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Paging Dr. Frischer - Edema
WRITTEN BY :   Dr. Alan Frischer

Along with the warm weather and school vacations, summertime does bring on its own unique health issues. Have you noticed that when you take off your socks at night, you can see ridges from the sock imprint, or puffy feet? If so, you may have a condition known as peripheral edema. Edema used to be commonly known as dropsy. Bloodletting, either by opening a vein or the use of leeches, was a popular way to alleviate dropsy symptoms…let’s be grateful that leeches and bloodletting are no longer the preferred method of treatment!
Edema is the swelling from fluid that accumulates in our body tissues. It is caused by a variety of conditions, so it may take some sleuthing with your doctor to arrive at the root cause. It might be caused by diseases that affect various organs, in particular the heart, liver, and kidneys; or most commonly by local conditions that involve the legs, ankles, and feet.
Local conditions include varicose veins, thrombophlebitis, cellulitis, and most typically venous insufficiency in general, caused by aging, salt, sitting, etc. Venous insufficiency means that the veins of the legs, responsible for transporting blood up to the veins in the torso and ultimately to the heart, do a poor job. Normally the veins of the legs have valves that prevent the backward flow of blood. If, however, the veins become incompetent or enlarged, their valves malfunction. The resulting backpressure in the veins forces fluid to stay in the extremities, particularly the ankles and feet. This excess fluid then leaks into the interstitial tissue spaces, causing edema. One leg may be more affected than the other.
Diseases of the heart, kidneys, and liver can also cause edema:
When heart failure occurs, less blood is pumped out of the heart. Consequently, less blood makes the trip to the kidneys, and the kidneys are essentially fooled into thinking that the body has a reduction in blood volume. To counter this, the kidneys retain salt and water in order to build up more fluid, when, in fact, the body already has too much. This in turn results in fluid accumulating in the lungs, leading to shortness of breath. This is known as pulmonary edema. At the same time, fluid builds up in the veins of the legs, causing pitting edema (when pressure is applied to the tissue, it leaves an indentation).
Why does edema occur in patients with kidney disease? One cause is nephrotic syndrome, where the kidneys can function fairly normally but lose a significant amount of protein, which leads to edema. The second cause is any kidney disease that limits its ability to excrete sodium. The more advanced the kidney failure, the greater the problem of salt retention, and thus the edema. Ultimately, kidney failure is treated by dialysis.
Chronic liver disease leads to scarring, and advanced scarring is known as cirrhosis of the liver. A damaged liver produces less protein, and the lack of blood protein leads to fluid leaving the blood vessels. This fluid enters the tissue and leads to edema, and, as above, results in the kidneys retaining salt and water.
Treatment for peripheral edema depends on its severity and symptoms. Mild to moderate swelling in the lower legs is common as we age, and does not always need to be treated with medication. We become more likely to collect fluid for reasons that are not dangerous, including hot weather, salt in the diet…and simple gravity! Also, our bodies become less able to regulate and balance salt. Older veins become increasingly incompetent, and that leads to swelling as well. Medications are necessary if the edema does not subside, or if other significant problems develop. In addition to treating the underlying problem, diuretics are often used. Antibiotics are given if there is an underlying infection (cellulitis of the skin of the legs), and blood thinners for deep vein thrombosis (DVT).
What are some easy ways to minimize peripheral edema?
*Avoid standing or sitting for too long. Get up and move around to get the blood circulating. Support hose may help.
*Elevate the legs as much and as high as possible. Let gravity work for you, not against you. When lying down, put a wedge at your ankles to elevate your feet above your heart.
*Cut down on salt. There are many salt substitutes available. Read labels and avoid excessive salt in prepared foods.
If your peripheral edema is accompanied by fever, shortness of breath, or redness or pain in the legs, this may indicate an urgent problem. See your doctor ASAP.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: August 23, 2012 – Volume 11 – Issue 19



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