A very typical health problem of homeless persons who sleep sitting up (as on a train or bus) instead of lying down is swollen legs. People are meant to sleep lying down; if they do not sleep lying down, swollen legs is one of the results. Edema, or fluid, builds up in the legs because of the lack of circulation.
Doctors should investigate the possible causes of the edema. In the case of a homeless patient the doctor should discover it is the lack of mobility and the sleeping in a sitting position. Doctors may also wish to look at ultrasounds and dietary possibilities. However, the simplest cause is the sleep in a sitting position. Many, many homeless people will tell you they have experienced this problem. Any many of them will admit they often have to sleep on a train or bus, or in the back of an all-night diner—seated and not lying down. Any of these locations mean the homeless person is not sleeping lying down.
Of course, swollen legs can also result in a person sitting for long periods in one position. (Swollen feet after sitting: Certain exercises may help reduce the swelling.) This is because many homeless people do not have access to exercise programs, to the mobility typical in many jobs, and may not be able to “get around much…” This is partly caused by the fact they may have no place to leave their belongings while they go to a gym or attend a class—if they have the funds to do so or the info on where such activities can be accessed.
What other ways can the swelling be treated? Wearing “pressure stockings” is one way to improve circulation. These are also called “compression stockings.” Having patients elevate their legs is another common short-term solution to the problem.
One terribly unfortunate side effect of the swelling is that the legs become compromised—meaning, they are not as sturdy and safe as normal legs that are healthy.
Why is this a problem? Legs with edema in them are in danger of not healing well if damaged. An example: a scratch, tear, or puncture in the leg, leading to edema and blood leaking out of the leg and the sore taking a very long time to heal.
A bandaid for dealing with the resulting sore is just that—a bandaid…but then it is hard to gets a bandaid or gauze to stick to the leg if it is very wet. This is a major problem.
A sore on a leg with edema could take a month to heal, instead of three to four days. The leg cannot produce “scabs” quickly to help the sore heal. This is because the sore is too wet. It is oozing edema.
Most nurses and physicians are unaware of the causes of this very typical homeless health issue. They imagine there are other problems, such as heart disease or diabetes. Because they come through medical school and residency with little or no contact with homeless health information or patients, they have no sources from which to draw knowledge about this info.
Often, physicians will assume the patient is having a heart attack when they come to an emergency room with complaints of swollen legs. Homeless people on the street often talk about edema—and other health challenges—as being frustrating problems because health care professionals often do not know the cause may be as basic as an unhealthy sleeping position, why the edema is problematic, or how to deal with this special brand of fluid.
There are indeed some programs meant to help future and current physicians learn more about homeless health issues, as some medical educators are aware of the lack of instruction regarding homeless health issues.
There is currently one leading institutions with the program called the Boston Health Care for the Homeless Program (BHCHP), an organization that provides comprehensive care to about 12,000 homeless adults and children. Medical educators there remind us that “Homeless people often have conditions that are aggravated by sporadic care and the rigors of their living situations, from chronic diseases such as diabetes to acute ailments, mental illness, or substance addiction.”
While there are a few special institutions like BHCHP, many more are needed.
Health care professionals need more education about—and resources on—issues in homeless health. Swollen legs is just one issue in this population’s health that needs attention and greater education.
Putting bandaids on the sores is a temporary fix. Bandaids can only do some much.
What the homeless really need is a place to live. This especially includes a place to sleep, lying down.
This piece was first published at Street Sense, a Chicago-based publication that provides news, profiles, columns, and creative writing about the homeless situation in Chicago and beyond.
Many thanks to Dr. Thomas Hansen and the Street Sense team.