September 21, 2020 Breaking News, Latest News, and Videos

Getting A Leg Up On Lower-Extremity Swelling:

Do you ever wonder why your socks leave an indentation where the elastic top rests against your skin? Could it be that your socks are too small? What’s more likely is that you have some degree of what doctors call “edema.”

Edema is a fancy word for swelling. It can happen anywhere, but my patients most commonly ask, “Why do I have swelling in my feet and legs?”  

There are many reasons for edema and knowing why is crucial to finding the correct treatment plan. While some causes of edema can be signs of a serious medical illness, edema also can be from age-related wear and tear on our blood vessels. This column will review both serious and common causes of edema and treatment options.   

Heart Failure

When your heart is not pumping as efficiently as it should, this can lead to fluid backup in the lungs, legs or both. Because edema in the lungs can cause shortness of breath, your doctor might ask if you have experienced any difficulty breathing when walking or lying flat.

Liver Disease

Liver disease is also known as “cirrhosis.” The liver is an important producer of protein that our bodies use and when it is unable to make enough protein, edema can occur.  

Kidney Disease

With some types of kidney disease, protein leaks into the urine, which lowers protein levels in your blood and causes edema. Your doctor might ask if you have noticed any changes in your urine as the presence of protein can result in foamy urine.

One thing people with heart failure, cirrhosis and kidney disease have in common is their bodies retain sodium and water, which also contributes to edema in these conditions.

Blood Clots

Sudden onset of one-sided leg swelling should bring you immediately to your doctor to be evaluated for a blood clot. Blood clots, also known as “deep-vein thrombosis” or DVT, for short, block the flow of blood back to the heart and cause swelling, often with pain.

Venous Insufficiency

Our veins play an important role in bringing blood back to the heart. Venous insufficiency occurs when veins are not working as well as they should, leading to fluid backup and edema. This can also occur with reduced mobility. When we are active, our calf muscles help squeeze the blood in our veins back up to the heart. Prolonged sitting or standing can worsen edema from vein insufficiency.  

Your doctor may ask you if the swelling is better in the morning and worse as the day goes on, as this is a common feature of venous insufficiency. Legs may also feel achy or tired. Risk factors for this type of swelling include age over 50, smoking, prolonged standing or sitting, obesity, a history of leg blood clots and varicose veins.  

Lymphedema

Your lymph system works in parallel with your veins and is involved in helping to transport your immune cells to and from areas where needed. Lymphedema commonly occurs after a surgery when lymph nodes are removed.

Medications

Some medications cause edema as a side effect. Common medications that can cause edema include some blood pressure medications (amlodipine and nifedipine), steroids, anti-inflammatory medications (ibuprofen and naproxen), hormones, some diabetes medications (pioglitazone and rosiglitazone) and even a medication (pramipexole) used to treat restless-leg syndrome. Although some medications can cause edema, it could be even more dangerous to stop these medications. Be sure to discuss any concerns with your primary care doctor before stopping any medications.

Other, less common reasons for lower-extremity swelling include allergic reactions, thyroid disease and malnutrition.

Treatment

Now that you know why we get edema, you will be glad to hear that there are effective treatments for this condition. These treatments will vary depending on the cause of the swelling.

The mainstay treatment for edema caused by vein insufficiency is to replica watches increase exercise, elevate the legs, and use special, high-pressure stockings called “compression socks.” Edema from other causes can also benefit from these maneuvers.  Special wraps or a manual lymph massage are also used to treat swelling caused by lymphedema.  

Edema from heart failure, liver, and kidney disease involves a dietary approach often combined with medications. Your doctor may advise you to limit the amount of sodium in your diet to help reduce swelling. In addition, medications called “diuretics” can be used to remove additional fluid from your body.

While you know how important it is for your doctor to listen to your lungs and heart during a checkup, now you know why examining your legs could provide vital clues to how your heart, liver, kidneys and blood vessels are functioning.

If you have concerns about swelling in your legs, be sure to discuss them with your doctor. He or she can diagnose why you are experiencing edema and come up a treatment plan that will work just swell!

Dr. Maija Sanna is a board-certified geriatrician with the highly regarded UCLA Geriatrics Program in Santa Monica and Westwood. For more information, call 310.319.4371 or visit www.uclahealth.org.

in Health
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