DR. HOOK- Big head: Swelling of parts has many causes
by JOHN HONG, MD, published April 10, 2008
Ex-Governor Eliot Spitzer must have had a pretty big ego to think he could hire prostitutes and not get caught. Hello! But then again, it seems most powerful people get a swollen head and feel untouchable-- until they get a swollen lip when they get caught. Perhaps if the head did visibly swell up, it would keep people "in check" because it would be pretty unattractive. Swelling, in medical terms, is called edema and occurs when fluid from the blood vessels leak into the soft tissues, such as into the legs, arms, lungs, and belly. Not sure what edema is like? Talk to a woman with PMS who's puffy all over-- and be sure to give her flowers.
Legs are the most likely place to have edema. People often complain their socks leave dents in their shins and calves, like a Tempur-Pedic mattress, a condition called "pitting edema." The edema can be uncomfortable from the tension. If the edema goes into the feet, wearing shoes can become difficult (yes, Imelda Marcos).
There are many causes of edema, but a big ego is not one of them. For the legs, poorly working veins are often the issue. If the blood doesn't go up the veins, the blood will pool in the legs and start to leak fluid. That's why folks with leg swelling often start the morning with thin legs-- lying in bed reduces the blood in the legs. Then being upright all day, gravity keeps blood down in the legs, and they begin to swell. In a worse-case scenario, a blood clot (DVT: deep venous thrombosis) backs up the pipes. A DVT usually causes fast edema and on one leg, and this requires immediate medical attention.
Poor lymphatics can lead to lymphedema. For example, a mastectomy with lymph node exploration can lead to permanent arm edema. Lymphedema (as well as edema due to thyroid disease) doesn't cause a pitting edema. (It's more of a Serta mattress.)
Salt! We all hear too much sodium (found in table salt) isn't good for us, and this is especially true for those with edema. If the kidneys can't excrete enough sodium, the pressure in the blood vessels pushes fluid into the soft tissue. It's like when I eat too many salty French fries on a hot day at an amusement park and my fingers swell up. Fluid depletion, like on a hot day in the park, can make the kidneys retain salt and water to worsen edema. Good working kidneys are important to prevent the body from swelling up like a sumo wrestler.
The heart pumps blood through the body-- and in particular to the kidneys-- for proper filtration. People with a weak heart, such as in congestive heart failure, can experience edema. If pulmonary edema occurs, the fluid in the lungs makes it hard to breathe, in particular when lying down, because blood pools in the lungs and they leak fluid. If it's bad enough, the person may have to sleep sitting up in a chair.
Cirrhosis of the liver can cause terrible edema throughout the body, but in particular the belly (ascites). The ascites often requires drainage via a needle. Also, protein levels can drop with cirrhosis, which leads to more edema.
Treatment for edema can be tricky. Compression stockings, exercise, and elevation of the legs might not create Betty Grable gams, but they can be pretty effective. Vascular surgeons can treat poorly working veins. Diuretics can help but also worsen edema depending on the underlying problem, so it's a balancing act.
For politicians with a big head, a little humble pie (minus any salt) might be the best treatment of all. Wouldn't that be swell?
Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.
