The Prairie Doc Perspective

The story of edema

By Richard P. Holm MD

Joe was a 60-something diabetic patient arriving at the emergency room swollen, very short of breath, and with fluid leaking from sores over his pitting-swollen legs. His swelling-puffiness or edema, worse in the legs, extended up all over his body even around his eyes.

When his kidneys were tested we found elevated waste in the blood and protein in the urine, indicating kidneys weren’t effectively excreting waste products, and yet were losing important proteins into the urine. We also learned his diet was terrible, his diabetes was out of control, his prostate had been troubling him for years, and his heart pump was weak after his heart attack five years earlier.

He was one sick fella, problems piling upon problems, and so we admitted him into the hospital.

Edema, that puffy, swollen, sock-denting problem, formerly called dropsy, is very common to the human condition, and can simply be due to poorly functioning veins and their tiny venous valves. Poor varicose veins are treated by support hose and/or elevating the legs.

Edema can also be due to a weak heart when the pump doesn’t have enough push and pull to either push the blood through the kidneys or to pull the blood back to the heart from extremities and the lungs. Mostly heart weakness is treated with diuretics and medicines.

Sometimes in men, the prostate will block urine flow enough to slow down kidney function causing edema. This can be fixed with catheters, prostate surgery, or prostate shrinking meds.

But the most challenging cause for edema happens when blood levels of egg-white-like protein get too low. This makes blood thin and watery so that fluid leaks out of blood vessels into tissue. Low blood protein can be due to several problems: a diet lacking in essential protein building blocks; a liver that isn’t making enough protein; or kidneys that no longer hold onto those proteins as they are filtered, resulting in protein lost into the urine. Low blood protein is difficult to treat.

Indeed, Joe’s problem with edema had several causes. We treated him by elevating and wrapping his legs, by medicines enhancing the heart pump and removing excess fluid, by a catheter opening up urine flow, and finally by improving nutrition and diabetic control. Long-term kidney problems wouldn’t go away for Joe, but for now we could help.

After a week in the hospital, Joe lost twenty pounds of water and went home without a catheter, breathing easy, leg sores healing.

Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call®,” a weekly program where medical professionals discuss health concerns for the general public.  “On Call®” is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. “On Call®” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at OnCallTelevision.com.

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