July 1, 2025 • 41 mins
- Listen Saturday mornings at 8 as Dr. Msonthi Levine discusses medical issues and takes your calls on News Talk 560 KLVI. Dr Levine is board certified in Internal Medicine and Geriatrics. His office is located at 3080 Milam in Beaumont, Texas. He can be reached at 409-347-3621.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
All right, Welcome South East Sexers Internet radio listeners. This
is your weekly host, Dark Levine. Welcome of the edition
of the Dark Levine Medical Hour. I am here in
a series of kov I hear in Boma, Texas, live
across the street from Parkdale Mall, taking your phone calls,
answering questions about healthcare and medicine as I see it
(00:21):
and as we both can see it, trying to make
you understand or get some clarity on what it is
you need to do to stay alive as long as
possible and as healthy as possible. It's tough out there.
It's difficult and can be very confusing out there in
terms of what to do and how to do it.
With all the information that's flooding and coming our way,
(00:45):
it's just totally, really, really difficult to figure out what
is the right thing to do. And this is here
our hour to try and figure it out so that
we can make clarity about what's happening. Lines are open
eight nine to six KALV. I went one hundred and
three three zero KALV. I would love to hear from
(01:06):
your two way radio.
Speaker 2 (01:09):
And while we wait on.
Speaker 1 (01:10):
Phone calls, we typically will launch into some topics that
may be of interest, maybe things that have happened over
the past week that are of interest, or maybe something
that I was thinking about this morning as I was
driving into the station to talk with you. Certainly the
(01:32):
summer months are heading our way, and we did spend
some time last week talking about protecting your skin as
the sun is very strong now and South East Sexes
gets pretty hot and humid, and certainly dehydration and just
what we call heat related illnesses sort of start picking
(01:52):
up a lot. And primarily that revolves around just your
body being exposed to the temperature and the heat, and
not just how hot it is, but just the length
of time that you get exposed to That can be
overwhelming for the human body to tolerate it, and you
(02:13):
can get sick from just too much heat and too
much sun and sometimes have to be hospitalized for that.
Like I say, what we call that heat related illnesses
and dehydration is a part of that. It can cause
a lot of metabolic derangements when you become dehydrated, but
(02:34):
for the most part, people just feel weak and nauseate
it and dizzy when they get dehydrated. They might even
be drinking water and doing their part to stay hydrated
out there in the summer heat. But the heat and
the amount of humidity here in Southeast Sex is even
(02:56):
that's not enough, meaning that a lot of patience, a
lot of workers understand the issue with the sun exposure,
and they understand dehydration.
Speaker 2 (03:07):
But because of just.
Speaker 1 (03:09):
Like I said, the intensity and the length of time
that they're out there, their body sweat and their hydration
system in their body just gets overwhelmed and it outpaces
their ability to keep up, and they get dehydrated and
they start feeling pretty sick. As it pertains to that
(03:32):
something that can happen within a few hours.
Speaker 2 (03:35):
Of being exposed to the heat.
Speaker 1 (03:37):
I certainly remember my experience with that as a athlete
here and in college, working out and running and having
pads on helmet with under all this heat like this.
I mean, it's something you did. It was a normal
routine thing. But a lot of the professional teams now
(03:58):
and sort of folks just understand it's very stressful on
the human body and can generate injury, especially for athletes.
Speaker 2 (04:08):
That's not so good.
Speaker 1 (04:09):
You see a lot of the professional teams having indoor
facilities or covered practices or maybe doing most of their
activities early in the morning before the heat kicks up,
or later in the evening when the sun is going down,
because we sort of get it now, we understand that,
and even talking with my patients in the office about exercising,
(04:29):
they're really, in my opinion, there really is no advantage
to exercising in the heat unless you like it doing
that again, because we kind of understand now that exposure
to intense sun for a long period of time is
injurious to your body, and that's not something that we're
(04:50):
trying to incorporate or encourage when you're exercising just because
we want you to enjoy it, we don't want you
to injure yourself. Which if you listen to my show,
I try to let you know all the time that
if you want to exercise, it's really super easy to
be honest with you in terms of the type of
exercising that you can engage in that does have benefit
(05:15):
to your metabolic function. And again, these exercises are pretty
easy to do, they're cheap, they don't really involve a
lot of equipment, and can be done by anyone. Like
walking or if you want to trot or jog or
just getting on a bicycle and pedaling. If you need
(05:36):
some basic equipment, the equipment has gotten more affordable. You
can get these devices just about anywhere, and they're small, convenient.
They fit in your bedroom or your garage. You can
a lot of times fold it up. I mean, there's
so many things you can do. But again, you don't
really need the big time equipment or the big membership.
(05:58):
I mean, if you want to do that, it's absolutely fine,
but you really don't need that to get some benefit
from exercising. Even if you are an employee at a
job and you sit most of the day doing paperwork
or pressing on a computer screen, whatever, answering phone calls,
(06:19):
just standing up more of the day than sitting is
beneficial and is helpful as it pertains to health. Remember
we've talked about prolonged sitting for a long time and
how that is just extremely unhealthy for you, and most
people who sit for a long period of time most
(06:41):
of the day will start to get some physical problems
related to that. It's just abnormal for that to do.
I remember when I was in medical school and studying
for exams. I mean, you could sit there for hours
just in a chair, looking at books and reading all
this information and trying to recall all this information. I
(07:02):
remember I used to get up sometimes and not have
swelling in my legs because I'd sat so long. Didn't
quite understand it then, but I get it now, and
as soon as I got up and walked around, the
swelling would go away. So any one of you or
who have a job it requires you to be at
a desk all day, it's going to be important to
(07:23):
try and just stand up and get your blood flowing,
because again, being in a seated position most of the
day is not good for you. Typically there will be
some way gain associated with that and some fatigue issues.
And again that swelling that comes in the lower extremities,
(07:44):
which tends to be a very common complaint for a
lot of Southeast Texans, which we have discussed that before.
The lower extremity swelling or edema as we call it,
is super super duper common complaint for most Southeast Texans.
We see that a lot they can't get their shoes on,
(08:05):
their ankles are big, and they come in with that
complaint alone trying to figure out why their ankles are
huge or their swelling. They can put a dent in
their leg or their skin and they see that dent
there and they know that that's not normal, and they
(08:25):
come in to be evaluated for that. And there's a
lot of causes of what we call lower extremity edema
or what we call peripheral edema. You know, your chest
and your abdomen, we call that the core core and
your foot, your hand that's more of in the periphery
are peripheral anatomy, and so that's why we call it
(08:46):
peripheral edema. But a lot, a lot of causes of
the swelling in the legs and again, super duper common.
There's a few things that we can discuss today while
wait on phone call a lot of times. Again, the
most common cause of that, again is being overweight and
(09:07):
being sedentary and unfortunate because the blood's not fluent. And unfortunately,
a lot of us get into that situation, whether we're
elderly or may maybe we have some arthritic problems and
we can't really move around the much, or maybe we
have neurological problems where we get dizzy when we get up,
(09:28):
and so we kind of just get into this habit
where we're sitting most of the day and more prolonged
sitting probably begets more sitting just because you get deconditioned
a lot. If you just sit all day long, it's
almost the same as laying in a bed all day long.
We get that exposure there in the hospital and patients
(09:49):
are very ill.
Speaker 2 (09:50):
They just don't feel well.
Speaker 1 (09:51):
They just kind of want to lay in bed all day,
which for a brief moment, it's okay. Obviously you need
to recover, and yeah, you may not feel well for
a day or two, and laying in the bed is
the way to tolerate that. But beyond that, unfortunately, you know,
we have to get patients up and moving around, just
because laying in a bed, sitting in a chair just
(10:14):
very very unhealthy. And that's what I mean when I
say you don't have to really exercise in a high
intensity way. Just getting up and walking, just simply walking
can be very advantageous. A lot of my workers out
at the plants and other various jobs where you're kind
(10:36):
of just walking throughout the day, you're not really sitting
at a desk.
Speaker 2 (10:39):
That stuff does count.
Speaker 1 (10:41):
And it does help with your blood pressure and your
weight control. Not that it's the end all to be all,
because you're walking, but certainly it does help with that.
So one of the most common causes of the swelling
is just you're not moving and you're overweight, because a
(11:01):
lot of us will get a little bit plus size
again about thirty forty pounds for various reasons. We've talked
before about the diet and exercise issues here in this
country and how it tends to promote weight gain over time.
Consuming a lot of the products that we'd like to consume,
a lot of the processed foods and beverages that we
(11:22):
consume what they call ultra processed, meaning it's probably gone
through many hands, it's probably been adulterated significantly to get
this end product. When consuming those products on a regular basis,
it tends to generate weight gain and disease in the
human body, just because a lot of this is just unnatural.
(11:45):
It's sort of synthetic, it's man made, and the human
body a lot of times it's just not designed to
tolerate or get exposed to these substances every day, and
so the reaction to the human body is inflammation.
Speaker 2 (12:00):
We've talked about that before.
Speaker 1 (12:01):
And you know, weight gain and fatigue, just because it's
almost like your body is lightly sick or lightly ill.
You can get through it. You can go to work,
you can still function. But man, you just you just
don't feel good, you know. And it's just sort of
this undercurrent or background sense of unhealthiness that you feel
(12:22):
when you get up in the morning throughout the day.
You know, you'd like to have more energy, you'd have
to have you'd like to have more mental clarity, and
it's almost like you can't achieve it for whatever reason.
And that a lot of times can prompt a visit
to the doctor's office as well to sort of get
a check up and see if there's anything else that
might be causing a lot of times it's just the food,
(12:44):
you know, the ultra processed food that again, we eat
it every day. It's everywhere, it's so convenient. A lot
of times, it's cheap, it's packaged, it's a one, two
three boom, ready to go.
Speaker 2 (12:58):
You can eat it.
Speaker 1 (13:00):
But again, the issue with that is the exposure and
the potential health issues. And again this is well chronicle
experts have talked about this over and over again. I'm
just another healthcare professional that has read these articles, and
I see patients all the time. And trying to get
(13:20):
everybody on board with that. So because of our elderly population,
you know, we are allowed or we're able to get
to our deeper ages and things like muscle skeletal pain,
joint pain, knee pain. We just become more sedentary and
doing that, weight gain comes and then that's swelling in
(13:42):
the legs come. But that's not the only reason while
we get swelling. Sometimes it's the doctor's fault that we
get swelling. We call that eyeatrogenic. That's the name for that.
When something happens because there's something that was prescribed to you,
a given to you, or done to you by a
healthcare professional, we call that iyatrogenic. And sometimes yeah, that
(14:03):
swelling is related to for the most problem, medications that
may be given to you to help one medical problem
and then the side effect issue then causes swelling of
your lower extremities. And a couple of those medicines are
blood pressure medications, most commonly called calcium channel blockers. You
(14:26):
might know them as amylodopene orniphittipine, which are used heavily
in the medical world to help control blood pressure just
because they're very strong and both of them are once
a day, and I use that a ton in my practice.
I prescribe it all the time as well as in
the hospital, just because the medications are extremely effective. They
(14:48):
work very well, and we use these medications to achieve
goals for the blood pressure. But for some people it
starts to cause swelling in the lower extremely They can
sort of like say, get see their ankles getting puffy,
top of their feet getting puffy when we put them
on these medications. You know, it's crazy because a lot
(15:09):
of times we can start the medication everything's working, and
then it's months later that they might get the swelling
and they come in specifically for that, and a lot
of times we just have to either reduce the dose
or maybe if the blood pressure is still high, we
can add what they call a diuretic. These are medications
(15:31):
that work in the kidney to help the body eliminate
excessive fluid. Like I said, we call that edema. You
see it as sort of the swelling that happens. Like
I say, we're talking about the lower extremities, but it
could happen in your hands, or your arms, your face,
just your torso around your abdominal area where you start
(15:52):
getting that swelling, that puffiness that you see, and a
lot of times we try and eliminate that with what
we call diuretics. Might know the mess ferosamide or LASiS
or hydrochlorothisi, chlorthalidone, torsomide, demodex just to name a few,
and we use these medications to help manage swelling our
(16:14):
dima as well as the hypertension that you might have
with the swelling that you might have as well. So
medications can be a reason for that. Gabapentin or neurontin,
which is a medication we use a lot for headaches
and neuropathy which a lot of our patients are suffering
(16:38):
from that can cause some swelling. Anti inflammatories such as motrin,
advil a, leave celebrecs, meloxicam. Again, most of our patients
out there are suffering some sort of pain issue, whether.
Speaker 2 (16:52):
It be the neck or the back, the knees, and.
Speaker 1 (16:55):
Go to the grocery store, go to the pharmacy, get
the eleville, I'm sorry, the advil and i'buprofens. Start taking
that and then several weeks later, maybe a month later,
you start having swelling, especially if you keep taking the medication.
So there's a lot of different medications. Those are just
(17:16):
some common ones that we use every single day. And
if you are on these medications and you're having some swelling,
you might need to talk to your healthcare provider about
changing or getting off those medications. Phone lines are open
eight and on six kV. I went in hundred three
three zero kilov. I'll be back in two minutes. All right,
(17:49):
welcome back to the doctor. Medical. Our phone lines are
open eight one six kV. I went in hundred three
three zero okiovy, I'll give us a call. See what's
on your mind. Talking about lower extremities dwelling our demon
which is a very common complaint in the medical world.
A lot of different reasons for that. We did discuss
the fact that probably in my opinion, the most common
(18:10):
cause is just becoming more sedentary and gaining a little weight,
which is extremely common in our community for various reasons.
You've gotta be active and keep the blood flowing so
that you do not develop this, but sometimes it's hard
to do. You maybe have some arthritic pain, or you
have a neurological disease that just does not allow you
(18:33):
to be very mobile, and so you start sitting more,
and we do see that a lot with maybe stroke
patients or the arthritis that can develop as we get older,
that back starts to wear out, and it's just walking
is very painful. It's uncomfortable and you just find yourself sitting.
Are our or our workers out there that have desk
(18:54):
jobs and they have to just sort of sit for
a long period of time start getting a swelling. But
sometimes it's the doctor's fault when it comes to that.
Medication such as blood pressure medicines or maybe anti inflammatory
medications or things like abapentin can certainly contribute to that
swelling of the lower extremities.
Speaker 2 (19:14):
We have Karl from clear Lake. How can we help you?
Speaker 3 (19:17):
Hi, doctor Levina. I listen to you often. I'm ninety
one years old. I'm in good health, but under under
my arms where the hair used to be, I have
small bumps and nothing hurts. But I'm curious what that
is and is that bad?
Speaker 1 (19:37):
It's in your in the pit of your arm, like
what we call the axe yellow where you put your deodorant.
Speaker 2 (19:44):
Maybe yes, And how long has it been there?
Speaker 3 (19:49):
I guess a year or two where the hairs used
to be their bumps. I went to skin doctor Jarving
the a they often and they cold under it. But he
seemed to be concerned. Uh, and it is curious to me.
I've never seen that before. There's a bunch of where
(20:12):
where here under the arms.
Speaker 1 (20:18):
Yeah, you know it would it would be better if
I could look and see what it looked like. But
seems like you've looked into it. You've seen a skin specialist.
They are more familiar and are experts with the skin
system and are better able to decide why you might
(20:39):
have a bump there or a blemish on the skin
or discoloration. Again, you said you are ninety Is that.
Speaker 3 (20:46):
Correct, Yeah, yes, ninety one, Yes, sir doctor, they're not.
It's not a special it's not a particular area. Several
of them, Yeah, almost like where the hair is used
to be. Right. It's just curious. Nothing hurts, uh, And
I'm not terribly concerned, but I find of the curiosity. Uh,
(21:09):
there's several of them under under both arms where the
hairs used to be. Well.
Speaker 1 (21:13):
Now, a lot of times when you can do carl Is,
you can get back to the skin doctor. They can
buy op see that area and look at it under
the microscope and give you a better idea of what
the pathology is or the pathophysiology in terms of what's
causing the bumps, if it's bugging you that much, Yes.
Speaker 3 (21:33):
Sir, yeah, once again, I mean there are several bumps
under both arms where he and uh uh, that's good advice.
I would return in there. I go there often, but
I've never heard of that. I just want to that's
simply part of the aging process.
Speaker 1 (21:53):
Yes, it can be. Certainly, the skin is part of
the human body and it goes through its own aging product.
It's as well, absolutely right that it could just be
a part of yeah, the skin becoming older. I think
the main thing is we just want to make sure
it's not part of any disease that needs to be addressed.
We want to make sure it's not cancerous, which is
(22:14):
uncommon in that area. And again, it's been there for
a couple of years. It hasn't really progressed or gotten worse.
It's not painful, so it's it's got a lot of
benign features to it. So I would probably assume that
it's probably, yes, related to just your skin becoming older.
It may not look pleasant to the naked eye, but again,
(22:35):
not anything that's going to cause any harm.
Speaker 3 (22:38):
It was under doctor. I listen to you often. I
appreciate your work.
Speaker 1 (22:43):
Thank you, sir, appreciate a car from clear Lake. And yes,
those skin blemishes can be very irritating. Certainly we see
more of the skin blimishes on the forearms and the hands,
as well as the face, the neck. You know, it's
getting all that exposure to the sun and the elements.
Understand that most of the time otherwise our skin is
(23:06):
covered by clothing, and so that's why most of what
we see are most of the blemishes that we see
are in those exposed areas. Not always, I mean, certainly
you can get areas or skin blimases in other parts
of your body. But yeah, those skin blimacies. Always want
to make sure it's nothing worrisome, that it's not linked
(23:28):
to some disease like an autoimmune disease or some sort
of metabolic derangement that might be going on. Maybe liver
or kidney disease sometimes presents with skin problems, or blood
disorder presents with skin problems, and so you always want
to make sure that yes, it's nothing like that, and
going to your healthcare provider to get checked out maybe
(23:50):
and get to skin doctor again. If they're confused. A
lot of times they will do a bopsy where they
can look under the microscope and that will give them
a better view of what is actually going on, so
they can decide what medications to give you or maybe
something to avoid. We have Michael from Pasadena. How can
we help you?
Speaker 4 (24:10):
Good morning? Uh uh. On Friday, I had a what
they call PET so I C T H stress test,
and I'm wondering. First of all, the reason the doctor
decided to do that is I had a cat scan
(24:32):
done in December and on the report it said coronary
artery is coronary artery calcification, and then it said some
calcification in the A order, but no aneurysms. And she
could not see in that cat scan, just only part
(24:56):
of the heart, so she thought we should just go
ahead and do the whole heart with this PET uh
slash C T H trust hess and I did it.
Now I'm wondering. I'm hoping they don't find anything. I'm
if you'll remember, I'm I walked and I have no
(25:18):
chest pains. I have had problems with the electrical part
of my heart, but just as a plumbing part and
uh so I've got the electrical part is completely fixed,
supposedly because I've had two oblations. Uh still I have
to watch that. But on if they do find something,
(25:43):
what's my what early options? Well he really didn't discuss that,
and I know I will later when I go back
for the follow up. But I wanted what you know,
you're very knowledgeable. I wanted to know what what my
what might happen?
Speaker 1 (26:02):
Well, I mean, most of the time, they're just trying
to figure out if you have some sort of circulatory problem,
which we call corner artery disease or athrosclerosis of the
cornary arteries plaque. Basically, they're just trying to figure that
stuff out, and they're trying to use more non invasive
tests to try and gain some knowledge about your circulation
(26:26):
so that they can maybe medicate you differently or recommend
what they call an arteriogram or a heart catheterization to
get the best view of your corner arteries and then
if they depending on what they see, they can perform
a procedure normally call it an angioplasty to correct the
blockage or the narrowings. So they are having more and
(26:50):
more fancy tests coming out to help cardiologists and other
doctors decide what is your risk of having this particular problem.
So yeah, they'll look at that and gather that information
to determine your risk, and then depending on that, Yes,
they might adjust your medications in terms of increasing or
(27:11):
adding medicine that the current medical literature suggests is very
helpful in controlling the disease process or reducing your chance
of having an event. And yes, they might want to
proceed with the left hard cat to figure out what
your circulation looks like. So yes, it's just information for
them to make decisions about you.
Speaker 4 (27:33):
Well, that show blockages.
Speaker 1 (27:37):
It normally suggests that there is a blockage. They cannot
see the blockage. The best way or the goal standard
way of being able to see the blockage is, like
I said, what they call a heart catheterization where they
use these small catheteris they put them in your artery
(27:58):
and they inject some and it lights up and they
can see all of your circulation, the narrowing, the blockage,
where it is, how big it is, and this is
how we perform that or figured that out. Now, all
these tests prior up to that is just a suggestion
that you probably have the blockage or narrowing, so they
(28:21):
won't be able to see it like they can with
an aigram, but it'll be suggested to them. So the
more positive these preliminary tests are, they're more likely it
is that you do have the blockages and the plaque
and the narrowing of your blood vessels, and they're more
(28:42):
likely that they would need to probably do an aigram
to actually take a look at it and perform an intervention.
If they do see it in performing the intervention, then
you're unlikely or less likely to have an event like
a heart attack is primarily what they're trying to prevent,
all right, Michael, Yeah, those, I mean, more and more
(29:06):
tests are being done now.
Speaker 2 (29:08):
We have the.
Speaker 1 (29:10):
Cardiac stress tests, we have ekg's, we have ultrasounds of
the heart, we have the coronary calcium scoring test that's
now very popular that some patients are getting cardiologists to
ordering that. We have Frank from Beaumont. How can we
help you?
Speaker 2 (29:27):
Frank? All right, Frank, please call back from Beaumont, give
us a call. We'd love to.
Speaker 1 (29:32):
Hear your question and try to help you out. Phone
lines are open eight on six. Kalf I won one
hundred three to three zero Kovy. I'll be back in
two minutes. All right, welcome back to doctor Medical. Our
phone lines are open eight none six kalv I won
one hundred three to three zero k l v I.
(29:54):
Talking about lower extremity swelling, A lower extremity deem a
very common physical problem that a lot of Americans suffer
from and is a lot of different causes. And certainly
if you see that your feet or your ankles are swollen,
that is something abnormal. You need to go get a
medical evaluation, because nine times out of ten there is
(30:16):
something significant that is going on. I have mentioned the
more common some common causes of loc shim be swelling,
and those typically can be reversed again if you can
get up and start moving around, loose some weight, maybe
adjust your medications. From your doctor's standpoint, some other more
(30:39):
common causes of loc show swelling would be diseases of
the kidney, liver, and heart system. Some people have one
of them, some people have all three. They have kidney problems,
heart and liver problems. And normally when that happens, you
start getting that accumulation of fluid in the lower extremities.
(31:02):
Now Normally, the way to figure that out is just
simple blood work as well as maybe some X rays
of the liver, your heart, or your kidneys. But most
of the time, your healthcare provider can just order a
basic laboratory work and look and see how your metabolic
system is doing. A lot of times when you get kidney, liver,
(31:26):
or heart issues, it will start to cause derangements of
those labs, and healthcare providers are trained to see these
sorts of variations in lab and that will suggest to
them that maybe you have these diseases. So a lot
of times when someone comes in with swelling like that,
we will target those vital organs to see if there's
(31:49):
any dysfunction of these vital organs, to see if that
is the contributing factor of your ructomy swelling. Most of
the time with kidneys, it's just related to high pertension
and diabetes. Remember in this country, that is the leading
cause of patients to be on dalyases. It's just diabetes,
poor management and high pretension that have been going on
(32:11):
for a long time. Obviously, there's a whole other list
of kidney diseases that can cause you to have kidney
failure and be on dalyasis, but high pretension in diabetes
in this country is the leading cause of why patients
get put on DALLAS. The same thing with the heart.
High pretension diabetes, right is the leading cause of heart failure,
(32:34):
which is what we call that when the heart muscle
is not being able to pump the blood as efficiently
and so you start getting reduced blood flow. And when
the blood is not flowing at the rate that it should,
the body reacts to that by retaining fluid, which is
again which is why we focus on the heart a
(32:55):
lot of times. When you get that swelling in your legs,
and high pretension diabetes leading cause of that, as well
as coronary ortering disease. Right plaque inflammation of the blood
vessel wall, which again comes from right highpertension diabetes and
being inflamed, which we talk about all the time, consuming
(33:16):
certain food items and beverage items, and this country generates
that inflammation, causes plaque to accelerate in the blood vessel wall,
and then that can affect the heart function. Heart's not
beating very well, blood starts to become congested, you start
getting the swelling in the legs. Sort of this chain
of events that tends to happen. Takes a while, but
(33:40):
certainly this is sort of the process that occurs. But
it could your first presentation of heart disease could just
be swelling in your legs. Your first presentation of kidney
disease could just be swelling in your legs. So you
have to take that symptom pretty seriously. When we get
a lot of physical symptoms throughout the day that we
(34:00):
can just sort of ignore and keep going. We don't
have to get evaluated. We're busy, We've got things to do.
Who wants to go sit at the doctor's office for
four or five hours or sit in the er for
six seven hours. We just, you know, we don't want
to get it checked out, you know, just keep putting
it to the side. But when you get swelling in
your legs and your feet and your ankles, that typically
(34:23):
is a pretty serious physical complaint and that needs to
be evaluated semi urgently. Now that you have to run
to the er the day you see it, but certainly
within a week or two that you need to be
seen by some healthcare professional to initiate a evaluation. Again,
I mentioned the liver is another organ that when it's diseased.
(34:45):
It can cause sluggishness of blood flow and can contribute
to swelling of the low extremities. Now, really, the big
reasons we see a lot of liver disease is from
a couple of different things. One, it's just alcohol consumption
over a longer period of times, several years typically again
compared to when I was a young person, I mean,
(35:06):
more Americans are drinking more alcohol than when I was young.
So alcohol, again, at the end of the day, is
a toxin, and when you're getting constant exposure to this toxin,
it can affect a lot of different vital organs, the
nervous system, cardiovascular system, and it attacks the liver because
liver basically is a big filter of the blood stream.
(35:30):
I mean a lot of blood goes to the filter
every day. It filters out impurities, it keeps things balanced.
It's a part of our immune system, it's a part
of our blood clotting system. I mean, it's a really
really important organ. So it's getting a lot of blood,
and alcohol tends to target the liver when it's being
(35:53):
consumed again because it's filtering all of those toxic elements
when you drink alcohol, And so for the most part,
it can protect itself. It has a lot of redundancy
built into its systems deliver that is, so it takes
a while for this to happen. So the longer exposure
you have to alcohol, then the more likely you will
at some point develop some liver disease, which we call
(36:17):
liver sorrhosis, which is basically just liver scar tissue, again
brought on by this sort of constant irritation, this constant
inflammation by being exposed to toxins like alcohol. Think of
it as a skin burn, or when you have a
lot of exposure to the skin, you start getting this
blotchy skin that maybe peels, it's flaky, and.
Speaker 2 (36:40):
Again it's just scar tissue. It's inflammation.
Speaker 1 (36:43):
This is how the body reacts to just being constantly
injured and harm. The liver is no different, and so
over time it gets scarred down and depending on the
amount of scarring, it can prevent blood from flowing through it,
and the blood sort of has to reroute itself and
do it knowing that it becomes very very sluggish or
more sluggish then it normally is the normal routine, and
(37:08):
that sort of sluggishness of blood flow would then generate
that swelling in the legs. So these are some other
more common causes of the swelling in your legs and
something that needs to be looked into semi originally.
Speaker 2 (37:21):
If you get it, we'll go on our last break.
Speaker 1 (37:23):
Phone lines or open eight down six kalv I one
one hundred three three zero klv. I'll be back in
two minutes. All right, welcome back to Act Medical. Our
phone lines open. At the end of the show, My
god man, an hour goes by so so rapidly. Here
(37:44):
talking about low extremity swelling and a deema that sometimes
you can get. Very common cause we did talk about
some of the more common.
Speaker 2 (37:54):
Cause of that.
Speaker 1 (37:55):
A couple of others that I wanted to mention are
blood clots, which we call dvd are deep vein thrombosis.
There's a lot of different causes of that. Again, being
sedentary is one of them, and other health care problems
such as liversrrosis, heart failure, gidney failure. You get that
sluggish blood flow on your legs and can generate the
(38:17):
dvt are thrombus in the vein. Cancers can generate clots
as well. So a lot of times when patients come
into my office with lordshim me swelling. I am going
to check for a DVT or a clot in the leg,
because it's extremely common in our community. Again, for all
(38:38):
these medical issues that we see cancer, heart failure, being sedentary,
a lot of being overweight. Again, we see that as
an independent risk factor for the development of swelling. Surgeries
you go in for hip replacement, all bladder surgery, any
sort of surgery where you're laying down, you get exposed
(38:58):
to anesthesia and sort of a prolonged recumbent position. A
few days later, you can sort of get that. So
a lot of times I'd like to do an ultrasound
of the legs of the lower legs to be sure
that there is no particular clot there in the legs.
That's a very serious problem.
Speaker 2 (39:19):
As you know.
Speaker 1 (39:19):
If the clot is not seen and it's not addressed,
it can lead to what we call a pulmonary embolis,
which can be a fatal development because it just basically
clogs the circulation back to the heart and basically the
heart that cannot get blood flow. And if the heart
is not getting blood and it can't work and sort
(39:40):
of the system shuts down. In that situation and a
blood clot in the lower legs, a game, which you
call a DVT can propagate and grow and build to
go to the circulation of the lungs, and it can
get so big that it can prevent blood flow from
getting to your heart, which again in causes sort of
(40:01):
a collapse of the cardiovascal system. So that's pretty serious stuff.
And again it can just start from sitting around too much.
I mean a lot of times we get that from
a long trip.
Speaker 2 (40:13):
You sat in the car for.
Speaker 1 (40:14):
A long time, you took a long plane trip and
you sat too long, you get that swelling your legs
and like, I'm busy, I don't have time for this
moment vacation. The swelling doesn't go away, and then several
days later you start getting short of breath or you
have chest pain.
Speaker 2 (40:30):
That's how that starts.
Speaker 1 (40:31):
We see that sort of situation happen all the time
in the hospital. So bottom line is, if you do
have swelling of your feet and your ankles, your legs,
you should get a thorough evaluation to sort of see
what is causing that, because normally there is something significant
that needs to be looked into, and hopefully it's something
that can be corrected a lot of times with being
(40:52):
set into and being of weight, you get that venus
insufficiency or poor vein circulation. You can correct that with
the compressions stockings which are just about everywhere. You can
purchase those. But the main thing is to get up
and start moving around and get that blood flowing. That
will correct the circulation problems. And thank you for joining
us another edition of the show. Remember don't drink and drive,
(41:14):
eat some vegetables, drink some water. See you guys next week.
All right, Welcome South East Sexers Internet radio listeners. This
is your weekly host, Dark Levine. Welcome of the edition
of the Dark Levine Medical Hour. I am here in
a series of kov I hear in Boma, Texas, live
across the street from Parkdale Mall, taking your phone calls,
answering questions about healthcare and medicine as I see it
(00:21):
and as we both can see it, trying to make
you understand or get some clarity on what it is
you need to do to stay alive as long as
possible and as healthy as possible. It's tough out there.
It's difficult and can be very confusing out there in
terms of what to do and how to do it.
With all the information that's flooding and coming our way,
(00:45):
it's just totally, really, really difficult to figure out what
is the right thing to do. And this is here
our hour to try and figure it out so that
we can make clarity about what's happening. Lines are open
eight nine to six KALV. I went one hundred and
three three zero KALV. I would love to hear from
(01:06):
your two way radio.
Speaker 2 (01:09):
And while we wait on.
Speaker 1 (01:10):
Phone calls, we typically will launch into some topics that
may be of interest, maybe things that have happened over
the past week that are of interest, or maybe something
that I was thinking about this morning as I was
driving into the station to talk with you. Certainly the
(01:32):
summer months are heading our way, and we did spend
some time last week talking about protecting your skin as
the sun is very strong now and South East Sexes
gets pretty hot and humid, and certainly dehydration and just
what we call heat related illnesses sort of start picking
(01:52):
up a lot. And primarily that revolves around just your
body being exposed to the temperature and the heat, and
not just how hot it is, but just the length
of time that you get exposed to That can be
overwhelming for the human body to tolerate it, and you
(02:13):
can get sick from just too much heat and too
much sun and sometimes have to be hospitalized for that.
Like I say, what we call that heat related illnesses
and dehydration is a part of that. It can cause
a lot of metabolic derangements when you become dehydrated, but
(02:34):
for the most part, people just feel weak and nauseate
it and dizzy when they get dehydrated. They might even
be drinking water and doing their part to stay hydrated
out there in the summer heat. But the heat and
the amount of humidity here in Southeast Sex is even
(02:56):
that's not enough, meaning that a lot of patience, a
lot of workers understand the issue with the sun exposure,
and they understand dehydration.
Speaker 2 (03:07):
But because of just.
Speaker 1 (03:09):
Like I said, the intensity and the length of time
that they're out there, their body sweat and their hydration
system in their body just gets overwhelmed and it outpaces
their ability to keep up, and they get dehydrated and
they start feeling pretty sick. As it pertains to that
(03:32):
something that can happen within a few hours.
Speaker 2 (03:35):
Of being exposed to the heat.
Speaker 1 (03:37):
I certainly remember my experience with that as a athlete
here and in college, working out and running and having
pads on helmet with under all this heat like this.
I mean, it's something you did. It was a normal
routine thing. But a lot of the professional teams now
(03:58):
and sort of folks just understand it's very stressful on
the human body and can generate injury, especially for athletes.
Speaker 2 (04:08):
That's not so good.
Speaker 1 (04:09):
You see a lot of the professional teams having indoor
facilities or covered practices or maybe doing most of their
activities early in the morning before the heat kicks up,
or later in the evening when the sun is going down,
because we sort of get it now, we understand that,
and even talking with my patients in the office about exercising,
(04:29):
they're really, in my opinion, there really is no advantage
to exercising in the heat unless you like it doing
that again, because we kind of understand now that exposure
to intense sun for a long period of time is
injurious to your body, and that's not something that we're
(04:50):
trying to incorporate or encourage when you're exercising just because
we want you to enjoy it, we don't want you
to injure yourself. Which if you listen to my show,
I try to let you know all the time that
if you want to exercise, it's really super easy to
be honest with you in terms of the type of
exercising that you can engage in that does have benefit
(05:15):
to your metabolic function. And again, these exercises are pretty
easy to do, they're cheap, they don't really involve a
lot of equipment, and can be done by anyone. Like
walking or if you want to trot or jog or
just getting on a bicycle and pedaling. If you need
(05:36):
some basic equipment, the equipment has gotten more affordable. You
can get these devices just about anywhere, and they're small, convenient.
They fit in your bedroom or your garage. You can
a lot of times fold it up. I mean, there's
so many things you can do. But again, you don't
really need the big time equipment or the big membership.
(05:58):
I mean, if you want to do that, it's absolutely fine,
but you really don't need that to get some benefit
from exercising. Even if you are an employee at a
job and you sit most of the day doing paperwork
or pressing on a computer screen, whatever, answering phone calls,
(06:19):
just standing up more of the day than sitting is
beneficial and is helpful as it pertains to health. Remember
we've talked about prolonged sitting for a long time and
how that is just extremely unhealthy for you, and most
people who sit for a long period of time most
(06:41):
of the day will start to get some physical problems
related to that. It's just abnormal for that to do.
I remember when I was in medical school and studying
for exams. I mean, you could sit there for hours
just in a chair, looking at books and reading all
this information and trying to recall all this information. I
(07:02):
remember I used to get up sometimes and not have
swelling in my legs because I'd sat so long. Didn't
quite understand it then, but I get it now, and
as soon as I got up and walked around, the
swelling would go away. So any one of you or
who have a job it requires you to be at
a desk all day, it's going to be important to
(07:23):
try and just stand up and get your blood flowing,
because again, being in a seated position most of the
day is not good for you. Typically there will be
some way gain associated with that and some fatigue issues.
And again that swelling that comes in the lower extremities,
(07:44):
which tends to be a very common complaint for a
lot of Southeast Texans, which we have discussed that before.
The lower extremity swelling or edema as we call it,
is super super duper common complaint for most Southeast Texans.
We see that a lot they can't get their shoes on,
(08:05):
their ankles are big, and they come in with that
complaint alone trying to figure out why their ankles are
huge or their swelling. They can put a dent in
their leg or their skin and they see that dent
there and they know that that's not normal, and they
(08:25):
come in to be evaluated for that. And there's a
lot of causes of what we call lower extremity edema
or what we call peripheral edema. You know, your chest
and your abdomen, we call that the core core and
your foot, your hand that's more of in the periphery
are peripheral anatomy, and so that's why we call it
(08:46):
peripheral edema. But a lot, a lot of causes of
the swelling in the legs and again, super duper common.
There's a few things that we can discuss today while
wait on phone call a lot of times. Again, the
most common cause of that, again is being overweight and
(09:07):
being sedentary and unfortunate because the blood's not fluent. And unfortunately,
a lot of us get into that situation, whether we're
elderly or may maybe we have some arthritic problems and
we can't really move around the much, or maybe we
have neurological problems where we get dizzy when we get up,
(09:28):
and so we kind of just get into this habit
where we're sitting most of the day and more prolonged
sitting probably begets more sitting just because you get deconditioned
a lot. If you just sit all day long, it's
almost the same as laying in a bed all day long.
We get that exposure there in the hospital and patients
(09:49):
are very ill.
Speaker 2 (09:50):
They just don't feel well.
Speaker 1 (09:51):
They just kind of want to lay in bed all day,
which for a brief moment, it's okay. Obviously you need
to recover, and yeah, you may not feel well for
a day or two, and laying in the bed is
the way to tolerate that. But beyond that, unfortunately, you know,
we have to get patients up and moving around, just
because laying in a bed, sitting in a chair just
(10:14):
very very unhealthy. And that's what I mean when I
say you don't have to really exercise in a high
intensity way. Just getting up and walking, just simply walking
can be very advantageous. A lot of my workers out
at the plants and other various jobs where you're kind
(10:36):
of just walking throughout the day, you're not really sitting
at a desk.
Speaker 2 (10:39):
That stuff does count.
Speaker 1 (10:41):
And it does help with your blood pressure and your
weight control. Not that it's the end all to be all,
because you're walking, but certainly it does help with that.
So one of the most common causes of the swelling
is just you're not moving and you're overweight, because a
(11:01):
lot of us will get a little bit plus size
again about thirty forty pounds for various reasons. We've talked
before about the diet and exercise issues here in this
country and how it tends to promote weight gain over time.
Consuming a lot of the products that we'd like to consume,
a lot of the processed foods and beverages that we
(11:22):
consume what they call ultra processed, meaning it's probably gone
through many hands, it's probably been adulterated significantly to get
this end product. When consuming those products on a regular basis,
it tends to generate weight gain and disease in the
human body, just because a lot of this is just unnatural.
(11:45):
It's sort of synthetic, it's man made, and the human
body a lot of times it's just not designed to
tolerate or get exposed to these substances every day, and
so the reaction to the human body is inflammation.
Speaker 2 (12:00):
We've talked about that before.
Speaker 1 (12:01):
And you know, weight gain and fatigue, just because it's
almost like your body is lightly sick or lightly ill.
You can get through it. You can go to work,
you can still function. But man, you just you just
don't feel good, you know. And it's just sort of
this undercurrent or background sense of unhealthiness that you feel
(12:22):
when you get up in the morning throughout the day.
You know, you'd like to have more energy, you'd have
to have you'd like to have more mental clarity, and
it's almost like you can't achieve it for whatever reason.
And that a lot of times can prompt a visit
to the doctor's office as well to sort of get
a check up and see if there's anything else that
might be causing a lot of times it's just the food,
(12:44):
you know, the ultra processed food that again, we eat
it every day. It's everywhere, it's so convenient. A lot
of times, it's cheap, it's packaged, it's a one, two
three boom, ready to go.
Speaker 2 (12:58):
You can eat it.
Speaker 1 (13:00):
But again, the issue with that is the exposure and
the potential health issues. And again this is well chronicle
experts have talked about this over and over again. I'm
just another healthcare professional that has read these articles, and
I see patients all the time. And trying to get
(13:20):
everybody on board with that. So because of our elderly population,
you know, we are allowed or we're able to get
to our deeper ages and things like muscle skeletal pain,
joint pain, knee pain. We just become more sedentary and
doing that, weight gain comes and then that's swelling in
(13:42):
the legs come. But that's not the only reason while
we get swelling. Sometimes it's the doctor's fault that we
get swelling. We call that eyeatrogenic. That's the name for that.
When something happens because there's something that was prescribed to you,
a given to you, or done to you by a
healthcare professional, we call that iyatrogenic. And sometimes yeah, that
(14:03):
swelling is related to for the most problem, medications that
may be given to you to help one medical problem
and then the side effect issue then causes swelling of
your lower extremities. And a couple of those medicines are
blood pressure medications, most commonly called calcium channel blockers. You
(14:26):
might know them as amylodopene orniphittipine, which are used heavily
in the medical world to help control blood pressure just
because they're very strong and both of them are once
a day, and I use that a ton in my practice.
I prescribe it all the time as well as in
the hospital, just because the medications are extremely effective. They
(14:48):
work very well, and we use these medications to achieve
goals for the blood pressure. But for some people it
starts to cause swelling in the lower extremely They can
sort of like say, get see their ankles getting puffy,
top of their feet getting puffy when we put them
on these medications. You know, it's crazy because a lot
(15:09):
of times we can start the medication everything's working, and
then it's months later that they might get the swelling
and they come in specifically for that, and a lot
of times we just have to either reduce the dose
or maybe if the blood pressure is still high, we
can add what they call a diuretic. These are medications
(15:31):
that work in the kidney to help the body eliminate
excessive fluid. Like I said, we call that edema. You
see it as sort of the swelling that happens. Like
I say, we're talking about the lower extremities, but it
could happen in your hands, or your arms, your face,
just your torso around your abdominal area where you start
(15:52):
getting that swelling, that puffiness that you see, and a
lot of times we try and eliminate that with what
we call diuretics. Might know the mess ferosamide or LASiS
or hydrochlorothisi, chlorthalidone, torsomide, demodex just to name a few,
and we use these medications to help manage swelling our
(16:14):
dima as well as the hypertension that you might have
with the swelling that you might have as well. So
medications can be a reason for that. Gabapentin or neurontin,
which is a medication we use a lot for headaches
and neuropathy which a lot of our patients are suffering
(16:38):
from that can cause some swelling. Anti inflammatories such as motrin,
advil a, leave celebrecs, meloxicam. Again, most of our patients
out there are suffering some sort of pain issue, whether.
Speaker 2 (16:52):
It be the neck or the back, the knees, and.
Speaker 1 (16:55):
Go to the grocery store, go to the pharmacy, get
the eleville, I'm sorry, the advil and i'buprofens. Start taking
that and then several weeks later, maybe a month later,
you start having swelling, especially if you keep taking the medication.
So there's a lot of different medications. Those are just
(17:16):
some common ones that we use every single day. And
if you are on these medications and you're having some swelling,
you might need to talk to your healthcare provider about
changing or getting off those medications. Phone lines are open
eight and on six kV. I went in hundred three
three zero kilov. I'll be back in two minutes. All right,
(17:49):
welcome back to the doctor. Medical. Our phone lines are
open eight one six kV. I went in hundred three
three zero okiovy, I'll give us a call. See what's
on your mind. Talking about lower extremities dwelling our demon
which is a very common complaint in the medical world.
A lot of different reasons for that. We did discuss
the fact that probably in my opinion, the most common
(18:10):
cause is just becoming more sedentary and gaining a little weight,
which is extremely common in our community for various reasons.
You've gotta be active and keep the blood flowing so
that you do not develop this, but sometimes it's hard
to do. You maybe have some arthritic pain, or you
have a neurological disease that just does not allow you
(18:33):
to be very mobile, and so you start sitting more,
and we do see that a lot with maybe stroke
patients or the arthritis that can develop as we get older,
that back starts to wear out, and it's just walking
is very painful. It's uncomfortable and you just find yourself sitting.
Are our or our workers out there that have desk
(18:54):
jobs and they have to just sort of sit for
a long period of time start getting a swelling. But
sometimes it's the doctor's fault when it comes to that.
Medication such as blood pressure medicines or maybe anti inflammatory
medications or things like abapentin can certainly contribute to that
swelling of the lower extremities.
Speaker 2 (19:14):
We have Karl from clear Lake. How can we help you?
Speaker 3 (19:17):
Hi, doctor Levina. I listen to you often. I'm ninety
one years old. I'm in good health, but under under
my arms where the hair used to be, I have
small bumps and nothing hurts. But I'm curious what that
is and is that bad?
Speaker 1 (19:37):
It's in your in the pit of your arm, like
what we call the axe yellow where you put your deodorant.
Speaker 2 (19:44):
Maybe yes, And how long has it been there?
Speaker 3 (19:49):
I guess a year or two where the hairs used
to be their bumps. I went to skin doctor Jarving
the a they often and they cold under it. But he
seemed to be concerned. Uh, and it is curious to me.
I've never seen that before. There's a bunch of where
(20:12):
where here under the arms.
Speaker 1 (20:18):
Yeah, you know it would it would be better if
I could look and see what it looked like. But
seems like you've looked into it. You've seen a skin specialist.
They are more familiar and are experts with the skin
system and are better able to decide why you might
(20:39):
have a bump there or a blemish on the skin
or discoloration. Again, you said you are ninety Is that.
Speaker 3 (20:46):
Correct, Yeah, yes, ninety one, Yes, sir doctor, they're not.
It's not a special it's not a particular area. Several
of them, Yeah, almost like where the hair is used
to be. Right. It's just curious. Nothing hurts, uh, And
I'm not terribly concerned, but I find of the curiosity. Uh,
(21:09):
there's several of them under under both arms where the
hairs used to be. Well.
Speaker 1 (21:13):
Now, a lot of times when you can do carl Is,
you can get back to the skin doctor. They can
buy op see that area and look at it under
the microscope and give you a better idea of what
the pathology is or the pathophysiology in terms of what's
causing the bumps, if it's bugging you that much, Yes.
Speaker 3 (21:33):
Sir, yeah, once again, I mean there are several bumps
under both arms where he and uh uh, that's good advice.
I would return in there. I go there often, but
I've never heard of that. I just want to that's
simply part of the aging process.
Speaker 1 (21:53):
Yes, it can be. Certainly, the skin is part of
the human body and it goes through its own aging product.
It's as well, absolutely right that it could just be
a part of yeah, the skin becoming older. I think
the main thing is we just want to make sure
it's not part of any disease that needs to be addressed.
We want to make sure it's not cancerous, which is
(22:14):
uncommon in that area. And again, it's been there for
a couple of years. It hasn't really progressed or gotten worse.
It's not painful, so it's it's got a lot of
benign features to it. So I would probably assume that
it's probably, yes, related to just your skin becoming older.
It may not look pleasant to the naked eye, but again,
(22:35):
not anything that's going to cause any harm.
Speaker 3 (22:38):
It was under doctor. I listen to you often. I
appreciate your work.
Speaker 1 (22:43):
Thank you, sir, appreciate a car from clear Lake. And yes,
those skin blemishes can be very irritating. Certainly we see
more of the skin blimishes on the forearms and the hands,
as well as the face, the neck. You know, it's
getting all that exposure to the sun and the elements.
Understand that most of the time otherwise our skin is
(23:06):
covered by clothing, and so that's why most of what
we see are most of the blemishes that we see
are in those exposed areas. Not always, I mean, certainly
you can get areas or skin blimases in other parts
of your body. But yeah, those skin blimacies. Always want
to make sure it's nothing worrisome, that it's not linked
(23:28):
to some disease like an autoimmune disease or some sort
of metabolic derangement that might be going on. Maybe liver
or kidney disease sometimes presents with skin problems, or blood
disorder presents with skin problems, and so you always want
to make sure that yes, it's nothing like that, and
going to your healthcare provider to get checked out maybe
(23:50):
and get to skin doctor again. If they're confused. A
lot of times they will do a bopsy where they
can look under the microscope and that will give them
a better view of what is actually going on, so
they can decide what medications to give you or maybe
something to avoid. We have Michael from Pasadena. How can
we help you?
Speaker 4 (24:10):
Good morning? Uh uh. On Friday, I had a what
they call PET so I C T H stress test,
and I'm wondering. First of all, the reason the doctor
decided to do that is I had a cat scan
(24:32):
done in December and on the report it said coronary
artery is coronary artery calcification, and then it said some
calcification in the A order, but no aneurysms. And she
could not see in that cat scan, just only part
(24:56):
of the heart, so she thought we should just go
ahead and do the whole heart with this PET uh
slash C T H trust hess and I did it.
Now I'm wondering. I'm hoping they don't find anything. I'm
if you'll remember, I'm I walked and I have no
(25:18):
chest pains. I have had problems with the electrical part
of my heart, but just as a plumbing part and
uh so I've got the electrical part is completely fixed,
supposedly because I've had two oblations. Uh still I have
to watch that. But on if they do find something,
(25:43):
what's my what early options? Well he really didn't discuss that,
and I know I will later when I go back
for the follow up. But I wanted what you know,
you're very knowledgeable. I wanted to know what what my
what might happen?
Speaker 1 (26:02):
Well, I mean, most of the time, they're just trying
to figure out if you have some sort of circulatory problem,
which we call corner artery disease or athrosclerosis of the
cornary arteries plaque. Basically, they're just trying to figure that
stuff out, and they're trying to use more non invasive
tests to try and gain some knowledge about your circulation
(26:26):
so that they can maybe medicate you differently or recommend
what they call an arteriogram or a heart catheterization to
get the best view of your corner arteries and then
if they depending on what they see, they can perform
a procedure normally call it an angioplasty to correct the
blockage or the narrowings. So they are having more and
(26:50):
more fancy tests coming out to help cardiologists and other
doctors decide what is your risk of having this particular problem.
So yeah, they'll look at that and gather that information
to determine your risk, and then depending on that, Yes,
they might adjust your medications in terms of increasing or
(27:11):
adding medicine that the current medical literature suggests is very
helpful in controlling the disease process or reducing your chance
of having an event. And yes, they might want to
proceed with the left hard cat to figure out what
your circulation looks like. So yes, it's just information for
them to make decisions about you.
Speaker 4 (27:33):
Well, that show blockages.
Speaker 1 (27:37):
It normally suggests that there is a blockage. They cannot
see the blockage. The best way or the goal standard
way of being able to see the blockage is, like
I said, what they call a heart catheterization where they
use these small catheteris they put them in your artery
(27:58):
and they inject some and it lights up and they
can see all of your circulation, the narrowing, the blockage,
where it is, how big it is, and this is
how we perform that or figured that out. Now, all
these tests prior up to that is just a suggestion
that you probably have the blockage or narrowing, so they
(28:21):
won't be able to see it like they can with
an aigram, but it'll be suggested to them. So the
more positive these preliminary tests are, they're more likely it
is that you do have the blockages and the plaque
and the narrowing of your blood vessels, and they're more
(28:42):
likely that they would need to probably do an aigram
to actually take a look at it and perform an intervention.
If they do see it in performing the intervention, then
you're unlikely or less likely to have an event like
a heart attack is primarily what they're trying to prevent,
all right, Michael, Yeah, those, I mean, more and more
(29:06):
tests are being done now.
Speaker 2 (29:08):
We have the.
Speaker 1 (29:10):
Cardiac stress tests, we have ekg's, we have ultrasounds of
the heart, we have the coronary calcium scoring test that's
now very popular that some patients are getting cardiologists to
ordering that. We have Frank from Beaumont. How can we
help you?
Speaker 2 (29:27):
Frank? All right, Frank, please call back from Beaumont, give
us a call. We'd love to.
Speaker 1 (29:32):
Hear your question and try to help you out. Phone
lines are open eight on six. Kalf I won one
hundred three to three zero Kovy. I'll be back in
two minutes. All right, welcome back to doctor Medical. Our
phone lines are open eight none six kalv I won
one hundred three to three zero k l v I.
(29:54):
Talking about lower extremity swelling, A lower extremity deem a
very common physical problem that a lot of Americans suffer
from and is a lot of different causes. And certainly
if you see that your feet or your ankles are swollen,
that is something abnormal. You need to go get a
medical evaluation, because nine times out of ten there is
(30:16):
something significant that is going on. I have mentioned the
more common some common causes of loc shim be swelling,
and those typically can be reversed again if you can
get up and start moving around, loose some weight, maybe
adjust your medications. From your doctor's standpoint, some other more
(30:39):
common causes of loc show swelling would be diseases of
the kidney, liver, and heart system. Some people have one
of them, some people have all three. They have kidney problems,
heart and liver problems. And normally when that happens, you
start getting that accumulation of fluid in the lower extremities.
(31:02):
Now Normally, the way to figure that out is just
simple blood work as well as maybe some X rays
of the liver, your heart, or your kidneys. But most
of the time, your healthcare provider can just order a
basic laboratory work and look and see how your metabolic
system is doing. A lot of times when you get kidney, liver,
(31:26):
or heart issues, it will start to cause derangements of
those labs, and healthcare providers are trained to see these
sorts of variations in lab and that will suggest to
them that maybe you have these diseases. So a lot
of times when someone comes in with swelling like that,
we will target those vital organs to see if there's
(31:49):
any dysfunction of these vital organs, to see if that
is the contributing factor of your ructomy swelling. Most of
the time with kidneys, it's just related to high pertension
and diabetes. Remember in this country, that is the leading
cause of patients to be on dalyases. It's just diabetes,
poor management and high pretension that have been going on
(32:11):
for a long time. Obviously, there's a whole other list
of kidney diseases that can cause you to have kidney
failure and be on dalyasis, but high pretension in diabetes
in this country is the leading cause of why patients
get put on DALLAS. The same thing with the heart.
High pretension diabetes, right is the leading cause of heart failure,
(32:34):
which is what we call that when the heart muscle
is not being able to pump the blood as efficiently
and so you start getting reduced blood flow. And when
the blood is not flowing at the rate that it should,
the body reacts to that by retaining fluid, which is
again which is why we focus on the heart a
(32:55):
lot of times. When you get that swelling in your legs,
and high pretension diabetes leading cause of that, as well
as coronary ortering disease. Right plaque inflammation of the blood
vessel wall, which again comes from right highpertension diabetes and
being inflamed, which we talk about all the time, consuming
(33:16):
certain food items and beverage items, and this country generates
that inflammation, causes plaque to accelerate in the blood vessel wall,
and then that can affect the heart function. Heart's not
beating very well, blood starts to become congested, you start
getting the swelling in the legs. Sort of this chain
of events that tends to happen. Takes a while, but
(33:40):
certainly this is sort of the process that occurs. But
it could your first presentation of heart disease could just
be swelling in your legs. Your first presentation of kidney
disease could just be swelling in your legs. So you
have to take that symptom pretty seriously. When we get
a lot of physical symptoms throughout the day that we
(34:00):
can just sort of ignore and keep going. We don't
have to get evaluated. We're busy, We've got things to do.
Who wants to go sit at the doctor's office for
four or five hours or sit in the er for
six seven hours. We just, you know, we don't want
to get it checked out, you know, just keep putting
it to the side. But when you get swelling in
your legs and your feet and your ankles, that typically
(34:23):
is a pretty serious physical complaint and that needs to
be evaluated semi urgently. Now that you have to run
to the er the day you see it, but certainly
within a week or two that you need to be
seen by some healthcare professional to initiate a evaluation. Again,
I mentioned the liver is another organ that when it's diseased.
(34:45):
It can cause sluggishness of blood flow and can contribute
to swelling of the low extremities. Now, really, the big
reasons we see a lot of liver disease is from
a couple of different things. One, it's just alcohol consumption
over a longer period of times, several years typically again
compared to when I was a young person, I mean,
(35:06):
more Americans are drinking more alcohol than when I was young.
So alcohol, again, at the end of the day, is
a toxin, and when you're getting constant exposure to this toxin,
it can affect a lot of different vital organs, the
nervous system, cardiovascular system, and it attacks the liver because
liver basically is a big filter of the blood stream.
(35:30):
I mean a lot of blood goes to the filter
every day. It filters out impurities, it keeps things balanced.
It's a part of our immune system, it's a part
of our blood clotting system. I mean, it's a really
really important organ. So it's getting a lot of blood,
and alcohol tends to target the liver when it's being
(35:53):
consumed again because it's filtering all of those toxic elements
when you drink alcohol, And so for the most part,
it can protect itself. It has a lot of redundancy
built into its systems deliver that is, so it takes
a while for this to happen. So the longer exposure
you have to alcohol, then the more likely you will
at some point develop some liver disease, which we call
(36:17):
liver sorrhosis, which is basically just liver scar tissue, again
brought on by this sort of constant irritation, this constant
inflammation by being exposed to toxins like alcohol. Think of
it as a skin burn, or when you have a
lot of exposure to the skin, you start getting this
blotchy skin that maybe peels, it's flaky, and.
Speaker 2 (36:40):
Again it's just scar tissue. It's inflammation.
Speaker 1 (36:43):
This is how the body reacts to just being constantly
injured and harm. The liver is no different, and so
over time it gets scarred down and depending on the
amount of scarring, it can prevent blood from flowing through it,
and the blood sort of has to reroute itself and
do it knowing that it becomes very very sluggish or
more sluggish then it normally is the normal routine, and
(37:08):
that sort of sluggishness of blood flow would then generate
that swelling in the legs. So these are some other
more common causes of the swelling in your legs and
something that needs to be looked into semi originally.
Speaker 2 (37:21):
If you get it, we'll go on our last break.
Speaker 1 (37:23):
Phone lines or open eight down six kalv I one
one hundred three three zero klv. I'll be back in
two minutes. All right, welcome back to Act Medical. Our
phone lines open. At the end of the show, My
god man, an hour goes by so so rapidly. Here
(37:44):
talking about low extremity swelling and a deema that sometimes
you can get. Very common cause we did talk about
some of the more common.
Speaker 2 (37:54):
Cause of that.
Speaker 1 (37:55):
A couple of others that I wanted to mention are
blood clots, which we call dvd are deep vein thrombosis.
There's a lot of different causes of that. Again, being
sedentary is one of them, and other health care problems
such as liversrrosis, heart failure, gidney failure. You get that
sluggish blood flow on your legs and can generate the
(38:17):
dvt are thrombus in the vein. Cancers can generate clots
as well. So a lot of times when patients come
into my office with lordshim me swelling. I am going
to check for a DVT or a clot in the leg,
because it's extremely common in our community. Again, for all
(38:38):
these medical issues that we see cancer, heart failure, being sedentary,
a lot of being overweight. Again, we see that as
an independent risk factor for the development of swelling. Surgeries
you go in for hip replacement, all bladder surgery, any
sort of surgery where you're laying down, you get exposed
(38:58):
to anesthesia and sort of a prolonged recumbent position. A
few days later, you can sort of get that. So
a lot of times I'd like to do an ultrasound
of the legs of the lower legs to be sure
that there is no particular clot there in the legs.
That's a very serious problem.
Speaker 2 (39:19):
As you know.
Speaker 1 (39:19):
If the clot is not seen and it's not addressed,
it can lead to what we call a pulmonary embolis,
which can be a fatal development because it just basically
clogs the circulation back to the heart and basically the
heart that cannot get blood flow. And if the heart
is not getting blood and it can't work and sort
(39:40):
of the system shuts down. In that situation and a
blood clot in the lower legs, a game, which you
call a DVT can propagate and grow and build to
go to the circulation of the lungs, and it can
get so big that it can prevent blood flow from
getting to your heart, which again in causes sort of
(40:01):
a collapse of the cardiovascal system. So that's pretty serious stuff.
And again it can just start from sitting around too much.
I mean a lot of times we get that from
a long trip.
Speaker 2 (40:13):
You sat in the car for.
Speaker 1 (40:14):
A long time, you took a long plane trip and
you sat too long, you get that swelling your legs
and like, I'm busy, I don't have time for this
moment vacation. The swelling doesn't go away, and then several
days later you start getting short of breath or you
have chest pain.
Speaker 2 (40:30):
That's how that starts.
Speaker 1 (40:31):
We see that sort of situation happen all the time
in the hospital. So bottom line is, if you do
have swelling of your feet and your ankles, your legs,
you should get a thorough evaluation to sort of see
what is causing that, because normally there is something significant
that needs to be looked into, and hopefully it's something
that can be corrected a lot of times with being
(40:52):
set into and being of weight, you get that venus
insufficiency or poor vein circulation. You can correct that with
the compressions stockings which are just about everywhere. You can
purchase those. But the main thing is to get up
and start moving around and get that blood flowing. That
will correct the circulation problems. And thank you for joining
us another edition of the show. Remember don't drink and drive,
(41:14):
eat some vegetables, drink some water. See you guys next week.
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