Should I worry about my swollen ankles?
QFOR a while I’ve had a problem with swollen ankles. My GP said she was worried about giving me any medication, as I already have chronic kidney disease and she feared it could make things worse. So I put up with the swelling but now it’s progressing up my leg — do you think it could turn into something worse? I also have hypertension, thrombocythaemia and asthma. I am 74 years old and mobile. Margaret Warner, Basingstoke.
AThE swelling you describe is known medically as oedema, and is caused by pooling of the interstitial fluid — the fluid in the tissues that surrounds the blood vessels.
This fluid is subject to the effect of gravity, which is why oedema tends to occur predominantly around the feet, ankles and legs.
There are many conditions associated with oedema, including kidney disease (which means fluid is not excreted as normal) and heart problems (if the heart is unable to pump blood around the body as effectively, the kidneys, detecting the reduced blood flow, activate hormones that prompt the body to retain fluid to boost the volume of blood in circulation). it can also occur as a result of some medicines including sodium antagonists — drugs used for high blood pressure (which widen the blood vessels).
While i can reassure you that the oedema you have will not progress into anything worse, the bigger question is what is causing it in the first place. it could be due to factors in your complex medical history — high blood pressure, kidney disease, asthma and thrombocythaemia (where the bone marrow creates an excess of blood platelets). For instance, the oedema may be a consequence of either your high blood pressure and its effects on the heart, or the kidney disease, or both. it may also be that you are taking a medication that contributes further.
The first-line treatment for oedema is diuretics — tablets that can force greater output of fluid from the body. however, they do this by acting on the kidneys, which, as your doctor has explained, may be counter-productive and even harmful in your case.
Something anyone with fluid retention should try is to watch the amount of salt in the diet, as this encourages fluid retention. So stop adding it to cooking or at the table.
The regular use of compression stockings may also be helpful. Careful fitting of these minimises the potential for discomfort and they can be purchased from a pharmacy without a prescription. The increase in pressure in the soft tissue forces fluid back into the capillaries (the small blood vessels) so it can then be sent around the bloodstream and excreted as normal.
Elevating your legs if you have the opportunity to rest at home during the day will also be beneficial, but don’t reduce your mobility levels as keeping active helps maintain good circulation.
QI’VE been diagnosed with rosacea and rhinophyma (bulbous nose), which I understand is very difficult to treat. I’ve been prescribed an antibiotic cream, metronidazole, and lymecycline tablets, which I’ve taken for four months, but these don’t seem to help. My condition is in its early stages but is noticeable and I feel very distressed about it. Michael Harris, Canterbury, Kent.
ARhinophyma is a complication of rosacea, which causes the skin to thicken and the texture to become bumpy; the sebaceous ( oil- secreting) glands also increase in size and number. This is what causes the ‘ bulbous’ effect you describe, along with the redness and oily discharge from the glands which leads to spots.
While typically it’s the nose that is affected, the chin, forehead, ears and eyelids can also change.
Rhinophyma is more common in men — we don’t know why — and usually occurs between the ages of 50 and 70.
The redness and inflammatory spots respond well to two antibiotics of the tetracycline group (such as the lymecycline you are taking, and minocycline); the topical antibiotic gel metronidazole can also help.
There are no drug regimens shown to halt or reverse the development of rhinophyma. While some improvement has been seen in patients in the early stages when treated with isotretinoin (brand name Roaccutane) over three to six months, whether the improvement is permanent remains uncertain.
Therefore surgery is the only established effective treatment. This is generally the work of a plastic surgeon, and laser therapy, cryosurgery (freezing technology), or excision by scalpel or wire loop may all be utilised to remove the excess tissue.
The cosmetic outcome that i have seen has always been good, but i must emphasise that all aspects of the rosacea must continue to be controlled. it is likely that antibiotics, by mouth, will be essential for this, with those you are currently taking being continued for many months after surgery.
QFOR months my sister, who is 78, has been existing on three pints of full-fat milk a day and the odd piece of cake. She says she can’t physically swallow anything else. She has not lost weight and her doctor says there is nothing to worry about.
I worry that milk alone is insufficient to maintain health. Name and address supplied.
AThaT your sister can eat an occasional piece of cake suggests there is no mechanical obstruction to swallowing, such as a narrowing of the oesophagus.
a sinister cause, oesophageal cancer, might be expected to cause weight loss. But there is a good case for asking for a referral for a barium swallow X-ray to identify any oesophageal disease.
in answer to your question, milk alone is not sufficient to maintain good health. as well as proteins, it contains vitamin a, fats, B vitamins, a trace of vitamin D and small amounts of vitamins C and E. But there is very little iron, which in time will lead to iron deficiency anaemia. milk’s vitamin C content declines over time to almost zero as the milk ages, too, raising concerns about the potential for scurvy.
if the X-ray proves normal, then psychological causes should be considered: in this case, the answer will lie in gently persuading her to broaden her intake to include soup or other very soft pureed options, to increase her iron and vitamin C intake.