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Medical Forum / General / General / December 2004Cellulitis Advice
A friend of mine is suffering cellulitis. about three years ago, she went hiking, and went in some muddy water to cool off. Three days later, her legs grew to huge, totally over sized thickness. Skin shiny and hard. Quite red down by ankles. Ankles and feet ordinary size. The doctors diagnosed "cellulitis". I had a net search, and this seems to be a cellular bacterial infection. She's been on antibiotics since then. At least once. Is cellulitis something that clears, and the size goes down later? Or is she stuck with very large, inflexible legs for the rest of her life?  SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com > A friend of mine is suffering cellulitis. about three years > ago, she went hiking, and went in some muddy water to cool [quoted text clipped - 11 lines] > later? Or is she stuck with very large, inflexible legs for > the rest of her life? Where was she hiking? Were parasites ruled out? Cellulitis should clear up promptly--if the correct antibiotic was used. She's not diabetic, is she? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY Somewhere in central NY state. I don't know the details of which parasites were found, or what lab work was done. I don't think she takes insulin or anything for diabetes. I could ask, of course. SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com Where was she hiking? Were parasites ruled out? Cellulitis should clear up promptly--if the correct antibiotic was used. She's not diabetic, is she? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY > Somewhere in central NY state. > [quoted text clipped - 3 lines] > I don't think she takes insulin or anything for diabetes. I > could ask, of course. I was thinking something more tropical when you said she was hiking in water. Don't know if there are any parasites that are a risk from doing this in NY State. The description sounded a little like elephantiasis to me, which is why I asked. Clearly her internist should be able to make an appropriate referral. I certainly would pursue this, and not leave it alone. Good luck, Steve Well, it is very possible they missed the diagnosis. Seeing as how she's not had any relief in three years. Supposing for the sake of discussion she does have elephantitis. What's the cause, prognosis, and is she contagious if in a swimming pool (for example)? SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com Stormin Mormon wrote: > Somewhere in central NY state. > [quoted text clipped - 3 lines] > I don't think she takes insulin or anything for diabetes. I > could ask, of course. I was thinking something more tropical when you said she was hiking in water. Don't know if there are any parasites that are a risk from doing this in NY State. The description sounded a little like elephantiasis to me, which is why I asked. Clearly her internist should be able to make an appropriate referral. I certainly would pursue this, and not leave it alone. Good luck, Steve > Well, it is very possible they missed the diagnosis. Seeing > as how she's not had any relief in three years. > > Supposing for the sake of discussion she does have > elephantitis. What's the cause, prognosis, and is she > contagious if in a swimming pool (for example)? I don't think she has to worry about picking up elephatiasis in upstate NY. Sounds like she's had medical care. Did she get any useful information? Steve Thanks for the follow up. Havn't seen her since our last email. I'm scheduled to see her Thursday the 24th in the afternoon for a visit, and may be there today (23rd, Wed) some time. SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com I don't think she has to worry about picking up elephatiasis in upstate NY. Sounds like she's had medical care. Did she get any useful information? Steve Ok, back from the hospital. I did talk to her. She says the cellulitis has been cleared up long time ago. Now the diagnosis is lympodema. Poor circulation. Wish I knew that a couple days ago. SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com Stormin Mormon wrote: > Well, it is very possible they missed the diagnosis. Seeing > as how she's not had any relief in three years. > > Supposing for the sake of discussion she does have > elephantitis. What's the cause, prognosis, and is she > contagious if in a swimming pool (for example)? I don't think she has to worry about picking up elephatiasis in upstate NY. Sounds like she's had medical care. Did she get any useful information? Steve > Ok, back from the hospital. I did talk to her. She says the > cellulitis has been cleared up long time ago. > > Now the diagnosis is lympodema. Poor circulation. > > Wish I knew that a couple days ago. Thanks for the update. Sorry, I don't know how it's treated, hopefully others will. Steve I did some net search. I find that th ere are three stages of lympodema. Mild, moderate, and permanant. I did not tell her this, but she shows signs of late 3rd stage, discolored, fibrous, and all that. Treatments are various. Get off your feet, elevate, compression, and some kind of gadget with pulsating compression. And a medication I didn't recognize. But the prognosis for late stage three isn't pretty. She's got her mind on the compression pulsation gadget she hears is at another hospital. I'm not going to discourage any treatment that is relevant, and has a chance of working. I'm not a doctor. I don't even have a first aid card. At the moment, I have absoloutely no authority or no desire to dim her hopes. Again, I thank you for your counsell. SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com Stormin Mormon wrote: > Ok, back from the hospital. I did talk to her. She says the > cellulitis has been cleared up long time ago. > > Now the diagnosis is lympodema. Poor circulation. > > Wish I knew that a couple days ago. Thanks for the update. Sorry, I don't know how it's treated, hopefully others will. Steve > Is cellulitis something that clears, and the size goes down > later? Or is she stuck with very large, inflexible legs for > the rest of her life? If it is indeed cellulitis, her symptoms should resolve once the infection clears. > A friend of mine is suffering cellulitis. about three years > ago, she went hiking, and went in some muddy water to cool [quoted text clipped - 11 lines] > later? Or is she stuck with very large, inflexible legs for > the rest of her life? Despite what other people have written in this thread, cellulitis can permanently damage the lymphatics of the leg and lead to permanent leg swelling. That said, it would be extremely unusual for cellulitis to occur in both legs at the same time. SignatureDavid Rind drind@caregroup.harvard.edu > Despite what other people have written in this thread, cellulitis > can permanently damage the lymphatics of the leg and lead to > permanent leg swelling. Possible. Not typical for simple cellulitis, though. > That said, it would be extremely unusual > for cellulitis to occur in both legs at the same time. It actually sounds more like erysipelas than simple cellulitis. But then, that's about all I can say having not actually seen it. It's a big help -- I'm very ignorant at the moment. Thank you very kindly. SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com On 2004-06-22 18:51:32 -0400, David Rind <drind@caregroup.harvard.edu> said: > Despite what other people have written in this thread, cellulitis > can permanently damage the lymphatics of the leg and lead to > permanent leg swelling. Possible. Not typical for simple cellulitis, though. > That said, it would be extremely unusual > for cellulitis to occur in both legs at the same time. It actually sounds more like erysipelas than simple cellulitis. But then, that's about all I can say having not actually seen it. >> A friend of mine is suffering cellulitis. about three years >> ago, she went hiking, and went in some muddy water to cool >> off. Oh, wait a sec...I just realized that the patient's initial presentation was three *years* ago (at first blush I thought it was three *days*). Obviously, there's something more chronic going on here than a straightforward cellulitis (probably venous insufficiency, if not lymphedema). Yes, she's spent much of the last three years in a nursing home, she's not quite old enough for that. Late 40's. But as you can guess, she has a lot of trouble walking. Someone at the NH cut her toe nails way far back. I have personally done battle with ingrown toe nails for aobu 10 years. After some net research I find out why (I cut them too far back, and then my podiatrists further cut them back; even to the point of several phenol treatments to cut the sides back). I could see all the signs of ingrown toe nails. but she's not my patient, and I'm powerless except to offer lots of sympathy. One got infected, she was on vancomycin IV for several days. So, from what I can see on the net, that oughta took care of any bacterial cellulitis. SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com On 2004-06-22 18:51:32 -0400, David Rind <drind@caregroup.harvard.edu> said: > Stormin Mormon wrote: >> A friend of mine is suffering cellulitis. about three years >> ago, she went hiking, and went in some muddy water to cool >> off. Oh, wait a sec...I just realized that the patient's initial presentation was three *years* ago (at first blush I thought it was three *days*). Obviously, there's something more chronic going on here than a straightforward cellulitis (probably venous insufficiency, if not lymphedema). Well, I'm not a doctor, nor do I have any active medical certification. But I assure you both her legs have the same very large size, and the same deep red coloring from ankles to nearly knees. That is, if my memory is working. Politely, I do try not to stare. SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com Stormin Mormon wrote: > A friend of mine is suffering cellulitis. about three years > ago, she went hiking, and went in some muddy water to cool [quoted text clipped - 11 lines] > later? Or is she stuck with very large, inflexible legs for > the rest of her life? Despite what other people have written in this thread, cellulitis can permanently damage the lymphatics of the leg and lead to permanent leg swelling. That said, it would be extremely unusual for cellulitis to occur in both legs at the same time. SignatureDavid Rind drind@caregroup.harvard.edu I realize this is a very old thread, but couldn't resist posting a reply. I was born with hereditary lymphedema (primary/Milroys) which predisposes one to severe spells of cellulitis. But, David is 100% absolutely correct. Cellulitis can and does damage the lymphatics. This can lead to secondary lymphedema wherein the swelling does not go away and must be managed by treatment therapy. Cellulitis is generally (but not always) caused by a gram-positive bacteria - staph or strep. With severe cellulitis, it may be necessary to do blood cultures and have long term antibiotic therapy. If a person has bilateral lymphedema after swimming in murk or dirty water, the possibility of a resistant gram-negative infection must be ruled out. This infection is serious and can actually be life threatening. Pat O'Connor Lymphedema People http://lymphedema.omno.org > > A friend of mine is suffering cellulitis. about three years > > ago, she went hiking, and went in some muddy water to cool [quoted text clipped - 16 lines] > permanent leg swelling. That said, it would be extremely unusual > for cellulitis to occur in both legs at the same time. > A friend of mine is suffering cellulitis. about three years > ago, she went hiking, and went in some muddy water to cool [quoted text clipped - 3 lines] > thickness. Skin shiny and hard. Quite red down by ankles. > Ankles and feet ordinary size. > The doctors diagnosed "cellulitis". I had a net search, and > this seems to be a cellular bacterial infection. She's been > on antibiotics since then. At least once. Well, Merck (or another webpage) says it's supposed to be treated immediately and I suppose if she had breaks in her skin or scrapes she could have gotten it in both legs.. http://www.merck.com/mrkshared/mmanual_home2/sec18/ch211/ch211b.jsp Symptoms of cellulitis usually disappear after a few days of antibiotic therapy. However, symptoms often get worse before they get better, probably because with the death of the bacteria, substances that cause tissue damage are released. When this occurs, the body continues to react even though the bacteria are dead. Antibiotics are continued for 10 days or longer even though the symptoms may disappear earlier." So I'm unsure what you mean by "at least once on antibiotics". Did she not continue the antibiotics? If that's what she has, maybe now she has to have "intravenous antibiotics" ? (and "Also, the affected part of the body, when possible, is kept immobile and elevated to help reduce swelling. Cool, wet dressings applied to the infected area may relieve discomfort.") I have to wonder why this was left for 3 years and whether she stopped (or didn't renew) her appointments with her doctor for more antibiotics? J The once I know of was a couple weeks ago, when she was on vacomycin for systemic infection. Started with an ingrown toe nail after a nurse trimmed her toe nails waaaaaaay too far back. I don't know the details about the early antibiotic regimen. I'll ask and let you know. SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com Stormin Mormon wrote: > A friend of mine is suffering cellulitis. about three years > ago, she went hiking, and went in some muddy water to cool [quoted text clipped - 3 lines] > thickness. Skin shiny and hard. Quite red down by ankles. > Ankles and feet ordinary size. > The doctors diagnosed "cellulitis". I had a net search, and > this seems to be a cellular bacterial infection. She's been > on antibiotics since then. At least once. Well, Merck (or another webpage) says it's supposed to be treated immediately and I suppose if she had breaks in her skin or scrapes she could have gotten it in both legs.. http://www.merck.com/mrkshared/mmanual_home2/sec18/ch211/ch211b.jsp Symptoms of cellulitis usually disappear after a few days of antibiotic therapy. However, symptoms often get worse before they get better, probably because with the death of the bacteria, substances that cause tissue damage are released. When this occurs, the body continues to react even though the bacteria are dead. Antibiotics are continued for 10 days or longer even though the symptoms may disappear earlier." So I'm unsure what you mean by "at least once on antibiotics". Did she not continue the antibiotics? If that's what she has, maybe now she has to have "intravenous antibiotics" ? (and "Also, the affected part of the body, when possible, is kept immobile and elevated to help reduce swelling. Cool, wet dressings applied to the infected area may relieve discomfort.") I have to wonder why this was left for 3 years and whether she stopped (or didn't renew) her appointments with her doctor for more antibiotics? J |
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