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Discussion Starter · #1 ·
I'd like to get more info on your take on edema/pitting edema... What constitutes "pitting?" What significance does this have? What would you do if you had a client with pitting edema?

Thanks for any info!
 

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Pitting is a way to measure the degree of edema, but why are we doing that? Would we do something to help change it? Sometimes.

What matters to me is the pronounced swelling in the face, arms and hands - that do not vary. Women will often have swelling in their hands and legs/calves/ankles, but anywhere else is considered reason for concern and an exploration of other signs.
 

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Pitting vs. nonpitting. Pitting is when you push in and it doesn't bounce back. it's usually measured +1, 2, or 3 depending how deep. I see this alot when i am teaching nursing students on the hospital floors, but it's for totally different reasons.

I do tend to be more concerned with pitting vs. nonpitting. But I agree with Pam, why is it like that? where else is there swelling? If the swelling is only in the extreme extremities, that's not as concerning as when it's in the face and moving up the legs and arms. Also, I would look at diet, increase fluid ALOT, not restrict salt (sometimes people do that thinking it will help, but it's also dangerous to be too low in salt), increase protein, epsom salt foot baths are nice. How's blood pressure? Urine? I would look at the whole picture.
 

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Discussion Starter · #4 ·
Thanks, ladies. It is always comforting to have non-knee-jerk reactions to things that can be rather concerning depending, as you say, on the exact circumstances.

I posted a week or so ago about BP questions. My BP seems to be okay - higher than it was but nothing "scary." I tend to be normal-to-borderline anyway, though it's really been pretty good this pregnancy. My last urinalysis (dip stick) was last Thursday and all was clear - my understanding is that will test for at least basic protein, right? However, the swelling seems to be here with a vengeance, something I haven't experienced in prior pregnancies. I've had major soft tissue damage in my feet and ankles, so I'm quite familiar with swelling and had it for years on end. My typical marker for whether or not I'm swelling is if my toes look "skinny" to me - and they, in general, aren't looking that bad. But I'm getting clear indentations from shoes (not entirely unusual for me, either, except it's lingering) and my ankles are puffy after sleep (when swelling goes down in general) and quite obviously swollen later in the day. They are pitting now, it's clear. If I press just on the top of my foot, the pitting is minor and goes away within a few seconds. If my foot or ankle is leaning on something for a while, it makes an indentation that looks rather bizarre, as it doesn't go away for at least several minutes.

My hands are swelling occasionally - this is generally when I've been out and not had enough water, or am hot (say at my DS's Little League games, where I may drink a couple bottles of water but by the time we leave still have some swelling in my hands). This is definitely not lingering, though. It comes and goes and really seems largely based on temp and water intake.

I can't tell if I have swelling in my face. I would say a week ago I for sure didn't, but now it's hard to know. No one I know has commented on it, and I've even asked DH if he thinks there is (he doesn't). Of course, I've also been more emotional and prone to crying lately, which has made my face puffy at times.

I'm quite prone to headaches, anyway, and have been dealing with more lately. I had one visual migraine the other day - I was afraid it would develop into a full-blown migraine, but it didn't. I just lost part of my field of vision for about 20 minutes or so, and it went away about as suddenly as it had started. I had a very bad "crick" in my shoulder/neck that day, too, so saw my massage therapist for some relief. That's the only thing I could think of to cause it. I get these occasionally and once it was a day I had major work on done on braces (10 yrs ago), and the other one I remember seemed likely hormonal when my cycles were starting up again after my last DS. So these are uncommon for me but not unheard of. I've felt sinus-type headaches (face hurts, teeth hurt) off and on, though I've also realized that sometimes my eye hurts, which was always typical of "normal" migraines for me. In reading about PIH/pre-e, etc., on the midwife archives, there was mention of BP-related headaches perhaps feeling like mild migraines. So I'm not sure if that's reason for concern, or not.

I'm taking cal/mag/zinc along with vit C, drinking tons of water (goal is 4 liters/1 gallon per day but I'm guesstimating), and trying to eat as much protein as I can (though I can't guess just how much I'm getting). I did a soak in the pool a couple of days ago and it helped, but it didn't make the swelling go away completely. I'm working on getting our own pool maintained again so I can get into it more regularly, as I know it helps and from what I've read it's best to do it daily.

So, I'm 38.5 wks now (last labor began at 39) and I'm really just hoping that, regardless of what's going on, baby will come and I won't have anything more to worry about! I will see my MW again on Friday, and so far she's not overly concerned, but she also knows how committed I am to HB and she's not going to overreact and send me off to an OB or something. I guess my fear is having a range of symptoms that would put her in a bad spot where she's "supposed" to recommend care beyond her scope. I don't want to get there, and I'm not sure if I'm there yet, or not.

While I've had no major BP related issues in my previous pregnancies, my mom had severe problems in hers. The difference for me this pregnancy is that I am NOT being treated for the underlying disease that likely caused my mom's severe problems, as I was being treated in the first two. So while everything has seemed well so far, I still have an awareness that things ARE different this time, and that there may be valid medical reasons to think that things could be different.

So I'm trying not to be too concerned and just get ready for baby - who is definitely getting ready to come before very long! But I really appreciate the input as I try to sort through the various symptoms, research, treatments, and emotions!

Thanks!
 
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