Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and former television broadcaster Gina Galaviz will share information to improve your health and well-being. And now here are Gina Galaviz and Dr. Rajay Seudath.

GINA GALAVIZ EISENBERG
Welcome to the award winning Docs in a Pod, presented by WellMed. I'm your host, Gina Galaviz Eisenberg. Ron Aaron is on special assignment today. I'm so pleased to have you with us. Our program is available on podcast wherever you get your podcasts. We're also on the radio in several cities in Texas and Florida. Each week, we talk about a variety of health and wellness issues that impact Medicare eligible seniors and others. Our Docs in a Pod co-host is Dr. Rajay Seudath. Hello, Dr. Seudath.

DR. RAJAY SEUDATH
Hello, hello. Glad to be here.

GINA GALAVIZ EISENBERG
Let me just toot your horn. He's a board certified family medicine physician. He's a Tampa native and lead physician for Optum. He's at the University location in Tampa. He earned his medical degree from the University of South Florida Morsani College of Medicine. He has a passion for primary care and guiding his patients to meet their health care goals while maintaining their values. He enjoys educating patients and us and caregivers on a variety of health and wellness topics. Before his career in medicine, he worked many jobs, but an English teacher abroad is what inspired you to become a family medicine doctor. That's great. You're always educating, even then and now.

DR. RAJAY SEUDATH
Absolutely.

GINA GALAVIZ EISENBERG
We have a fascinating topic today, one that truly involves all of us women and men. It's about swelling. Lower extremity edema and lymphedema. Dr. Allyson Larkin is our special guest today. She grew up in Corpus Christi, Texas. She received her B.A. magna cum laude in Zoology from Iowa State University, and she earned her medical degree with honors from Texas A&M University College of Medicine. Gig Ôem! Welcome to the show today, and welcome on the win over the weekend.

DR. ALLYSON LARKIN
Well, thank you. Yes, very pleased to be here.

GINA GALAVIZ EISENBERG
Tell us, how do we know if we are experiencing edema?

DR. ALLYSON LARKIN
Edema is the smart person word for swelling. If you have swelling in your tissues, meaning that they feel puffy and your rings don't fit, or your shoes don't fit, or perhaps you reach down and you push on your lower leg and it pits or it makes a dent. Those are all signs of edema. Of course, edema comes in many varieties. It would be easy if there was one cause for edema, but there's not. There are lots of causes of edema. I think the easy thing is identifying it, and then the harder thing is figuring out what caused it and what to do about it.

GINA GALAVIZ EISENBERG
So, if you're experiencing this, you go to your doctor and you're like, doctor, I'm embarrassed to bring this up, but I feel like I'm swelling. I mean, that's something that we should bring up.

DR. ALLYSON LARKIN
Absolutely. It can be a sign of some bad things. If you notice that you have swelling in your lower legs, and particularly if it extends up above your knees, or if you can feel swelling in your belly. If you say, gosh, my belly seems like it's getting bigger and I'm having a hard time buckling my pants, or I'm having a hard time leaning over, those can be signs of what we call volume overload. Having too much fluid in our body. Having too much fluid in the body, again, there are lots of different causes for it, but those are definitely things that we would want to explore with our doctor. We want the doctor to examine us and possibly do some tests to make sure that our heart is working properly, that it's pumping properly, and that we don't have something called heart failure. The doctor would also maybe want to check out our kidneys and make sure that our kidneys are functioning and that we're able to urinate off, pee off our fluid like we're supposed to. Also, sometimes patients who have liver failure or cirrhosis can hold on to too much fluid or have trouble getting rid of extra fluid, and they can experience swelling as well. I would also say that occasionally patients can have a rapid onset of swelling, meaning all of a sudden. They've never had swelling, and they wake up one day and they're very swollen. Particularly if it's in one leg, that could be a sign of a blood clot or something we call it deep venous thrombosis or DVT. That could be something that would need to be treated right away so that it might not dislodge and go someplace where it could cause bigger problems. Also, if we were having swelling and association with any discomfort in our chest. Chest pain or tightness or trouble breathing, that would make us worried about something going on with our heart, possibly having a heart attack or not enough blood going to our heart. We call this schema, and those are things that we would want to identify because there are things we can do about it to make it better and to prevent any further harm. Having said that, most of the time it's none of those things. Most of the time it's not anything bad or dangerous. We recognize we've got a problem and then we rule out the bad stuff.

DR. RAJAY SEUDATH
Absolutely.

DR. ALLYSON LARKIN
When we've done that, we can feel good about taking things a little bit more slowly.

GINA GALAVIZ EISENBERG
Before you continue, I'm just going to say hello to everyone who's just joining us right now. You're listening to the award winning Docs in a Pod with our co-host, Dr. Rajay Seudath. I'm Gina Galaviz Eisenberg. Our podcast is available wherever you get your podcasts. Dr. Allyson Larkin is our guest today. Dr. Seudath, what were you saying?

DR. ALLYSON LARKIN
Sometimes, it can be insidious, and it happens over a long period of time. We were just talking about when I wake up and I've got all the swelling, but sometimes it can be a little insidious. It starts to happen a couple of days out of the week, and then it's a little more. Someone can say, whenever I take my socks off, I've got this ring around the bottom of my ankle, and it's just kind of a step off. What is that? Yeah, that's swelling. Let's talk about what could be causing your swelling. Let's do some bloodwork. Let's see your kidney function. Let's see your liver function. Tell me what kind of exercise you are doing. Oh, I don't do any exercise. Tell me what kind of things do you eat? Fast food. Okay, so those are some things that could be contributing to your swelling. We do some testing and, like Dr. Larkin said, we get rid of or we rule out all of the dangerous stuff. Then sometimes we're left over with things like what's called venous insufficiency. It's not something dangerous it's just the veins in my legs are not bringing back blood flow as well as it should. And that could be for a number of reasons, but oftentimes it's due to lack of exercise. That blood is pooling down there and it's stretching those veins apart so they don't work well. So, that's why exercise is good for everything. Immunity, for your vascular health, for your mental health. Exercise is always important.

GINA GALAVIZ EISENBERG
So, if someone's not feeling good because they're starting to swell, but they say, doctor, I can't do this, what can they do?

DR. ALLYSON LARKIN
What I would definitely say is that one of the more common causes of swelling is, as Dr. Seudath said, venous insufficiency. What that means is that your veins are a little bit leaky, and that can happen with age. Just like everything else with age. We have these our veins are these amazingly designed little tubes, and they normally will bring blood from our extremities back to our heart. So, arteries bring blood from our heart to our extremities, and veins bring that blood back from our extremities to our heart. We're designed that our veins have little valves inside of them that prevent backflow. Then when we exercise, like Dr. Seudath was saying, our calf muscles in particularly, will push the blood up towards the heart and then those veins close after that and they prevent backflow. In an ideal world, we do lots of walking and calf muscle pumping because that helps our veins to push the blood upstream and then the valves prevent backflow. There are things that can cause those veins to become leaky or we call it incompetent, and that can allow backflow of the blood, which is called venous hypertension. It causes those veins then to bulge, and they can even leak. Blood can leak out of those veins. People will experience that as seeing some swelling in their lower legs. A lot of times it'll start in the ankles first, but it can start sort of going upstream. Sometimes it can cause things like discoloration of the tissue, some brownish discoloration of the tissue, or some reddish discoloration of the tissue. It can sometimes cause itching. It can sometimes cause scaling and dry skin. In its worst stages, it could be associated with having wounds that are difficult to heal or scarring and fibrosis in the tissues and in the lymphatic vessels, which are these kind of tiny scavenger vessels that bring fluid out of our tissues and cause something called lymphedema.

GINA GALAVIZ EISENBERG
As we get older, what do you think about compression socks? Is that something we should invest in and just start wearing now before we start getting to this point?

DR. ALLYSON LARKIN
A lot of people will wear what we call support socks. They're very light compression socks. If they're noticing they're having any of what we call venous insufficiency, any of those symptoms we were talking about. As the disease gets worse, you're going to need tighter compression. They come in socks, they come in Velcro, they come in wraps that you actually wrap around.

DR. RAJAY SEUDATH
Zippers.

DR. ALLYSON LARKIN
Yep. There are even pumps that will give you compression. But all these things, what they're doing is they are applying pressure on the outside of your leg, sort of pushing it in. What it does is it pushes those incompetent leaky valves together so they leak less. So, that's what's happening. So, wearing compression garments can be a great idea because we know that if you have leaky veins and you don't deal with them, they get more leaky and you get more problems. It's sort of this sort of vicious cycle. Not everybody is going to need to wear compression. There are 99-year-olds that their valves and their veins have just done great all their lives, and honestly, they don't need anything. The large majority of older people need them. People my own age, post-menopausal, people that have had children, if you've ever had a significant injury, people that have had surgeries, especially knee replacement surgeries. A lot of people, in fact, I would say most people would benefit from some light compression to prevent worsening.

DR. RAJAY SEUDATH
I wanted to touch on the compression socks, the support socks, not just to stop the swelling, as Dr. Larkin had mentioned, it can cause fibrosis. It can cause your skin to harden. So, I almost like to think of support socks as a second skin.

DR. ALLYSON LARKIN
I love that.

DR. RAJAY SEUDATH
You're supporting your skin because your skin, when it's swollen over a long period of time, is like a balloon. What your skin in your body tries to do is it tries to contain that swelling. So, it starts to harden your skin like wood. But if the swelling continues, that wood cannot contain that pressure and it starts to split instead of stretch, and that's where those wounds come from. Sometimes I tell patients, look, these compression socks are going to help with the swelling, but if they're too tight, get any kind of stockings support hose, just to act as a second skin so that even if the swelling isn't going away, you're protecting your skin from taking that next step of going from swelling to wounds.

GINA GALAVIZ EISENBERG
Some of these garments make you look like soccer players.

DR. ALLYSON LARKIN
I was going to say tall socks are really popular right now, so thatÕs great.

GINA GALAVIZ EISENBERG
They really are, so you could be cool. We're going to continue our discussion in just a moment. I'm Gina Galaviz Eisenberg along with Dr. Rajay Seudath. We'll be right back.

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GINA GALAVIZ EISENBERG
Thanks so much for staying with us on the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. I'm Gina Galviz Eisenberg, and we are back talking about swelling. Before the break, we were talking about cool support garments and socks. We took a quick poll and at least two of us on this podcast right now have some very fun-looking, support socks.

DR. ALLYSON LARKIN
That's right. They're a statement. They're good for your health, and they're also a fashion statement. You can't get any better than that.

DR. RAJAY SEUDATH
One of the things that I often hear from patients is, doctor, these are just so hard to get on. I really can't put these things on. They are too tight. So, they have some apparatuses that you can put them on, and you can slide your foot through. But if the compression socks are too hard to get on, I feel that just regular, thick, high-quality over the knee socks can actually do a fairly good job at preventing worsening of the swelling. If you're a large person, a compression sock is not going to go on it. But there are places online like Amazon. You can get plus size over-the-knee socks. All the advertisements and all of the models are going to they're going to be in skimpy clad clothes. It's always a boudoir kind of thing. But, I have little 80-year-old women who are walking around with thigh high socks and they are perfectly clothed.

GINA GALAVIZ EISENBERG
Is there a Donnor that you can purchase that helps you put your socks on? Not to TMI on Ron, but he uses that thing every morning.

DR. RAJAY SEUDATH
Absolutely.

DR. ALLYSON LARKIN
IÕm going to jump in. People want to do the right thing, and sometimes they struggle. So, I'm going to say a couple things, which is that something is better than nothing. I'm a wound doctor and I would like to get you in the tight ones, but something is better than nothing. I will say that it is important if you have a tendency to swell that you don't want to leave your foot uncovered. What can happen if you just put the compression on your mid-calf, because sometimes you see the athletes sell those calf sleeves and they are easier to get on. I would encourage people to know that that's probably not a good choice if you're using it for swelling. The reason is because you can trap swelling in your foot, and it can cause what we like to refer to it as a blowout. It can cause your foot to swell, and then you'll start to leak between your toes. I'm going to tell you that you don't want to do that. So, something is better than nothing. We also want to make sure that we're compressing from our foot upwards. A lot of people only need compression to the level of the knee. I would say most people only need compression to the level of the knee. If you're wearing compression or socks to the level of your knee but then you notice that your knee balloons up, or we call it the muffin top, you start to swell over the top of it. If youÕve got a muffin top then that means you really do need higher compression, and you can do that by using thigh high hose or a higher hose. We also have lots of people that they mix and match their compression. So, even people that have what we call lymphedema, which is a little bit of a different thing, but it still requires compression, so I think we can talk about treatment in the same and in the same breath. We send them to these compression places where you can get compression shorts, you can get compression capris, you can get compression ankle garments. Again, we're so lucky because they're popular now. Spanx has them. Again, you can get them really tight or you can get them just a little bit tighter.

GINA GALAVIZ EISENBERG
Our 12-year-old wears compression things to playing basketball.

DR. ALLYSON LARKIN
Something's better than nothing. There are a lot of options out there, so if you try one option and it doesn't work for you, I don't want you to think like, oh, I can't wear compression. I just can't do it. The other thing is there are things other than just hose. There are hoses that you pull on that are just like a sock. There are some that come with zippers, which sounds easy but I actually find that to be kind of hard.

GINA GALAVIZ EISENBERG
They're hard.

DR. ALLYSON LARKIN
I love Velcro. Velcro is my friend. Velcro is the best, and the reason I like Velcro is because a lot of times you can just pull on a loose liner, and then you can do a Velcro piece on your foot. You could do a Velcro piece on your hand. And you know what? I'm getting older and I have hand arthritis, and I'm telling you, I never realized, but it's hard to get on. That's easy for me, I can pull it together. For some of our patients that have heart disease or kidney disease or liver disease, you may have what we call fluctuate swelling, meaning some days they're going to be a lot more swollen than other days, Velcro or adjustable garments can be a good choice as well. Then the next thing is that you should look at Donning devices. There are so many things on the market. There are these little plastic things on a string that you load the sock onto it on your lap, and then you just put it on the ground and you pull it on and you can get that sock all the way up just below your knee, and it just slides right off. They are frames that you can use. There are little donuts that you can use. There are so many different Donning devices out there to use. Now, of course, when there's a million products for something, it means that no one is going to work for everybody. But you can get on YouTube and you can put how do I get my compression garment on? And you're going to see so many videos and so many really great ideas. I also tell people, if you have a problem with swelling, a lot of times your doctor has told you how important it is to put lotion on your skin, like a really a greasy, hypoallergenic lotion. But a lot of times we'll say, do that at night. Don't do it right before you try to put your socks on because that's going to make it a little harder. I tell people that it's harder to put your garments on when you're sitting on your bed. Getting in a straight-back chair that your feet are sitting firmly on the ground can be helpful. Also, they have plastic gloves that will help. So anyway, all this to say, compression truly is probably once you've treated all the medical conditions that can be treated, is one of the cornerstones of treatment of swelling. So, don't give up. I think sometimes people give up just a little too soon. If you're struggling, go back to your provider and ask them to help you to find the right compression option for you.

GINA GALAVIZ EISENBERG
How do you get rid of the swelling in the in the liquid. Of course, medication, but what about massage and therapy. How do you get your legs back to normal, if you will, in quotation?

DR. ALLYSON LARKIN
We've got actually three kinds of vessels in our body. We've got those arteries that we talked about that take the blood that's got the oxygen and the nutrients out to our limbs and all our body. Then we've got the veins that bring that blood back that's been used up, and it's going to dump it back into the heart in the lungs, where it can be re nourished. Then we've got vessels called lymphatics, and these lymphatics are these tiny capillary like vessels. I always think if you ever seen a plant that you've planted that gets all these little tiny roots and they're all underneath the top of your skin, and their job is to actually scavenge back and drain the fluid that has leaked out of the veins. The fluid that's leaked into the tissue goes back into the lymphatics. Then the lymphatics, they actually kind of run similar to where the veins run, and eventually they will dump the fluid back into the veins. What helps the lymphatics to work better and to scavenge that fluid out of our tissues? Light compression. Also, whatÕs called a lymphatic massage, which is a very light, gentle massage. Lymphedema therapists are trained specifically in how to sort of push that fluid into the lymphatic system. Again, you can get on YouTube and you can Google, how can I push fluid out of my leg? A lot of people can do what we call self-lymphatic massage. We treat we teach our patients how to do that. The other thing is we have lymph nodes behind a lot of our joints, and those are just little areas that the lymphatic vessels travel through. If we squeeze those lymph nodes, that helps to push the fluid upstream as well. So, that's part of that whole exercise. Another thing that I tell people when they're swollen, in addition to walking and exercise, is to pump the ankles. That pushes the fluid into the lymphatics into those little lymph nodes that are at the ankle and to pump the knees because that also pushes fluid into those lymph nodes and into the lymph system. Then to pump the hips to do internal and external, just like rotating those hips. All those things also help to push that lymph fluid upstream.

DR. RAJAY SEUDATH
One of the things I wanted to touch on was when we talk about swelling, it's the compression, the mechanical factor of it, but there's also the food factor. If you are eating a lot of sodium, that's going to make you swell. Sodium is going to make your body retain that. There's really only three ways to get rid of salt. You can eat less, you can take a pill to pee it out or you can sweat it out. Those are really the only three ways that in general we get them out. So, you want to make sure that you're taking water pills if you have them. Make sure you're using them correctly. Make sure that you are talking with your provider about ways to safely cut back on salt, ways to safely get them out of your system, and doing exercise and sweating to help get that out in a different way. That's one of the other ways that we can actually help to decrease swelling before it gets down to the legs.

DR. ALLYSON LARKIN
I love that.

GINA GALAVIZ EISENBERG
All right, we were out of time. Can you believe it?

DR. ALLYSON LARKIN
Are we out? I'm ready for another two hours.

I know. Swelling is swell. Thank you everyone for joining us today on the award winning Docs in a Pod. I'm Gina Galaviz Eisenberg along with Dr. Rajay Seudath. Thanks to our special guest, Dr. Allyson Larkin. In the words of the late Charles Osgood, I'll see you on the radio.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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