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Edema is a symptom, not a disease in its own right

Dear Dr. Douma:  I am a 52-year old female with a constant problem of swollen ankles.  It occurs every day.  By the end of every day, I am so uncomfortable.

I take 40 mg of Lasix daily to help with this problem, but to no avail. I have had extensive testing, but nothing was found wrong with my heart, leg veins, kidneys or liver.

Any suggestions?

Answer:  There are a number of reasons for swollen ankles but, from what you described, you have what is called edema.

This is an abnormally large amount of fluid collected in the spaces between the cells in body tissues.

It's called "pitting" edema when you can push your finger into swollen skin and the pit left by your finger remains visible.

Edema is a symptom rather than a disease, so some detective work needs to be done to rule out potential causes one by one.

Edema can be localized due to increased blood pressure in the veins caused by an obstruction or increased permeability of blood or lymph vessels.  Or it may be systemic (over the whole body), caused by heart failure or kidney disease.

Lower leg edema is one of the earliest signs of chronic venous insufficiency.  This disorder results from damage to the valves of the deep veins.

It is often caused by physical injury to the leg or inflammation of the veins of the lower leg.  Venous obstruction may also contribute.

Congestive heart failure causes blood pressure to increase in the veins and can also cause edema in the lower extremities.  Chronic kidney disease, especially a condition known as chronic nephrotic syndrome, often results in edema.

Edema caused by kidney problems is usually due to salt retention. Edema is also a symptom of having too little thyroid hormone.  Drugs, such as nonsteroidal anti-inflammatory drugs and some calcium antagonists, can cause ankle edema.

Also, for chair-bound people, inactivity and compression on the back of the legs can cause edema.

Since your medical tests have not turned up any problems, I suggest that you re-review and write down all of your medical history and talk with your doctor again.

You may also want to talk with your doctor about taking a larger dose of the furosemide (Lasix) to reduce the swelling.

And there are a number of things you can do on your own to relieve the swelling.  First, try to elevate your feet above your heart, especially at night but also, whenever possible, during the day.

One of the most important things you can do is to reduce your intake of salt (especially from processed foods). Maintain a good exercise program. For example, walk 30 minutes every day.  Also, you may want to try elastic stockings, especially when walking for exercise.

Avoid sitting or standing for long periods.  Sitting on any seat, particularly with pressure on the back of the legs, will not only increase the swelling but also may increase the chance of blood clots.

When you fly, it would be important to put something under your feet to relieve the pressure on the back of your legs.  Also, change positions often and get up frequently simply to stretch your legs.

Exercise is an excellent way to maintain and improve your health and you would probably not be harmed by it.  But if heart disease or kidney problems are causing your edema, it's especially important to check it out right away.

SOURCE: By Allen Douma, M.D., Tribune Media Services, Home News Tribune, Primetime, 11-26-03

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