Re-attend the clinic

Mr Paul Roberts re-attends the Lymphoedema Clinic at his local hospital for his 6-monthly check-up. When he arrives the lymphoedema therapist comments that he isn’t wearing his compression socks. He admits that he forgets to put them on most days. The therapist also comments that he has gained 4kg since his last appointment. She asks, “how has the weight loss and exercise plan been going?”, to which Mr Roberts replies, “work is incredibly busy at the moment and I haven’t had the chance to join the gym yet. I’ll get round to it soon though. I haven’t felt that great recently, but I’ll do it when I get my energy back.”

The lymphoedema therapist asks if there have been any new medical problems since the last consultation and if he has started any new medications. Mr Roberts replies to say that he was diagnosed with a cellulitis infection of his right leg a couple of weeks ago and his GP treated it with one week of oral antibiotics called flucloxacillin. Currently, his only medication is Ramipril 10mg daily.

When the lymphoedema therapist examines Mr Roberts she notices that he looks tired and a bit flushed. She checks his observations and notices that his heart rate is 110 beats per minute, and his temperature is 38.5 °C. His oxygen saturations are 99% on room air, and his blood pressure is 130/84.

She examines his lower limbs and detects that the right lower leg is more swollen than the left, with a redness over the right gaiter area. It is tender to the touch. She asks, “how long has it been red”? 

Mr Roberts replies, “oh, it all looked fine the last time I looked! My leg wasn’t red this morning. However, I have been feeling a bit tired for a few days, almost like I was coming down with the ‘flu.”

 PHOTO OF RIGHT LOWER LIMB CELLULITIS