My mother was diagnosed with congestive heart failure. she has taken 40 mg of lasix for the last year or two, and her feet have been free from swelling. this last weekend, her left foot got swollen, then her right. i called her doctor, and he told her to double the dosage, and to see him this week. she doubled her dosage, and the swelling went down somewhat in both feet. tonight, after sitting without much movement, her left foot started swelling again. is this normal?
can anyone give me any insight?
thanks,
hh
I am not a medical doper, but I do have lymphedema, and I think you might want to have mom checked out by a vascular specialist (her legs, not her heart).
In lymphedema, either the lymph nodes are missing (usually due to cancer surgery) or the lymphatic vesssels are damaged (by excessive weight, too much sitting, too much standing, too much salt consumption or just plain old age and a genetic weakness) and lymph fails to return back from the lower limbs. Essentially, what you end up with in the long run is what used to be called “elephantiasis.” It is not painful at all, but it is exceedingly disfiguring if not dealt with promptly, properly and consistently. (I should know. My legs look like something out of a carnival sideshow.) There is no real cure, but lymphatic massage, pressure wraps, etc. are used to keep it from progressing. Unfortunately, treatment is a daily, time-consuming pain in the ass. Some doctors have attempted treatment with surgery, but the jury is still out on whether that is a good idea.)
If it turns out to be lymphedema, it is essential that mom reduce salt intake down to almost nothing, keep active (walking is very good–it’s sitting or standing still that causes trouble), lose weight if appropriate, and be very careful not to injure the skin on her legs while shaving, because healing in the affected area is compromised and infections are a real possibility. Oddly enough, diruetics are not particularly recommended for lymphedema, though I won’t attempt to explain why. She should keep her legs elevated when she sits and when she sleeps.
That’s my thought, anyway. Obviously, mom needs to get this checked out by a doctor ASAP, and not to assume anything until she has been seen by a competent doctor. The doctor may also send her for a pelvic ultrasound, to make sure there’s nothing going on her abdomen that might be causing pressure on her vascular system from the inside. Oh–I almost forgot. If it is lymphedema, she should check to see if there is a lymphedema support group available at her local hospital, or through a local breast cancer organization (women who have had mastectomies with node removal are prone to lymphedema in the arms.)
Best of luck to mom and to you.
Your mom’s congestive heart failure (assuming she was correctly diagnosed) is the main cause of her swelling, unless this was a problem she had prior to the heart failure. Tenar is correct in that edema can also be caused (or exacerbated) by damaged lymph vessels, but diaretics are definitely indicated for your mother’s condition. Exercise may be helpful if her doctor allows it. Watching salt intake, elevating the feet, pressure wraps, and lymphatic massage will also help, as Tinel noted.
Her feet are swelling because blood is backing up in her systemic circulation. Her right ventricle is not strong enough to pump all the venous blood that it is receiving from the body, and so veins begin to overfill. The increased pressure in the veins leads to excess leakage of fluid into the surrounding tissue. Feet are affected the most because of gravity and their greater distance from the heart.
A vital treatment for heart failure is the use of diuretics to reduce blood volume to a level that can be managed by the weakened heart.
As to why her feet suddenly got worse, I can only guess. Possibly she ate a lot of salt and retained some water. Maybe she was standing longer than normal. It’s also possible that her heart has weakened further, although there would probably be other symptoms in that case besides the edema, such as being more easily fatigued or having fluid in the lungs.
I hope this is the information you were looking for. I wish your mother the best.
In unilateral lower extremity swelling, a deep vein thrombosis needs to be considered. This can be life-threatening if the thrombosis breaks free and travels to the lungs.
It would be advisable to run this past her doctor today!
QtM, MD