated with mosquito bites.[2]

Bacteria naturally live on our skin. Bites, cuts, or other abrasions give the bacteria an entryway through the skin, causing infection.

Risk factors for infection include:

  • Bites, scrapes, abrasions
  • Chronic edema (lymphedema)
  • Diabetes
  • Chronic venous insufficiency
  • A weakened immune system
  • Obesity
  • Inflammatory skin conditions[3]

Many of our patients have cellulitis due to complications from poor circulation. For our patients who use the NormaTec PCD (pneumatic compression device) for lymphedema treatment or peripheral vascular disease treatment, the pump will actually help prevent recurrent cellulitis by improving circulation in the blood and lymphatics.

How do I know if my mosquito bite is infected?

If you are prone to infection due to lymphedema, peripheral vascular disorders, frequent cellulitis, or a weakened immune system for any other reason, monitor for the following symptoms:

  • A large area of swelling and redness
  • Low-grade fever
  • Hives
  • Swollen lymph nodes

If you notice these symptoms, contact your doctor immediately to prevent the infection from spreading.[4]

Why do some people get bitten more than others?

Scientists have been researching several possibilities as to why mosquitoes prefer to bite some people more than others. While there are still many unanswered questions, here are several commonly accepted risk factors:

  • Higher metabolism
  • Higher amounts of carbon dioxide expelled
  • Type O Blood
  • Higher body temperature
  • Drinking beer
  • Pregnancy
  • Brightly colored clothing
  • Lactic acid (e.g., from recent exercise)
  • Certain types of skin bacteria[5]

Recent research points toward certain scents (from chemicals in the body) that may repel mosquitoes and may be why some people are not bitten while those around them are. Part of the research involves identifying these chemicals for use as an insect repellent.[6]

What can I do to avoid mosquito bites?

The CDC recommends using a product with at least 20% DEET. However, do not use insect repellent over cuts or abrasions, only use it on exposed skin, and wash your treated skin after going indoors. Call your doctor if you have an adverse reaction to the repellent to prevent possible complications.[7]

Aside from using insect repellents, the CDC suggests many ways you can help fend off pesky mosquito bites:

  • Wear long sleeves, pants, shoes, and hats
  • Stay in air-conditioned rooms or screened-in areas
  • If you are sleeping outdoors, use a bed net[8]
  • Note the risk factors listed above and take extra precaution if you meet any of the criteria. Avoid certain activities that make you more prone to bites, or make sure you wear appropriate clothing or use repellents to decrease your risk.

If you do get bitten, there are several things you can do to help prevent a bite from becoming infected:

  • Clean the skin around the area of the bite with soap and water
  • Use an antiseptic cream after rinsing the area
  • Cover the affected skin with a bandage
  • Keep your fingernails clean and trimmed
  • Keep skin moisturized and drink plenty of water to maintain skin hydration
  • Try to maintain healthy circulation through weight management, exercise, and eating healthy foods[9]

Remember, call your doctor if you notice any signs of possible infection. It’s always best to catch and treat an infection early before it has a chance to spread. For those using the NormaTec PCD, once on antibiotics, the pneumatic compression device treatments will speed recovery by improving circulation and effectively allowing the antibiotic to reach the area of infection.

Your NormaTec nurse,
Lea Cassetta, RN

Please note: The content contained in this post is not a substitute for medical advice, diagnosis, or treatment from your physician.

References:
[1]http://www.mayoclinic.com/health/mosquito-bites/DS01075/DSECTION=treatments-and-drugs
[2]http://www.mayoclinic.com/health/mosquito-bites/DS01075/DSECTION=causes [3]http://www.medicinenet.com/cellulitis/article.htm#cellulitis_facts
[4]http://www.mayoclinic.com/health/mosquito-bites/DS01075/DSECTION=symptoms
[5]http://blogs.smithsonianmag.com/science/2013/07/why-do-mosquitoes-bite-some-people-more-than-others/
[6]http://online.wsj.com/article/SB10001424052970204660604574378933761528214.html
[7]http://www.cdc.gov/westnile/faq/repellent.html
[8]http://wwwnc.cdc.gov/travel/page/avoid-bug-bites
[9]http://www.medicalnewstoday.com/articles/152663.php