How do we help with Edema & Pleural Effusion?

[KDLJ]

My mother, 71y/o has a diagnosis of stage IIIC ovarian cancer. She had extensive surgery where her omentum, remainder of L. ovary, an 8cm mass near her liver and multiple nodes larger than 1cm were removed. She also has a mass in her R. lung. She had extreme abdominal fluid retention. The fluid on micro had cancer cells (we haven't been told what type of cancer cells were found). Post surgically she has developed extreme edema across most of her body (back, arms and legs). She has significant pleural effusion. Her colon is not very active though there is no obstruction. Meds are: Lasix anxiolytics and pain med's. As yet no schedule re chemo.  Both lower legs are taught and dry. We (my brother and I) carefully massage her legs and arms using moisturizer and to give some assistance to the fluid movement. Her arm edema has improved but not her legs. She is very weak and frail though her spirits are good. The surgeon found tumors throughout her abdomen and some on her liver. Her appendix was also removed. She needed two units of blood post surgically and has needed low flow O2(2.5L) for comfort and to keep her SpO2 levels above 93%. Until she can take in and process food consistently we don' think they are going to start chemo. We are concerned that even with the significant reduction in her tumor mass from the surgery that the cancer is aggressively reasserting faster than she can recover to be able to start chemo. Both for her comfort and treatment future what else can we do about the edema? Is there any reason to think epsom salt baths would help? She is moving around pretty well she just can't take in enough protein to power her body. We are using protein shakes and good home cooked food and her appetite is improving though her digestive system is not processing adequately. Is her stage IIIc overly optimistic? We are struggling between being optimistic and encouraging her fight and being realistic about what is most likely to come and how quickly.

[Annekathryn Goodman, M.D.]

Hi There,
I take it that your mother recently had surgery.

Possibilities:
1. It is very common to have excess fluid from all the IV fluids that are given after surgery.
If this is the case, reducing the amount of IV fluids and giving a diuretic such as lasix is the right intervention

2.Isolated edema such as only in one arm or one leg is worrisome for a blood clot and the evaluation would be an ultrasound of the arm or leg to look for that

3.total body edema that does not get better with diuretics and fluid restriction means that something other than #1 is going. That is called anasarca . This is usually due to protein malnutrition. The diagnosis can be made by checking a blood test albumin

4.other serious conditions such as renal failure and liver failure can cause edema but you would know that from her blood work

finally it is important to start chemo as soon as possible to start to treat the malignancy. It is important to wait for the final pathology and also for bowel function
best wishes

[KDLJ]

Thank you for your thorough reply and the time you put into this site. My mother's protein levels are very low as confirmed by blood albumin tests prior to her discharge from hospital. Her renal function was normal as was her liver function. Lasix has had little effect. Her nutritional status was poor going into surgery and after 8 days without food her albumin was very low. She is slowly 'restarting' her bowel function and eating some food daily. We see her Oncologist Mon. Morning (11/29). I suppose we will find out then if we are going to start chemo or if she is too weak to do so. She is so frail and yet she will only get more so if the cause ( the cancer) is not treated but can she start chemo with so much edema and low blood albumin and low hemoglobin? Your answer helped; thank you.