[bay bay]

Hi all! Any suggestions on how to relieve scrotal edema? Not meant to be a joke. I have 2 guys, one with Pancreatic CA, and pitting edema in his lower extrem. MD has him on a 5 day trial of HCTZ and Spironalactone BIDx's 5 days. Does not want lasix right now. This guy has great discomfort "down below, and I'm not sure what to suggest. My other guy has T Cell lymphoma, with profuse weeping in his lower extrem. His disease is far more advanced, so I'm not sure if I can manage his scrotal edema. My concern with this guy is that his foley insertion site is not visible because of the massive swelling. Both guys have voiced great concern and discomfort, and 80mg of lasix BID has not helped at all with pt #2. Any suggestions or comments?

[ktwlpn]

Originally Posted by bay bay

Hi all! Any suggestions on how to relieve scrotal edema? Not meant to be a joke. I have 2 guys, one with Pancreatic CA, and pitting edema in his lower extrem. MD has him on a 5 day trial of HCTZ and Spironalactone BIDx's 5 days. Does not want lasix right now. This guy has great discomfort "down below, and I'm not sure what to suggest. My other guy has T Cell lymphoma, with profuse weeping in his lower extrem. His disease is far more advanced, so I'm not sure if I can manage his scrotal edema. My concern with this guy is that his foley insertion site is not visible because of the massive swelling. Both guys have voiced great concern and discomfort, and 80mg of lasix BID has not helped at all with pt #2. Any suggestions or comments?

I'm betting you are only going to be able to medicate to keep them comfortable at this point..I have made several "bridges" or "slings" crafted from linen,disposable pads,casting materials etc but then you run the risk of causing pressure areas so you really have to be vigilant... For the pancreatic ca pt ...-why no lasix now-especially if there is a chance it will help alleviate some of the edema? What is the doctor thinking? Advocate for this guy...Same goesfor your other pt.-pain control is the best you can do....Suppose the foley gets blocked from the edema? I would not think he is a candidate for a supra-pubic cath at this point.....How long have these pts been on hospice? It looks like they need some help doing the work they need to do to move on in the process-they are both very concerned about the edema because they can focus on it to the exclusion of what is really happening to both of them...Pts like this need help understanding that they are still in control and still need to make plans..Good LUck

[Mermaid4]

I was going to suggest a bellvue bridge but then that would date me terribly....

[muzicone]

Sometimes add Zaroxyln can decrease the swelling, short term use, heavy diuretic.

[river1951]

elevation, ice, and diuretics

[bay bay]

Thanks for all your suggestions! It's always nice to "suggest options" to the docs after hearing from other nurses.
Cheryl

[Julian Dodd]

Originally Posted by bay bay

Hi all! Any suggestions on how to relieve scrotal edema? Not meant to be a joke. I have 2 guys, one with Pancreatic CA, and pitting edema in his lower extrem. MD has him on a 5 day trial of HCTZ and Spironalactone BIDx's 5 days. Does not want lasix right now. This guy has great discomfort "down below, and I'm not sure what to suggest. My other guy has T Cell lymphoma, with profuse weeping in his lower extrem. His disease is far more advanced, so I'm not sure if I can manage his scrotal edema. My concern with this guy is that his foley insertion site is not visible because of the massive swelling. Both guys have voiced great concern and discomfort, and 80mg of lasix BID has not helped at all with pt #2. Any suggestions or comments?

This problem sounds to me like a severe form of lymphoedema. My experience has shown that fitting the patient with lycra bike pants reduces the oedema somewhat - sometimes though the oedema is just shunted up into the abdomen. Having massage by a qualified lymphatic therapist across the lymphatic pathways in the groin can also reduce the oedema. Author:
cbinns

[Julian Dodd]

Originally Posted by Julian Dodd

This problem sounds to me like a severe form of lymphoedema. My experience has shown that fitting the patient with lycra bike pants reduces the oedema somewhat - sometimes though the oedema is just shunted up into the abdomen. Having massage by a qualified lymphatic therapist across the lymphatic pathways in the groin can also reduce the oedema. Author:
cbinns

We have had great success with a patient with scrotal,penile and bilateral leg oedema with the use of spirinolactone and frusimide, referral to a physiotherapist who specialises in lymphodema and the use of special "bike" pants and stockings. This patient needed an indwelling catheter for three months until edema was under control. He and his partner have been very conscientious with treatment with excellent results. The combination of the three modalities seemed to be the key.bulletinboard@palliativedrugs.com