Tag Archives: Opinion

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #61: EDEMA (SWELLING)

Swelling of the ankles becomes increasingly common as you get older. This swelling can be caused by thrombophlebitis, or skin infections which have been discussed in previous articles. Otherwise it is usually part of a condition called edema.

Edema is commonly caused by problems in the cardiovascular system, kidneys, or liver. Edema can occur in the face and abdominal cavity or elsewhere, But because of gravity and the fact that we are  usually upright-on our feet, it is usually is most prominent in the legs, especially the ankles. Edema can be caused by a normal pregnancy. The developing baby puts quite a strain on the heart and circulatory system.

Chronic accumulation of fluid in the tissues usually occurs because of heart and blood vessel problems, liver disease (albumin lack), diet (excess salt intake), kidney disease (deficient salt excretion), vein problems (valve malfunction), and lymphatic problems (surgical lymph node excision).

Obesity contributes by impacting the heart and liver primarily. Proper sleep, diet and exercise help in most of these areas, and edema is rare in healthy people.

I have always considered sugar(obesity, cardiovascular effects) and salt(hypertension, cardiovascular and  kidney load) as poisonous. I discovered the valve incompetence in the veins of my left leg because it became more blue than my right leg. With good exercise, sleep, diet program and compression stockings, edema never occurred.

The swelling and stretched shiny skin in the ankles that I see in many of my overweight friends makes a tempting target for germs of all kinds. and small skin sores often follow.

If you developed swelling in your ankles or other areas, it’s best to check with your doctor to get an explanation.

—Dr. C.

Covid-19: The Unwanted Thanksgiving Day Guest

The risk of Covid starts with the level of infection in your community. If high or rising,of course, you have to be more careful. If low or dropping, you can be less worried. The whole adventure revolves around your personal tolerance for risk.

If you are healthy, young and fully immunized, especially with a booster, you can take more risk. If you have actually had test-positive  Covid, that counts as one injection.

Remember that your immunity begins to wane after 3 to 6 months.
If you have an immune deficiency, such as age more than 60, obesity, or a variety of immune associated illnesses, you should be more careful.

If you have decided to go to one or more holiday venues, you might consider reducing your exposure for a week before, or possibly take a rapid test the day before you go, as a courtesy to the other guests. At the party, you can choose to be as close to a window, or fan, as possible, or prefer those groups who are outside. Wearing a mask might also be helpful, and at least will tell the other guess that you are worried.

The catch 22 is that if you are really worried you might consider not attending the gathering. Distancing to more than six or 9 feet is still a good idea, but makes you seem like a Grinch, and is difficult at a party. Do remember that the greater the density of people the greater your risk. If you are a host, especially in an area where Covid is rampant, your guests should be vaccinated. You might consider asking your guests to get a rapid test the day before they come. 

If you have children who are unvaccinated, you might ask them to wear a mask, and keep their distance from the guests. You could open the window a crack to improve the ventilation in the room, and hold as much as possible of the gathering outside your house. You could ask the guests to wear masks when they are not eating. The N-95, KN-95, and KF-94 masks are all excellent, and will protect the people who wear them to some degree, and be very protective against their spreading the Covid virus.

After the gathering, especially if good protocol has not been followed, you might be alert to the possibility of an infection within a week to 10 days following the party. If you develop symptoms, a prompt rapid test is advisable. If positive, you can check with your doctor about the possibility of IVIG, or other medications. If negative, and the symptoms persist, the test should be repeated, since they are not 100% reliable.

There are a couple of oral  tablets that are on the verge of being approved. You might ask your doctor about fluvoxamine, an already approved medication.

Immunization is not a ironclad guarantee against getting the infection, or spreading it. Unfortunately, Covid is still lurking in the background, and gatherings for the holidays should be evaluated on a risk-reward basis.

For an interesting discussion of this topic, I would recommend the Sunday, November 21, 2021 edition of the New York Times, where three knowledgeable people discuss individual situations.

—Dr. C