Harold Gunatillake 

Doctor, my feet and ankles are getting swollen. What can I do?
What is the most common cause of leg
swelling?
In older adults is what we call venous
insufficiency.” The second most common
cause of leg swelling is a reaction to certain
medications.
When you remove your socks and shoes at the end of the day and detect swelling around your ankles and feet, you need to worry about it. Travelling by plane for long hours and not moving your legs is an acute problem. In some situations, this can be due to DVT, meaning that the deep veins in your calf muscles become clogged up
https://youtu.be/9ofc6yBFlos
with clots due to a lack of peripheral pumping action in the calf muscles, or may be due to a condition called ‘lymphatic stasis’ meaning that the extra-cellular fluid is not being returned from the dependent areas, It is essential to move your ankles whilst being seated on the plane to prevent such episodes.
Today’s discussion concerns leg, ankle, and foot swelling due to more chronic conditions and prevention and control.
When your feet, ankles and legs get swelled mildly as a daily event, the most common situation may be drug-induced.
Most of you may be on Amlodipine, a calcium channel blocker prescribed for your high blood pressure, especially if given high doses such as 10 mg daily.
In such a situation, wearing compression socks or elevating your legs is best to help with swelling from amlodipine.
Or, you may be on Gabapentin, a medication used to treat nerve pain from shingles, seizures and restless legs syndrome.
You may be prescribed Pioglitazone, also called Actos, or rosiglitazone or Avandia, for type 2 diabetes. Leg swelling is a well-known side effect of these medications. These drugs have a greater risk of having heart failure, too.
Talk to your healthcare provider if you experience swelling while taking pioglitazone or rosiglitazone. They may be able to help switch you to a different diabetes medication.
If you take Non-steroid anti-inflammatory drugs for arthritic pain, the long term may cause water retention, leading to swelling in the legs and ankles. If you have kidney problems, you should avoid taking these drugs.
Ladies taking birth control pills also get water retention, which may show up as swelling in the legs or ankles.
When taken long-term, steroids are prescribed for asthma, chronic obstructive airway disease, and severe allergic reactions, another cause of water retention and leg swelling.
For many people, swelling from a medication isn’t severe and will typically go away once you stop taking it. Depending on the medication, lifestyle changes or lowering your dose may help if it’s something you need to take long-term.
Other causes of leg, ankle and foot swellings, or oedema, may be standing or sitting in the same position for too long.
Eating too much-added salt in your food can give rise to leg swelling.
Being overweight could cause leg swelling.
More severe causes of leg swelling come with your kidney, liver or heart disease.
If you have had coronary heart disease treated with stents, you must take special precautions to avoid further damage to the heart muscles. If you continue your happy, enjoyable lifestyle, you may have a condition called CCF or congestive heart failure. This is a sign that your heart muscles do not have the strength to pump blood from the heart’s lower chambers efficiently.
People with heart failure tend to retain fluid. This appears as swollen ankles and legs because of excess fluid building up. You may notice that your shoes don’t fit and socks appear tight or leave a prominent indent above the ankle.
When the right side of the heart (right ventricle) starts to fail, fluid collects in the feet and lower legs. Puffy leg swelling (oedema) is a sign of right heart failure, especially if the oedema is pitting oedema. With pitting oedema, a finger pressed on the swollen leg leaves an imprint.
Early symptoms of heart failure are breathlessness on exertion, fatigue, rapid or irregular heartbeat, exhausting exercise, and leg swelling.
It would be best if you saw your cardiologist soon, as it is a serious situation, to salvage yourself from your serious situation.
Now, let’s discuss how you could get leg swelling due to kidney issues.
As the kidney function begins to fall, sodium retention causes swelling in your shin and ankles. In short, any person noting new onset leg or foot oedema should get an immediate evaluation of their renal function after visiting a nephrologist.
Damage to the tiny filtering nephrons can result in nephrotic syndrome; declining levels of the protein albumin in your blood and increasing levels in the urine can cause fluid to build up and result in oedema, most commonly around the ankles and feet.
Let’s discuss how you could get leg swelling due to liver disease.
Cirrhosis slows the regular flow of blood through the liver. This increases pressure in the vein that brings blood to the liver, causing swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs, called oedema, and ascites in the abdomen.
In Stage 3, cirrhosis of your liver, caused by severe liver scarring, may cause more liver damage symptoms, including jaundice, weakness, fatigue, appetite and weight loss, abdominal bloating, and oedema in your extremities.
In most chronic illnesses that cause leg swelling, only symptomatic medication is available to make you feel comfortable, and a complete cure is impossible.
I advise that preventive measures are best taken, as it is impossible to complicate the process in this day of ‘indulged’ living.
I hope this video article is helpful. Goodbye for now, until we meet again