Intended for healthcare professionals

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Palliative care for heart failure

BMJ 2002; 325 doi: (Published 26 October 2002) Cite this as: BMJ 2002;325:915

Rapid Response:


My 88-year-old father has severe congestive heart failure, due partly
to severe aortic stenosis. He also had poor circulation in his feet and
legs long before the onset of congestive heart failure. The latter has
been treated by balloon angioplasty several times with only moderate
improvement. He is on 11 drugs, including Lasix and Digoxin. He has always
been thin and athletic.

He is no longer able to exercise to keep the circulation in his legs
adequate for proper blood flow and comfort. He had to wear double layers
of socks and knitted slippers to keep his feet warm and the discomfort
from the edema disturbed his sleep.

Because I knew how effective Epsom salts soaks were for swollen feet,
I got his consent to try an experiment. Using a large enough rectangular
plastic bucket, I put about 2/3 cup of Epsom salts in enough comfortably
warm water to cover the edematous areas and had him soak his lower legs in
it for about 40 minutes, until the water had cooled to room temperature. I
put additional hot water in after about 20 minutes to rewarm the water.

We were both delighted to find that this procedure successfully
extracted the accumulated fluid from the tissues in his ankles and feet.
His feet and ankles clearly had better circulation afterwards. This was
done in the evening before he went to bed. The following morning, I
checked his ankles and feet and found they were only slightly more
edematous than they had been immediately after the previous evening’s
soaking. The circulation to his feet remained good overnight; this
improved his sleep.

The next afternoon, he said he felt better than he had in a long
time. I believe some of the improvement is due to the fact that his heart
does not have to do as much work against the resistance of swollen

I hope this discovery will help other patients with congestive heart
failure. There are several additional benefits to using Epsom salts
(magnesium sulphate) soaks. Sulphur is well known to be a bactericide.
Magnesium is well absorbed through the skin and is known to help
strengthen tissues. Epsom salts soaks leave the skin soft and make it easy
to rub off dry skin and reduce calluses. It is also easier to cut
thickened toenails afterwards.

The question I put to doctors now is whether full-body Epsom salts
soaks could possibly help to extract excessive fluid build-up and possibly
reduce the dosages of diuretics required. I would welcome feedback from
others who would like to try this.

Sharon Williams R.N.

Competing interests:  
None declared

Competing interests: No competing interests

01 June 2003
Sharon J Williams
Retired Registered Nurse