Pitting Edema: Please See a Physician

December of 2008, after six months of massage school, I flew out to the East Coast to help celebrate my brother’s 60th birthday. I was practicing my newly found skills with enthusiasm. My sister-in-law kindly agreed to let me practice on her. Her feet and ankles were pale, swollen and puffy, with a few areas swollen and hard. When I gingerly tested with my finger tips, the impressions stayed, as deep, round, threatening indentations. This is known as “pitting edema”.

When the lymph and circulatory systems cannot reabsorb the fluid that accumulates between cells adequately, it stays in the tissues–warning of possible heart or kidney failure. Circulatory massage, which moves lymph, does not help. It could even hurt, putting the heart under greater stress.

I told my sister-in-law I could not massage her feet and ankles because it looked like pitting edema. I asked if she had regular medical care, and advised her to see a physician. She said she just had “fat feet” and body image issues. Knowing I could not diagnose, I encouraged her to see a doctor or cardiologist. Her answer then and two weeks later: no way. I felt anxious and distressed, concerned for her and my brother.

I checked with my instructors in massage school. They said confidentiality required me not to tell my brother. All I could do was what I had done. Nine months later, she and my brother took a vacation to Ireland. She had some shortness of breath, but they both had a wonderful time. Four nights after they came back, she had a heart attack and died.

I was not surprised, unlike the rest of my family. I shared with them about the pitting edema and her choice not to see a doctor. Sometimes I wonder: did I lack authority as a half-baked massage student, or because I was family? Is there something else I could have done? Not for her. She was very clear. I thank her for leaving me determined to not diminish myself or feel intimidated when I believe someone needs to see a physician: this won’t happen again.

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