Q: I have been told I have edema, swelling of the legs. When I press on them the dent remains for some time. Due to medical problems of my recently deceased wife, I’m afraid of doctors. Is this dangerous? Is there an over-the-counter medicine for it and what should I expect? Also, I’m 90 years old and have COPD and shortness of breath. I had pneumonia about seven or eight years ago. Thank you.
A: Edema occurs when blood vessels known as capillaries leak fluid into the lower extremities. When that fluid builds up into surrounding tissues, swelling occurs. While the condition may not pose any appreciable health risk, it certainly could. Therefore, it is important to remain in contact with your health care provider who can confirm or rule out heart failure or other serious health issues that can be treated with medication or other non-invasive treatment. If left untreated, edema can cause an increased risk of skin ulcers, a decrease in your blood circulation, pain and stiffness, difficulty ambulating, and more.
There are a number of potential causes leg edema, many of which are the result of being on specific medication that include being prescribed some blood pressure drugs, non-steroidal anti-inflammatory drugs (NSAIDS), some antidepressants, or rarely, steroids. Medical conditions that can cause the legs to swell include venous insufficiency, lymphedema (blockage of the lymph system), blood clots, infections of the lower extremity, kidney/heart/liver failure, and pericarditis (swelling of the membrane around the heart). Situations in which a person sits or remains in one position for too long is also a common cause of edema.
I can appreciate that you had a difficult time with your wife’s medical issues, however you already have COPD and shortness of breath which is a common symptom of the COPD, making you susceptible to hypertension, respiratory infections, and heart issues. And, you’re 90 years old. Keep in mind that your primary care physician or cardiologist may only have to examine you without performing any tests at all. If he or she should recommend testing for confirmation, it may only be in the form of an X-ray or lab work. If a diagnosis can be made without testing, you may be prescribed a diuretic to help your body expel excess fluid through urination. This pill I refer to is taken by mouth will cause you to urinate more but will help reduce the severity of the edema. I urge you to be up front when you make your visit. Explain that you had a difficult situation to contend with and are fearful of what he or she might do but keep in mind, you are in control. You can accept or decline any recommendations. Because you make that appointment doesn’t imply you must go along with what is said. Take a relative or friend with you who knows how you feel and allow that person to be present during the visit.
On the home front while waiting for your appointment, remove your salt shaker from the kitchen table. If you are in a skilled nursing facility, request a salt-free diet. Eliminate any potato chips, nuts or salted foods. Avoid some canned soups that can be very high in sodium (salt). If you have any questions regarding which foods to stay away from, ask for referral to a dietitian at your local health care facility. Elevate your legs above the level of your heart for a minimum of a half hour three or four times each day. This can easily be done by placing a pillow or two at the foot of your couch or bed and resting your legs on the pillows. Just remember to use sufficient pillows so your legs are positioned above your heart. Compression stockings or hose may be in order and can be purchased at many pharmacies or medical supply houses. Your physician may have to write an order to have them covered through insurance. Ask your physician if they would help you, as they will prevent fluid from building up in the tissues. With the approval of your physician, attempt to walk more. Lastly, consider massage that should reduce the swelling.
