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Foot & Leg Edema With No Apparent Cause? HELP!!

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Foot & Leg Edema With No Apparent Cause? HELP!!

Old 04-16-2012, 11:22 PM
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Default Foot & Leg Edema With No Apparent Cause? HELP!!

I'll try to be brief. Having A LOT of problems with edema. Legs, feet. Been going on a while, but, past several months, really bothersome. Been to my doctor, and two others. One said it was my heart, had all checked out, besides a leaky valve (not abnormal in many folks) and Right Side Bundle Branch Block (they say not to worry) plus, machines show I suffered a heart attack at some point (I know EXACTLY when this was, back in 2007, seem to have gotten over it & no APPARENT damage...passed the stress test a few months ago) my heart is okay.

Blood work, all good, no sugar, no kidney or liver issues, etc. About six to eight months ago, BOTH legs & feet swelled nearly over night, terribly. Put on 20 additional pounds in a matter of DAYS! Extra water pills (doc prescribed) and bed rest with feet up, feet went back to normal, legs have never gotten back to normal, always have some fluid retention since. My right leg & foot is a lot more painful than the left.

So, over the months, it's up & down with swelling, but, never as bad as the first time. Then, a week or so ago, both feet, but, again, the right foot more so, swells up a lot, and are VERY painful. Legs swell too, but, the feet more so. Doc puts me on lasix, 5 days bed rest with feet elevated. After 3 days, feet begin to go down, day 4, almost "normal" again. By 5th day, all seems well.

I start to get around, nothing heavy or strenuous, and, today, after tinkering around the garage on a couple things, my right foot is throbbing & hurting, both legs & feet (more so my right, again) are swelling, skin is tight and stinging, oh, and last week, both feet broke out in a horrible red rash, from the skin stretching so tight.

I NEVER had anything itch a bad as my feet did...and I ended up digging into them! I used all sorts of anti-itch creams, ointments, but nothing worked. I finally tried apple cider vinegar, and it did the trick! I STILL have the remains from the rash, dry, bumpy patches...can't be seen, really, but I can sure feel them!

My regular doc says it's from "getting older', that my blood has trouble circulating back to my heart, etc., and, as a result, my legs & feet retain fluid. This doesn't sound "right" to me. I'll be 51 in a couple months. Do all, or most, people my age have this problem? No. I didn't think so. I asked if he thought I could have a blood clot, but, he said no, my symptoms didn't fit that kind of diagnosis. I do find it painful to sit too long, not just from my bad back, but, the pain in my right leg. Sitting makes it worse.

I have been on blood pressure meds since 1997, which also have a diuretic in the pills. Doc changed my bp meds a year or so ago, as my pressure began to go up...and, recently, switched it BACK to the original strength because my heart was beating too fast, which he thought was from my pressure dropping too low & my heart was trying to compensate. it seems to have worked.

Finally, I do have a lot of back, joint, spinal issues. A lot of nerves getting pinched, crimped, damaged from my deteriorating spinal conditions. I thought it might be the reason for a lot of my leg & foot problems, but, the doc seems to think not, at least, not enough to cause the edema in my legs & feet.

I just want to find out WHY!!! Then, get whatever is wrong, right! Now, I'll have to stay off my feet until the swelling goes down. I can't wear socks because they cause me A LOT of discomfort & pain (I even wear extra large, diabetic style socks, but they hurt, ESPECIALLY the TOPS of my feet. I wear extra wide shoes. I can't even wear "normal" shoes much at all, anymore. I wear Crocks. I have to remove all footwear when driving, the discomfort & pain is too much to take.

I'm at the end of my rope! I have to get to the root cause of this problem, it's really starting to make my life hell! ANY ideas or advice...anyone with the same problem(S)...I just want to get back to my daily tasks, without having to spend several days with my feet in the air like some sort of penalty for WALKING & STANDING!!

Sorry so long, best I could do & still try & describe what is happening, and, believe me, I left a good bit out!! Just the "meat & potatoes", the core of the matter at hand...or, in this case, FOOT!!!
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Old 04-17-2012, 01:33 AM
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It's called peripheral vascular disease. Smoking is a major factor as is heart disease, obesity, sodium intake, and blood pressure. Improving your cardio fitness like walking or running or doing the stair master can often increase your vascular health.

http://en.wikipedia.org/wiki/Periphe...scular_disease
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Old 04-17-2012, 04:38 AM
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Change your doctor.
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Old 04-17-2012, 05:06 AM
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AGENT86, your problem...in one word...is gravity.

As we age, our vessels (especially the veins, with have less connective tissue) get stretched. The valves in the veins get overwhelmed by blood trying to go back down the legs to the feet, and blood pools in the lower extremities. Since the vessels are permeable to fluid, the water in your blood easily escapes into the tissue outside the vessels, and your legs swell. If you elevate your legs, this resolves--so it's typically less of an issue in the mornings, and more of an issue in the evenings after you've been upright all day. Blood pressure medications can exacerbate this problem, especially things like Norvasc (Amlodipine). But any blood pressure medication that causes a relaxation of vessel tone can cause this. The WRONG treatment for this, is Lasix or Hydrochlorothiazide (HCTZ). Well it's not so much that it is wrong, as it is simply ineffective.

Think of your swollen legs as wet sponges. Imagine yourself washing your boat, and using a sponge. If your sponge is wet and you want to soak up some water with it, what do you have to do? Dry it! So how do you dry it...you squeeze the sponge. You don't stick a straw into the sponge and suck the water out! But that's exactly what lasix and HCTZ are trying to do...but most doctors simply don't get this.

For the last 8 years of my medical career, I treated chronic ulcers and non-healing wounds. Many of these were venous ulcers, caused by chronic swelling (edema) that wasn't handled correctly. Most of the time, doctors simply give a diuretic like lasix. This is ineffective by itself, at least for resolving edema. It's a GREAT medication, if used as intended. But the treatment for edema is compression. If the sponge is wet...squeeze the sponge! If your legs are full of edema, compress them! The compression force helps force fluid back into the vessels, and also resists more fluid escaping the veins.

So go back to your doctor and make sure that you haven't had a deep vein thrombosis that has caused swelling. You very probably haven't, but without an evaluation you cannot be sure--and you would treat that very differently than plain old edema. Your doctor will likely be able to tell you right away if he/she suspects that, or considers that unlikely. But then once you're sure that isn't what is causing your swelling, then get some compression stockings--and WEAR THEM! Most people simply don't wear them. But the stockings should be at least 30-40 mmHg pressure, and go all the way to the knee. Those white stockings they give you while you're in the hospital (TED hoses) will not work--they don't have even compressive force to do much good.

Once you get the stockings and start wearing them, you'll likely need to continue lasix. The stockings will cause mobilization of that fluid back into the veins, and so you'll need a diuretic to tell your kidneys to get rid of that excess fluid. Otherwise it will simply move to a place not being compressed and you'll never really get rid of it. Also, weigh yourself daily. Water weighs over 8 pounds per gallon, so if your weight is decreasing a pound or two every couple days, that's water going away. Fat "weighs" about one pound for every 3500 Calories, so to lose two pounds of fat in a couple days would mean not eating about 7000 Calories during that time. Highly unlikely.

Finally, if you are on Norvasc or something with it in combination (or another such drug that can cause edema as a side effect), I would ask your doctor if there is something else you can be on. This would help control your edema, simply by reducing it.

I can't tell you how many patients I've seen over the years, with problems like you describe. And it was ALWAYS the same--lack of compression. Make sure there's no blood clot (DVT) causing the problem, and then squeeze the sponge.

TB
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Old 04-17-2012, 05:42 AM
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Is that the same lasix that was banned in the horse racing industry?
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Old 04-17-2012, 06:42 AM
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I don't have the medical knowledge to give a "real" answer like what tcbetka had to say. Very interesting and helpful!

For me, I find that if I sit too much, my legs swell and are very painful. I had to give up sneakers or any low cut shoe a long time ago. I wear work boots with calf high "compression" socks. In warm weather with shorts, I still wear the boats with socks that just come to the top of the boot. It's what I wore for construction, so it's normal for me.

Also, I sleep in a recliner. The recliner helps the legs, GERD, my back and a neck/spine problem I have.

BTW, I found what works for me, doctors were of little help. Like you, I had a battery of tests over a period of years to be told everything is "fine". Poor circulation runs in my family, so I saw first hand how debilitating it can be long before I had problems.
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Old 04-17-2012, 07:31 AM
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"Poor circulation" can be two things really...poor ARTERIAL circulation, or poor VENOUS return. The arteries take blood to the feet, aided of course by your heart beating, and by gravity. Atherosclerosis (hardening of the arteries) is also known as Peripheral Arterial Disease (PAD) can be caused by smoking, high cholesterol, diabetes and old age basically. That's what they do a by-pass for...to fix PAD. If the blockage is not able to be by-passed (or STENTed), then the patient often needs amputation of part of the limb if the tissue dies. It's very ugly, actually.

Poor venous return is MUCH more common and caused by years of gravity trying to stretch (distend) the veins, eventually to the point where the valves in them are overwhelmed as I discussed above. Then fluid escapes and causes edema. You treat this, providing it's not caused by a *blocked* vein like with a blot clot (DVT), with compression stockings. The Lasix (furosemide) simply tells your kidney to not reabsorb chloride, which then holds sodium in the urine...which then holds water in the urine. Eventually this water makes it out of the kidney to the bladder, and then to the great outdoors. But the point is that Lasix works in the kidney...not in the legs. What most doctors think though is that by reducing the volume of the blood with Lasix, the excess water in the legs will be "drawn into the veins" again. Wrong. Well, it might work a little--but it's really just trying to suck the water from a wet sponge using a straw! I'd rather just squeeze the sponge, as it's a much more effective way to get rid of the water. That's why you treat leg edema with COMPRESSION, not with Lasix. We *do* use Lasix though as I've said--because you have to do something with that excess water, once it's back in the vessels. But Lasix alone cannot generate the sort of driving force needed to get that water back into the vessels in the leg. Also, don't forget that people continue to eat and drink while taking Lasix--so any small amount of water Lasix removes from the system, just gets added right back from the person's diet.

So there are two completely different problems, but people still call them by the same thing...poor circulation.

Just remember one thing: If the sponge is wet, squeeze the sponge.

TB
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Old 04-17-2012, 08:18 AM
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I am an internal medicine physician and deal with this all the time. If you would like to PM me, I will share what I can.

Ultimately this is very likely functional venous insufficiency or simple venous insufficiency as already suggested by the other clinician here, but there are some other etiologies to consider.

While you may have PAD, it is exceedingly unlikely to be the source of your swelling. If you can feel your dorsalis pedis or posterior tibial pulse, you almost certainly do not have PAD (which is a far worse condition to have than venous insufficiency, not only because of the obvious circulatory issues, but also the significantly worsened prognosis for other cardiovascular maladies such as stroke and heart attack).

Also agree with other clinician here that lasix reduces effective circulating volume thus reducing oncotic pressure and encouraging resorption of fluid from interstitial spaces, but you have to reduce the entire circulating volume to accomplish this. Sometimes we can get away with lasix but I do like to use properly fitted stockings whenever practical. Unfortunately with the hot weather and people wearing shorts, stockings are not preferred by patients.

If your swelling is bilateral it is unlikely you have had a DVT, but it wouldnt hurt to have an inexpensive doppler ultrasound done.
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Old 04-17-2012, 08:47 AM
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Right 606zpx...unlikely to have a DVT at all, but I really don't like giving medical advice on an Internet forum, so it at least needs to be discussed so the person knows about it.

For the last 8 years before I retired two months ago, I took care of chronic wounds and ulcers. BY FAR the most common problem I saw were non-healing venous ulcers. But although this is one of the most common problems seen in folks (in terms of non-healing sores), I would estimate that fewer than 5% of patients had actually been prescribed or were using compression stockings. Edema is, as you noted, not usually indicative of PAD. In fact most of the time a leg with significant PAD is non-edematous, very thin with a wax-like (shiny) skin, and cold to the touch. You can of course have both venous edema and PAD, and I've seen it a fair amount--people can have ticks and flees, in that sense (more than one problem). Point is that you cannot simply compress someone's legs to control edema, before you verify that their arterial flow is sufficient to supply their feet under those compression stockings.

I practiced in Florida for three years, and you could more easily get people to have a root canal without novocaine...rather than wear compression stockings in the Summer. They simply didn't want to do it. Then they'd all go down and eat salty seafood when the Royal Red shrimp were running, and of course their legs would swell up like balloons. There was certainly no shortage of work for a wound doctor down there, in terms of treating venous ulcers...

TB
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Old 04-17-2012, 09:10 AM
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Originally Posted by edale99 View Post
Change your doctor.
The guy that has his boat next to mine had the same issue and was wearing leg stockings as part of his therapy
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Old 04-17-2012, 09:14 AM
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Originally Posted by tcbetka View Post
AGENT86, your problem...in one word...is gravity.

As we age, our vessels (especially the veins, with have less connective tissue) get stretched. The valves in the veins get overwhelmed by blood trying to go back down the legs to the feet, and blood pools in the lower extremities. Since the vessels are permeable to fluid, the water in your blood easily escapes into the tissue outside the vessels, and your legs swell. If you elevate your legs, this resolves--so it's typically less of an issue in the mornings, and more of an issue in the evenings after you've been upright all day. Blood pressure medications can exacerbate this problem, especially things like Norvasc (Amlodipine). But any blood pressure medication that causes a relaxation of vessel tone can cause this. The WRONG treatment for this, is Lasix or Hydrochlorothiazide (HCTZ). Well it's not so much that it is wrong, as it is simply ineffective.

Think of your swollen legs as wet sponges. Imagine yourself washing your boat, and using a sponge. If your sponge is wet and you want to soak up some water with it, what do you have to do? Dry it! So how do you dry it...you squeeze the sponge. You don't stick a straw into the sponge and suck the water out! But that's exactly what lasix and HCTZ are trying to do...but most doctors simply don't get this.

For the last 8 years of my medical career, I treated chronic ulcers and non-healing wounds. Many of these were venous ulcers, caused by chronic swelling (edema) that wasn't handled correctly. Most of the time, doctors simply give a diuretic like lasix. This is ineffective by itself, at least for resolving edema. It's a GREAT medication, if used as intended. But the treatment for edema is compression. If the sponge is wet...squeeze the sponge! If your legs are full of edema, compress them! The compression force helps force fluid back into the vessels, and also resists more fluid escaping the veins.

So go back to your doctor and make sure that you haven't had a deep vein thrombosis that has caused swelling. You very probably haven't, but without an evaluation you cannot be sure--and you would treat that very differently than plain old edema. Your doctor will likely be able to tell you right away if he/she suspects that, or considers that unlikely. But then once you're sure that isn't what is causing your swelling, then get some compression stockings--and WEAR THEM! Most people simply don't wear them. But the stockings should be at least 30-40 mmHg pressure, and go all the way to the knee. Those white stockings they give you while you're in the hospital (TED hoses) will not work--they don't have even compressive force to do much good.

Once you get the stockings and start wearing them, you'll likely need to continue lasix. The stockings will cause mobilization of that fluid back into the veins, and so you'll need a diuretic to tell your kidneys to get rid of that excess fluid. Otherwise it will simply move to a place not being compressed and you'll never really get rid of it. Also, weigh yourself daily. Water weighs over 8 pounds per gallon, so if your weight is decreasing a pound or two every couple days, that's water going away. Fat "weighs" about one pound for every 3500 Calories, so to lose two pounds of fat in a couple days would mean not eating about 7000 Calories during that time. Highly unlikely.

Finally, if you are on Norvasc or something with it in combination (or another such drug that can cause edema as a side effect), I would ask your doctor if there is something else you can be on. This would help control your edema, simply by reducing it.

I can't tell you how many patients I've seen over the years, with problems like you describe. And it was ALWAYS the same--lack of compression. Make sure there's no blood clot (DVT) causing the problem, and then squeeze the sponge.

TB
Very informative. Great response to the problem
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Old 04-17-2012, 09:41 AM
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Originally Posted by tcbetka View Post
AGENT86, your problem...in one word...is gravity.

As we age, our vessels (especially the veins, with have less connective tissue) get stretched. The valves in the veins get overwhelmed by blood trying to go back down the legs to the feet, and blood pools in the lower extremities. Since the vessels are permeable to fluid, the water in your blood easily escapes into the tissue outside the vessels, and your legs swell. If you elevate your legs, this resolves--so it's typically less of an issue in the mornings, and more of an issue in the evenings after you've been upright all day. Blood pressure medications can exacerbate this problem, especially things like Norvasc (Amlodipine). But any blood pressure medication that causes a relaxation of vessel tone can cause this. The WRONG treatment for this, is Lasix or Hydrochlorothiazide (HCTZ). Well it's not so much that it is wrong, as it is simply ineffective.

Think of your swollen legs as wet sponges. Imagine yourself washing your boat, and using a sponge. If your sponge is wet and you want to soak up some water with it, what do you have to do? Dry it! So how do you dry it...you squeeze the sponge. You don't stick a straw into the sponge and suck the water out! But that's exactly what lasix and HCTZ are trying to do...but most doctors simply don't get this.

For the last 8 years of my medical career, I treated chronic ulcers and non-healing wounds. Many of these were venous ulcers, caused by chronic swelling (edema) that wasn't handled correctly. Most of the time, doctors simply give a diuretic like lasix. This is ineffective by itself, at least for resolving edema. It's a GREAT medication, if used as intended. But the treatment for edema is compression. If the sponge is wet...squeeze the sponge! If your legs are full of edema, compress them! The compression force helps force fluid back into the vessels, and also resists more fluid escaping the veins.

So go back to your doctor and make sure that you haven't had a deep vein thrombosis that has caused swelling. You very probably haven't, but without an evaluation you cannot be sure--and you would treat that very differently than plain old edema. Your doctor will likely be able to tell you right away if he/she suspects that, or considers that unlikely. But then once you're sure that isn't what is causing your swelling, then get some compression stockings--and WEAR THEM! Most people simply don't wear them. But the stockings should be at least 30-40 mmHg pressure, and go all the way to the knee. Those white stockings they give you while you're in the hospital (TED hoses) will not work--they don't have even compressive force to do much good.

Once you get the stockings and start wearing them, you'll likely need to continue lasix. The stockings will cause mobilization of that fluid back into the veins, and so you'll need a diuretic to tell your kidneys to get rid of that excess fluid. Otherwise it will simply move to a place not being compressed and you'll never really get rid of it. Also, weigh yourself daily. Water weighs over 8 pounds per gallon, so if your weight is decreasing a pound or two every couple days, that's water going away. Fat "weighs" about one pound for every 3500 Calories, so to lose two pounds of fat in a couple days would mean not eating about 7000 Calories during that time. Highly unlikely.

Finally, if you are on Norvasc or something with it in combination (or another such drug that can cause edema as a side effect), I would ask your doctor if there is something else you can be on. This would help control your edema, simply by reducing it.

I can't tell you how many patients I've seen over the years, with problems like you describe. And it was ALWAYS the same--lack of compression. Make sure there's no blood clot (DVT) causing the problem, and then squeeze the sponge.

TB
Originally Posted by tcbetka View Post
"Poor circulation" can be two things really...poor ARTERIAL circulation, or poor VENOUS return. The arteries take blood to the feet, aided of course by your heart beating, and by gravity. Atherosclerosis (hardening of the arteries) is also known as Peripheral Arterial Disease (PAD) can be caused by smoking, high cholesterol, diabetes and old age basically. That's what they do a by-pass for...to fix PAD. If the blockage is not able to be by-passed (or STENTed), then the patient often needs amputation of part of the limb if the tissue dies. It's very ugly, actually.

Poor venous return is MUCH more common and caused by years of gravity trying to stretch (distend) the veins, eventually to the point where the valves in them are overwhelmed as I discussed above. Then fluid escapes and causes edema. You treat this, providing it's not caused by a *blocked* vein like with a blot clot (DVT), with compression stockings. The Lasix (furosemide) simply tells your kidney to not reabsorb chloride, which then holds sodium in the urine...which then holds water in the urine. Eventually this water makes it out of the kidney to the bladder, and then to the great outdoors. But the point is that Lasix works in the kidney...not in the legs. What most doctors think though is that by reducing the volume of the blood with Lasix, the excess water in the legs will be "drawn into the veins" again. Wrong. Well, it might work a little--but it's really just trying to suck the water from a wet sponge using a straw! I'd rather just squeeze the sponge, as it's a much more effective way to get rid of the water. That's why you treat leg edema with COMPRESSION, not with Lasix. We *do* use Lasix though as I've said--because you have to do something with that excess water, once it's back in the vessels. But Lasix alone cannot generate the sort of driving force needed to get that water back into the vessels in the leg. Also, don't forget that people continue to eat and drink while taking Lasix--so any small amount of water Lasix removes from the system, just gets added right back from the person's diet.

So there are two completely different problems, but people still call them by the same thing...poor circulation.

Just remember one thing: If the sponge is wet, squeeze the sponge.

TB
Originally Posted by 606zpx View Post
I am an internal medicine physician and deal with this all the time. If you would like to PM me, I will share what I can.

Ultimately this is very likely functional venous insufficiency or simple venous insufficiency as already suggested by the other clinician here, but there are some other etiologies to consider.

While you may have PAD, it is exceedingly unlikely to be the source of your swelling. If you can feel your dorsalis pedis or posterior tibial pulse, you almost certainly do not have PAD (which is a far worse condition to have than venous insufficiency, not only because of the obvious circulatory issues, but also the significantly worsened prognosis for other cardiovascular maladies such as stroke and heart attack).

Also agree with other clinician here that lasix reduces effective circulating volume thus reducing oncotic pressure and encouraging resorption of fluid from interstitial spaces, but you have to reduce the entire circulating volume to accomplish this. Sometimes we can get away with lasix but I do like to use properly fitted stockings whenever practical. Unfortunately with the hot weather and people wearing shorts, stockings are not preferred by patients.

If your swelling is bilateral it is unlikely you have had a DVT, but it wouldnt hurt to have an inexpensive doppler ultrasound done.

Okay!
Now, everything makes A LOT more sense! For the record, I don't smoke, so, that's a good thing. I do wear compression socks, they are black in color, got them at Wally World. They go all the way up to my knees. I wear them as much as I can, once the swelling goes down, I stop wearing them. I guess, I should (and I will) start wearing them all the time, even if the swelling in minimal.

My legs are ALWAYS slightly swollen, anyway. So, it won't hurt to wear the compression socks, but, I'll tell you, after a while they are VERY uncomfortable! I worry about DVT in my right leg, because it's always worse & more painful than the left. My doctor said it is HIGHLY unlikley, last time he examined me for the swelling. I have another appointment with him this month, I will INSIST he set up the ultra sound test just to positively rule out DVT.

My blood pressure medication, used to be brand name, LOTENSIN HCTZ. Never had a problem. Due to insurance policy changes, etc., I've had to start using the generic equivalent, BENAZEPRIL/HCTZ and, back to my original dose, 10/12.5 once per day. It seems to be working right now, but, I have NEVER had the same results from most generic medications as I have with the brand stuff. The generic pill is almost 5X LARGER than the brand...I wonder why they have to put so many fillers in the generic?

What else...oh, as far as my arteries, and blood flow, I think all is good. Doctors have checked & said I have strong pulse in my lower legs, had a full body ultra sound about 3 years ago & results showed I have the "arteries of a 20 year old", to quote the technician reading the results. My doctor, when I told him that, said "veins are different than arteries" meaning, it didn't matter if my arteries were clear in relation to whether or not my veins were functioning as they should, in my legs. IDK.

So, I will follow up on the 25th of this month with my doctor. Set up the ultra sound. I will wear my compression socks nearly 24/7, I'm now on a liquid diet because of my scheduled colonoscopy Thursday @ 2P.M. I will cut back further on my salt intake, which, I have already done, but, will go further. I will try to get some more simple exercise but, I am VERY limited in anything because of my back & other bone/joint issues.

I am grateful to both doctors, for taking the time to reply & explain things to me so I actually understand the situation a LOT more clearly now! 606, I may Pm you sometime in the next few weeks, depending how things turn out with my doctor, etc. Thank you for the offer!

And, to davedowneast & ThreeLittleFish, I appreciate your input, as well. I will sign off my thread/post, for now, with this thought, getting old SUCKS!!
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Old 04-17-2012, 09:45 AM
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I bet in Florida between the atropic sun exposed skin and massive edema you had plenty of business. Usually these same patients have diabetes and some element of PAD so healing is not that great. After a few rounds of unna boots most of them will decide stockings arent so bad after all.
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Old 04-17-2012, 10:25 AM
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Originally Posted by edale99 View Post
Change your doctor.

For the record..I did. THREE times! My current doctor is the best I've had to date.
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Old 04-17-2012, 12:06 PM
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Putting on 20lbs in a "matter of days" is bordering on an emergency....you could wind up with CHF...do you have trouble laying flat on your back?...
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Old 04-17-2012, 12:22 PM
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I have been reading with great interest. I just got through with a hard to heal wound on my ankle due partially to edema (?) and the fact that my ankles were already leather like from the sun. The wound doctor used a wrap of some type of foam wrap with Coban holding it tight. They used Santyl to help debried (sp?) it and then an antibiotic to finish the healing. It healed failry quickly (non diabetic).

I have an appointment, that I had to put off due to MIL's death, with a vascular surgeon and what I am doing is wrapping an ace from my toes up to the top of my calf every morning. I realize that the compression stocking is what I need but the ace seems to be really helping until I can get to the Doc and get his prescription. I probably will still use an ace when I wear shorts just so it will look like I am injured instead of falling apart.
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Old 04-17-2012, 12:31 PM
  #17  
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Originally Posted by slickster View Post
Putting on 20lbs in a "matter of days" is bordering on an emergency....you could wind up with CHF...do you have trouble laying flat on your back?...

What is "CHF"? What kind of "trouble" You mean, breathing? If so, then, no. I can lay on my back o.k. I do get somewhat short of breath at times, and, lately, I feel as if I can't get quite enough oxygen into my lungs, if that makes sense. Kind of like, how you feel when you have to yawn, but sometimes can't? Does that make sense?

When I put all that weight on, I went to a doctor, not my doctor, because he was so booked up & couldn't get me in right away. Had simple X-rays of the chest/lungs, and all looked clear. OH! CHF...CHRONIC HEART FAILURE!

well, like I said, I had a recent stress test, with echo cardiogram & some other type special imaging, and everything checked out. The only things that came back "irregular" was, leaky mitral valve, which doc said is no biggie, Right Side Bundle Branch Block, which, doc said seems to be a non-issue with me? And, that I had had a heart attack sometime in the past several years, which, I know was in summer of 2007. I ended up in the ER, but, declined to stay due to the cost & lack of insurance at the time.

Apparently, I suffered no permanent damage, so it must have been quite minor as far as heart attacks go, or I would have had some form of permanent damage...yes?

Thing is, I never really lost all this extra weight. Every time I would drop five to ten pounds, it just pops right back on within a day or two. Very frustrating. I REALLY have to lose at least 40 pounds. I've cut way back on all sorts of foods & how much I eat, but still, no luck. I have never had any trouble dropping weight, until now.

Anyway, I have to go. Taking my son to try out/test for the national guard. He wants to join that, and, is also looking into the Marines. I don't know how it all works together, but, he claims it does? Whatever. Thanks!!
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Old 04-17-2012, 01:00 PM
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CHF = Congestive Heart Failure. It's when excess fluid builds up in the body someplace. Could be either side of the heart so you might see the fluid in the legs (right-sided failure) or the lungs (left-sides failure) for instance. One of the symptoms of left-sided failure is getting short of breath when you lay flat on your back (supine); or getting easily winded while trying to walk some distance (or up stairs). That sort of thing. But the test for that is an echocardiogram to verify that the heart is working as an effective pump. But you said you had one and it was OK. So although you might have a small component of CHF by history, it's probably not as significant if it didn't show up on the echo. Your medication is very good, but I would also suspect that they have you on a beta-blocker and an aspirin as well...given your past heart attack.

As for the other doc's comment about Unna boots, I would say YES...people tend not to like them as much, given that they cannot come off once applied, and their legs tend to itch when the swelling is going down. But in terms of compression stockings, they should really be fitted to your legs, so off-the-shelf stockings are less likely to do the job you need done. Go to a home medical supply and get measured for knee-high compression stockings, after talking to your doctor about it. If your edema has responded to compression in the past and does now...I'll bet the ranch that you don't have a blood clot.

As for the comment about Santyl, this is a very good product. We used to have much better enzymatic debridement agents, but the FDA took them off the market. I used a TON of Panafil and Accuzyme, and they generally worked much better than Santyl. But Santyl is all that is left now, and it does work--albeit more slowly than the others. And it's expensive. But we used it...a lot.

Anyway, good stuff in this thread. I elaborated on the answers I gave so that others might learn as well. These are very common problems that we see in medicine. Bread & butter stuff, really. So that means that there are a lot of people being treated for them--and you would think that also means people are being treated aggressively and correctly. But that just isn't always the case.

It really is not rocket science. If your legs swell, make sure there's no blood clot, make sure there are adequate pulses...and then squeeze the sponge. Add a little Lasix or HCTZ (better than Lasix for lowering the blood pressure) to dump the excess fluid, and you're good to go. Teach the patient about salt in the diet, and try to get them to exercise--as the leg muscles are a natural pump to help venous blood return to the heart, and not pool in the legs. Also, weight loss is usually a good thing as well...for 99.9% of us, lol.

TB

EDIT: Oh, almost forgot... If you get your legs measured when they are swollen, then the stockings will obviously have to be larger. But once the swelling goes down, those stockings WILL NOT WORK as much. They are simply too large in diameter for your legs, so they are loose. Hence you will probably need to get re-measured for a smaller pair of stockings. Then you wear these EVERY DAY, to help prevent the recurrence of more edema.

So the first pair of stockings (fitted when your legs were swollen) were DE-swelling devices--you used them to get rid of edema. But the second pair (fitted when there wasn't any edema) are ANTI-swelling devices--used to prevent edema from returning. You must understand this fundamental difference, because it is huge. Not recognizing why one pair of stockings won't work indefinitely is a very common cause of treatment failure in many patients. And it's usually because the doctor doesn't explain it properly...or doesn't understand it themselves.

Last edited by tcbetka; 04-17-2012 at 01:13 PM.
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Old 04-17-2012, 03:34 PM
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It's called peripheral vascular disease. Smoking is a major factor as is heart disease, obesity, sodium intake, and blood pressure. Improving your cardio fitness like walking or running or doing the stair master can often increase your vascular health.
Ha.... so I was right? And I'm not even a doctor!
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Old 04-17-2012, 04:19 PM
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This is pretty good stuff Doc. And unusual to a degree from as you stated, most will not offer diagnosis on line. Understandably so.
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