Transcription:
Leg Swelling -- Symptoms, Causes and Treatments

Giovanna Cantor: Our legs swell. Gravity's working against us at that point.

Caitlin Whyte: Many factors varying greatly in severity can cause leg swelling. Swelling in the legs can be caused by fluid buildup from sitting or standing for extended periods of time, excess salt intake, muscle injury, or from heart or kidney-related diseases.

If the swelling resolves on its own within a day or so, it's probably nothing to worry about. But if it tends to happen more frequently, lasting longer in duration, affects just one leg or develops along with other symptoms, it might be time to consult your healthcare provider.

Joining us today to discuss the signs and symptoms of vascular health is Dr. Michael Brown, a board-certified vascular surgeon on the medical staff at Southwest General; and Giovanna Cantor, a certified nurse practitioner specializing in vascular surgery at Southwest General.

This is Southwest General Health Talk. I'm Caitlin Whyte. Dr. Brown, start us off today. When is leg swelling a sign of something serious?

Dr. Michael Brown: Well, I think that swelling in general can be an issue that people live with on a regular basis. If it's mild, it may not be of any real concern. It could just be due to diet or lifestyle. But if swelling tends to be more significant, going up above the ankle basically and occurring daily, it's something that you should initially talk your primary care about, primary care physician, and then potentially go to a specialist for further help if it's something that they aren't able to identify as a medical cause such as a heart problem or dietary or activity issue. In particular, if leg swelling occurs abruptly, one day you wake up with significant swelling associated with pain, then that is something that you have to be evaluated immediately for.

Caitlin Whyte: And Giovanna, what are some general causes of leg swelling?

Giovanna Cantor: Well, there's multiple causes of leg swelling that can happen. Again, like Dr. Brown said, lifestyle, sedentary, where you're not moving very frequently. You sit at a desk and your legs are down for eight, nine hours at a time. You know, then there's also medical causes, which could be heart issues, nerve issues from the back can cause swelling, kidneys and then vein issues, which we look at in the vascular surgery setting.

Caitlin Whyte: Well, Dr. Brown, let's get into some details. What is edema?

Dr. Michael Brown: Edema is just a general term for swelling. So it's the accumulation of fluid in an extremity. Again, whether that's from a blockage of a vein, so the blood is not able to get out and some of the fluid gets into the tissues of either the arm or leg. It's just a general term for swelling.

Caitlin Whyte: Gotcha. And now, we touched on this a bit already, but I'd love to dive in a bit more. Giovanna, can you talk to us about how diet or lifestyle could be to blame for swelling?

Giovanna Cantor: Well, if you are on the heavier side where you're carrying extra weight in you're abdomen, that can push on veins that can cause swelling. If you have a heart condition and you have too much salt in your diet, that can cause swelling. If you don't walk as much, walking can help push extra fluid out of the legs. But a lot of us now have jobs where we sit at a desk all day long and we don't get up, we eat at our desks. And, you know, our legs swell. Gravity is working against us at that point. And the fluid just sits there. So if you combine that, you know, sedentary lifestyle or working at a desk with carrying extra weight, and then, maybe you have a heart condition, you kind of have, you know, this trifecta where you can have swelling in the legs. And then, also there's lifestyle jobs where people work in factories and they stand on concrete all day and they develop varicose veins over time. You know, nursing is another profession where they can end up with swelling in their legs, just for an example, because they're on their feet constantly. So those are some of the lifestyle issues. There's also some family genetic background to it that, you know, maybe mom or grandma or dad or grandpa had varicose veins, that you might have them as well.

Caitlin Whyte: Well, Dr. Brown, let's talk about diagnosis now for a minute. When is the swelling considered mild and then when should I be concerned?

Dr. Michael Brown: Yeah. So again, if it's something where it's going above the ankle and your leg is swelling and it's something that's happening on a daily basis, you should see a medical professional. The basic workup of that would be an ultrasound that is able to visualize the veins. And then, looking specifically at the valves in the veins of the leg, the valves are one way, they're supposed to open to let the blood flow out of the leg and then snap shut quickly in less than a second to keep the pressure from building up in the leg.

We want all the blood to continuously flow out of the leg. And if these little valves are not working correctly, pressure builds up and then swelling occurs. So the ultrasound is a painless study that's relatively quick that can accurately diagnose if you have venous insufficiency, which is the valves not closing appropriately.

Caitlin Whyte: And Giovanna, how about treatment options? What is available to patients?

Giovanna Cantor: Well, after we've seen you in the office and, you know, we've ordered this ultrasound that Dr. Brown just talked about, we take a look and see where the problem is. And based off of that and symptoms, veins can be ablated, meaning we turn them off. They can be surgically removed or, depending on where the issue might be, there may be a blockage or a narrowing in a vein in the pelvis. We may need to go up and put a stent in, but it's hard to talk about treatment options without seeing that ultrasound and seeing what patient's symptoms are because everyone is very individualized.

Caitlin Whyte: Well, as we wrap up here, Dr. Brown, are there any other situations where people should seek out the care of you and your team?

Dr. Michael Brown: The population that Giovanna and I have a particular interest in, we've been trying to treat patients for the last several years and, in particular, the individual that comes in with one-sided leg swelling, the typical presentation is usually the left leg has been swelling on a daily basis and they can be passed around to primary care physicians, wound care centers or other types of physicians. Myself, when I was early in practice, I used to see patients with one-sided leg swelling, do a quick ultrasound and pretty much tell them there was nothing we could do. That was probably 10 years ago. But now with the advent of kind of advanced ultrasound abilities, we can evaluate the veins in the pelvis. And when a patient comes in with long-term leg swelling of one side, predominantly we do the basic ultrasound in the office to rule out any valve closure problems. And then, if their swelling is associated with significant pain during the day, we then take them to the cath lab and put AN ultrasound catheter inside the vein. And what we're looking for is a narrowing in the vein in the pelvis, that's a relatively uncommon situation or at least we thought it was. And now as we're looking for it more, we're finding that there are a lot of patients in the community that have this problem, and it's relatively easy to fix with a stent that's specifically placed at the area of narrowing and that then allows the blood to flow without resistance. And a lot of times, you can have a relatively dramatic change in their symptoms where the pain goes away and then the swelling significantly improves.

Caitlin Whyte: And last question, how can we learn more?

Dr. Michael Brown: Well, there are several societies, Society of Vascular Surgery, as well as the American Venous Forum. They all have their websites and have great educational tools to learn more about venous health in general, and specifically varicose veins or iliac vein disease.

Caitlin Whyte: Well, thank you both for being with us today and for all of this great information. To learn more about Southwest General, visit swgeneral.com.

This is Southwest General Health Talk. I'm Caitlin Whyte. We'll see you next time.