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Leg Swelling (Dr. Celestin, Dr. Srivastava 11/16/10)

Tuesday, November 16, 2010 - Noon

Carmel Celestin, MD
Staff Physician, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Vascular Medicine.

Sunita Srivastava, MD
Vascular Surgeon, Department of Vascular Surgery in the Sydell and Arnold Miller Family Heart & Vascular Institute.

Description

Leg swelling is a common problem that affects millions of Americans and can be disabling for many. There are various causes of leg swelling, including vascular problems. Things that are important to help with determining the cause of swelling include its timing, if it is associated with pain, and other symptoms and findings that are associated. Testing to evaluate for leg swelling should be done after a thorough history and physical examination and treatment is directed at the cause. Vascular specialist Carmel Celestin, MD and vascular surgeon Sunita Srivastava, MD answer your questions about leg swelling, diagnostic testing and vascular symptoms.

More Information

Cleveland_Clinic_Host: Welcome to our online chat with our Dr. Srivastava and Dr. Celestin. They will be answering a variety of questions on "Leg Swelling." We are very excited to have them here today! Thank for joining us, let's begin with the questions.


Diagnostic Testing

John_M: Do you do Pulse Wave Velocity to determine arterial health?

Dr__Celestin: We usually do pulse volume recordings to determine the extent of arterial disease - but not necessarily arterial health.


Symptoms of Leg Swelling

Pat_Kerry: Should I be worried if my legs swell only at night when I sleep?

Dr__Celestin: This is something to be discussed with your physician because there is a lot more to this that a simple answer.

K590345: What if only one of my leg swells. Should I be worried?

Dr__Srivastava: You should see your medical physician to have an ultrasound of your leg to rule out a deep vein thrombosis. Other possibilities include lymphedema and this should also be diagnosed by your medical doctor. Recent trauma or injury can also cause unilateral leg swelling.

Regardless, any of these possibilities should be addressed with your primary medical physician.

neorix: Not only have my legs started swelling recently, but now I am feeling some tingling... is this something I should make an appointment for, or next time it happens should I go to the ER.

Dr__Srivastava: The next time it happens you should go to the emergency room. But in the interval, I would touch base with your physician to trouble shoot underlying causes and prevent another episode. You should pay attention to any activity or stress that occurred prior to your symptoms, the duration of your symptoms, and what makes it better or worse.


Leg Swelling Causes

KatieM: What are the most common causes for leg swelling?

Dr__Celestin: The most common causes for leg swelling include:

  1. chronic venous insufficiency where your veins do not sufficiently work to bring blood back to the heart.
  2. Medications are also a common cause of leg swelling, such as anti-inflammatory medications and some of the blood pressure medications.

There are many causes of leg swelling - these are two of the more common causes.

girhs: If leg swelling is a build up of fluid in the legs and ankles, what is that fluid?

Dr__Srivastava: This is tissue fluid and it can accumulate from multiple causes or due to multiple reasons.

Stacey: Hello! My left ankle is swollen. I am on Verapamil, but it has been this way since before I started the calcium channel blocker. My right ankle shows a bit of swelling too, but it's mainly my left. Since it's just the one ankle, I haven't really been too concerned. Should I be?

Dr__Celestin: It can be due to many causes and I would discuss the leg swelling with your primary care physician to rule out any of the more serious causes and to assist in the management of your leg swelling.

909ilo: Is it true that you should avoid sodas coffee teas and herbs such as parsley? I read in a forum somewhere that these cause more swelling??

Dr__Celestin: I am not aware of these being causes of leg swelling.


Leg Swelling Causes and other Medical Conditions

BeaP: What sorts of heart diseases do you see with people who have swelling of the legs?

Dr__Celestin: If the leg swelling is due to heart failure, usually it is due to right sided heart failure which is the part of the heart that gets blood from the body. Right sided heart failure is usually associated with lung diseases such as emphysema or obstructive sleep apnea.

M35J64: Is cervical cancer related to leg swelling??

Dr__Celestin: Cervical cancer can be related to leg swelling:

  1. if there is a blood clot associated with the cervical cancer.
  2. if there was any radiation in the treatment of cervical cancer - this can be associated with leg swelling.
  3. if there is any surgery related to the cervical cancer - this can be related due to damage to the veins or lymphatic system.

Sutton: I have read that leg swelling can be a sign of heart disease or blood clot... is this true?

Dr__Celestin: True although leg swelling can be caused by many things. Blood clot and heart failure are two causes of leg swelling.

swoat: How is diabetes related to leg swelling?

Dr__Celestin: Diabetes directly is not related to leg swelling however there are certain diabetic drugs that can be associated with leg swelling.

heinW: Is high blood pressure a cause of painful ankle swelling?

Dr__Celestin: High blood pressure can be an indirect cause of leg swelling due to its association to how the body handles salt. I would however discuss with your primary care doctor given your symptoms of pain that is associated with your leg swelling to insure there are no other causes contributing to this.


Causes of Leg Swelling: After Surgery

SandraT: Could a surgery that has nothing to do with your legs, such as a tummy tuck, cause leg swelling?

Dr__Srivastava: There are post surgical changes that can include accumulation of fluid from the procedure as well as trauma to tissue channels that can result in leg swelling. Most importantly a blood clot in the deep veins can occur with surgery especially if there has been prolonged immobilization. A venous ultrasound is critical to determine if a blood clot is present as this would require therapy such as blood thinners, and potential procedures to remove the blood clot.

sarah33: My husband is 5 weeks post total knee replacement and continues to swell so bad that he is unable to do the exercises. He also experiences extreme sharp shooting pains down the left side of his right knee (that was replaced). The doctor sent him for a blood clot test last week (none found thank goodness) and he is baffled as to the reason for the swelling. Any suggestions?

Dr__Srivastava: Leg swelling is not uncommon after a knee replacement and can be due to several causes. The most worrisome diagnosis is a deep vein clot and since that has been ruled out other causes may include trauma from his procedure, and trauma related to physical therapy.

If elevation and ice packs do not alleviate the pain and swelling a repeat ultrasound should be performed to insure that the initial test was not a false negative finding for a DVT.


Causes of Leg Swelling: Medications

Redmink: One of my legs is swelling badly everyday. Can my medicine be causing this? I am a diabetic with an insulin-dependency with high blood pressure and thyroid problems.

Dr__Celestin: Although a medication can be related given that you have one leg that is swollen, I would seek medical attention to rule out more serious causes of the swelling such as a deep vein thrombosis.

KimL984: What are medications that cause leg swelling?

Dr__Celestin: There are many medications that can cause leg swelling - some of the more common include: anti-inflammatory medications, blood pressure medications, some of the diabetic medication; and some of the medications used for neuropathy.

davegreg: I have minor swelling in both legs, plus some pain in my inner thighs on both legs. I recently started toprol XL 25MG as well as norvasc 10 mg that I have been on for 5 years. I see my cardiologist next week. anything I can do? more concerned about the pain in the inner thighs.

Dr__Srivastava: The pain and swelling may be related to your new drug therapy - you should relay your concerns to your medical physician to have it checked out.


Causes of Leg Swelling: Pregnancy and Menopause

cjcm: Leg swelling during pregnancy is a problem for me, along with superficial clots, anything recommended for this?

Dr__Celestin: Leg swelling is not uncommon during pregnancy. In these cases, mild graduated compression is recommended however given the history of superficial clots, I would discuss this with your primary care physician. As there may be certain treatment regimens recommended during pregnancy for superficial clots such as blood thinners.

Dr__Srivastava: Moist compresses and anti-inflammatory agents and sometimes antibiotics are sometimes prescribed for superficial phlebitis.

MollyJ: It is well known that pregnancy can cause leg swelling... when is it time to see a doctor when you are pregnant and your legs swell?

Dr__Celestin: I would seek medical attention at the onset of leg swelling as in addition to pregnancy being the cause, the physician can rule out if there is a more serious cause of swelling such as blood clots which are also not uncommon during pregnancy. At the onset of leg swelling if early intervention such as compression is used it may help decrease the progression during the rest of the pregnancy.

Anna_P: I have just recently started to get leg swelling and I am 45... could age or even the onset of menopause cause this?

Dr__Srivastava: The follow up question is - is it one leg or both legs that are swollen - that has an impact. If the swelling is in both limbs, likely it is due to a systemic cause from medication, electrolyte imbalance, increased salt intake.

If it is unilateral leg swelling then isolated causes such as limb trauma, blocked lymphatic channel, or even blood clot should be assessed. You should see your primary medical physician to initiate a work-up. Lymphedema, which is another cause of leg swelling, can be related to menopause and age.


Prevent Leg Swelling

Laine: Is there anything I can do to reduce the risk of my legs ever swelling?

Dr__Celestin: There are some measures that can be done to prevent leg swelling. These include: walking; exercising as much as possible; not sitting or standing as much as possible; and leg elevation and graduated compression stockings


Treatment

DanC: If I have leg swelling, which type of doctor should I see?

Dr__Celestin: If you have leg swelling, the evaluation should start with your primary care physician who may do basic labs to determine the cause, medication review and if felt necessary will send you to the appropriate consultants.

Catri: Are there any over the counter medications I can take to reduce leg swelling?

Dr__Celestin: Over the counter - no. But really you have to look at the cause of the leg swelling to determine what to do to reduce leg swelling.

Julia_Metro: What are treatments for leg swelling?

Dr__Celestin: The treatments for leg swelling are really directed toward the cause. If the swelling is due to chronic venous insufficiency then treatment can include graduated compression. If it is due to medication, then medication adjustment may be recommended.

Diuretics are usually not recommended unless the leg swelling is due to heart failure. I typically recommend people to have a fitting for compression stockings so that you have the right kind and type rather than going to the store on your own

Allanc: I have been noticing that when I am on my feet for prolonged periods of time, my legs and feet swell up. Is this common and what can I do at home to reduce this?

Dr__Srivastava: Leg swelling is very common after prolonged standing and does not necessarily indicate circulation impairment. Taking frequent breaks and elevating the legs may relieve much of the discomfort and swelling. Mild compression stockings that fit well will also help with leg swelling and pain.

Sleeping with one to 2 pillows under your calves will also alleviate leg swelling and discomfort If these measures do not improve your symptoms, you should see your primary medical care physician for assessment of other causes and treatment options.

Kevin_Dg: My mother has recently developed swelling in the legs and feet and water blisters that are bursting and draining water. The skin is drying out and she cannot bend her legs at the knees. I have heard that this could be a sign of congestive heart failure and am very concerned about what to do. please help....

Dr__Srivastava: The drastic swelling of the legs with limitation of movement is a serious problem. She is at risk for infection if there is skin breakdown and a blood clot in the leg if she is unable to move. You should seek immediate medical attention for your mother so that acute measures can be taken to diagnose the cause of her leg swelling and to treat it immediately.

Kellen: What can I do for pain and swelling in the legs in the proximity of the knees?

Dr__Celestin: The management of swelling is really directed at the cause of swelling. In some instances graduated support stockings - including thigh high stockings. Other compression techniques such as wrapping may be beneficial but this depends on the underlying cause of the swelling.


DVT

cjcm: I am a 31 yr old male who had a dvt in my left leg 2 yrs ago. I am on lovenox injections for this clotting disorder. I had an ultrasound and it showed the clot is still there. I still have swelling in this leg. Will the swelling remain as long as the clot is there?

Dr__Celestin: First of all the swelling may remain if the clot is still there. So the answer is yes. Unfortunately the swelling may still persist in spite of the clot not being there due to damage to the blood vessel wall.

HiuJ: What if you find that the swelling of my legs is caused by a blood clot, what do you have to do to get rid of the clot?

Dr__Srivastava: If the blood clot is acute or fresh then systemic anticoagulation or blood thinners can be used. Other options include catheter directed clot busting medication to decrease the clot burden in the vein and promote recovery. If the clot is old, then likely chronic graduated compression stockings, elevation, and measures to protect the leg should be used. This should be done with the supervision of your physician.

Miller5768: Will the swelling in my legs go down once the clot is removed?

Dr__Srivastava: There can be mild to moderate improvement in leg swelling after directed clot removal and more importantly it can potentially preserve the valve function in the deep veins and prevent valvular insufficiency long term.


Procedures to Treat Varicose Veins

PaulaW: What is the most effective way to treat varicose veins? Are there good outcomes with surgery? What are the negative effects? Thank you in advance for your answer.

Dr__Srivastava: Effective treatment of varicose veins depends on the extent and level of valve dysfunction in the superficial and deep veins. New technology such as laser and radiofrequency ablation provide effective treatment and minimize post operative discomfort and encourage early ambulation. These procedures can be performed as outpatient procedures and can sometimes be done in appropriate physician office settings. Minimally invasive treatments result in less pain, earlier recovery, and less chance of bruising and scarring.

Dr__Celestin: In those who have mild form of symptoms with varicose veins, graduated compression stockings may be used.

Reviewed: 11/10


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