By Joseph G. Magnant, MD, FACS, RPVI and Jill Tanner, MSN, NP-C
Swelling (also known as edema) in the lower extremities is a common concern for many patients seen in our practice at Vein Specialists. Swelling may occur when fluid becomes trapped in the tissues of the body. Although swelling can occur in various parts of the body, the lower extremities are the most common. Swelling can occur in one or both of the lower extremities and can vary in severity. The goal of this article is to address contributing factors that can cause swelling such as diet, medications, underlying heart or kidney disease, lymphedema and venous insufficiency. In some cases, there may be multiple contributing factors.
Diet is one factor that can lead to swelling. Salty foods are a common culprit. Salt is made up of both sodium and chloride. Sodium binds to water in our body and assists with maintaining the balance of fluids both inside and outside our cells. When we eat foods that are high in salt such as processed foods (examples: deli meats, pre-packaged or frozen meals and chips), our body retains water which then leads to swelling. By cutting back on foods that have a high salt content we may be able to decrease swelling.
Healthcare providers prescribe medications for a multitude of conditions. Although medications are beneficial in most cases, they may also have unintended side effects. One such side effect is swelling. The most common medications that may lead to increased swelling include steroids, anti-hypertensive medications (Calcium Channel Blockers such as Amlodipine), anti-inflammatories such as Naproxen or Ibuprofen, as well as diabetes medications. In our practice we have found Amlodipine to be the prime cause of medication induced leg edema. It is important to discuss possible medication side effects with your healthcare provider before making adjustments on your own.
SYSTEMIC MEDICAL PROBLEMS
Heart disease issues such as congestive heart failure (CHF), often present with bilateral lower extremity swelling. CHF occurs when one or both of the heart’s lower chambers lose their ability to pump blood effectively. As a result, blood does not circulate properly and can back up causing edema in our legs, ankles and feet. The diagnosis of CHF is often made after a series of tests which may include; EKG, Chest X-ray, blood work and an echocardiogram.
Kidney disease can also cause swelling in the lower extremities. As with CHF, this most commonly affects both lower extremities. When the kidneys are not functioning properly, fluid can build up in the body. When the kidneys become damaged there are often low levels of a protein called albumin. The job of this protein is to hold on to water and salt within our blood vessels. If the levels of albumin get too low, fluids leak out of the circulation into the tissues. Kidney disease can range from mild to severe stages. This is often diagnosed with a blood test, urine sample, an ultrasound and in some cases a kidney biopsy.
Lymphedema is swelling secondary to a defect in the lymphatic system. Lymph is basically scavenged fluid that flows from the tissues through the small lymphatic channels back to the jugular vein. The lymphatic system has multiple functions which include the following: maintaining a balance of fluid between the blood and tissue, providing defense against bacteria as part of the immune system, and assisting in the absorption of fats and fat-soluble nutrients. A key characteristic of lymphedema when it involves the lower extremities is that the swelling usually extends into the feet and toes. There are two categories of lymphedema; primary and secondary.
Primary lymphedema is congenital, while secondary lymphedema is due to another disease or condition. Causes of secondary lymphedema
may include surgical scarring from a harvested saphenous vein for a heart bypass, removal of lymph nodes, radiation treatment, cancer, infection and venous insufficiency. Secondary lymphedema is the most common type encountered in day to day medical practice. Treatment of lymphedema consists of different therapies and devices. Compression hose or pneumatic compression pumps are often helpful in reducing leg swelling. Manual lymph massage encourages the flow of lymph fluid out of the legs. This type of massage therapy should be performed by someone who is specially trained in these techniques. Although there is no cure for lymphedema, the treatment modalities mentioned above can help reduce the swelling and discomfort associated with this condition.
Venous disease (or venous insufficiency) may also contribute to swelling in the lower extremities. It is estimated that 50 million adults in the United States have treatable venous disease which is caused by “leaking” of the one-way valves within the veins that normally carry blood back toward the heart. This allows blood to flow away from the heart instead of continuously back towards the heart, as it should. Venous Disease is related to genetics, gender, age, weight, and occupation. Unlike the swelling of lymphedema, venous disease related swelling usually is limited to the legs and spares the feet and toes. Patients may have swelling in one or both legs. Venous disease can be accurately diagnosed by ultrasound and may be effectively treated by a procedure called endovenous ablation that seals the veins with heat or “medical glue”. Symptom improvement may also be observed with use of compression hose, although this is not a definitive treatment for venous disease. Other conservative therapy may include elevation and pool exercises as this helps the calf muscles to pump blood back towards the heart.
Swelling may be caused by a variety of underlying diseases however, it is important to determine the specific cause so that it may be treated most effectively. Vein Specialists has a team of experienced registered vascular sonographers who can perform a thorough ultrasound evaluation to see if your swelling is vein related. Please contact our office for further information regarding swelling that you may be experiencing by calling 239-694-VEIN (8346) or visiting our website at www.WeKnowVeins.com.
Joseph G. Magnant, MD, FACS, RPVI Board Certified Vascular Surgeon
1500 Royal Palm Square Blvd., Suite 105, Fort Myers, Florida
3359 Woods Edge Circle, Suite 102, Bonita Springs, Florida