DEAR DR. DONOHUE: Please explain why I have to take my shoes off late every day because my feet and ankles have swollen and don’t fit into the shoes. I flop around in slippers without heels. In the morning, after a night’s sleep, my feet are back to normal. I am 77 and take no medicines. — K.M.
ANSWER: I can’t give you an unequivocal response because there are numerous causes of foot and ankle swelling.
The medical name for such swelling is edema. Even in relatively healthy people, it occurs if people sit or stand for any length of time. Gravity pulls fluid out of the circulation, and it accumulates in the feet and ankles. This is especially true at older ages, when the circulatory system becomes somewhat leaky.
For this kind of swelling, the solution is to elevate the legs when sitting. The most effective elevation is raising the legs above heart level, something that can be done only by lying down with pillows propping up the legs. Getting up and moving about is another way to prevent fluid accumulation in the feet.
Heart failure is a more serious cause of such swelling. When the heart’s pumping action becomes feeble, fluid escapes from blood vessels and again accumulates in the ankles and feet. Kidney disease with retention of body fluid is another cause of edema. Liver disease does the same.
Another condition called lymphedema produces the same picture. Lymph is fluid that normally escapes the circulation to percolate around tissues and organs to provide nourishment and to wash away germs. Small vessels called lymphatics vacuum up this fluid and return it to the circulation. Anything that disrupts lymphatics can lead to ankle/foot swelling. An old infection and surgery are two such disruptors.
Since ankle and foot swelling is a sign of many urgent medical conditions, don’t fool around with this. See your family doctor.
The booklet on edema and lymphedema clearly describe these conditions and their treatment. Readers can obtain a copy by writing: Dr. Donohue — No. 106W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I am concerned about my brother, who is 63, diabetic, weighs 300 pounds and is 5 feet 8 inches tall. He falls asleep, wakes and falls asleep repeatedly at the table and when he sits down. Why? He says he’s tired. He picked a scab on his leg and blood squirted out 6 inches. What does that mean? — Anon.
ANSWER: Your brother might have sleep apnea. His body size suggests that it could be the reason for his daytime sleepiness. Spurting blood indicates that an artery was broken. No one should pick at scabs, especially a diabetic.
Your brother needs medical attention. He has to lose weight both for control of diabetes and for control of sleep apnea, if that is what he has. He is at great risk of incurring the complications of diabetes — heart attack, stroke, blindness, kidney failure — if he doesn’t start paying attention to his health.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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