Lower Your Salt Intake to Bring Down Swelling

Published by Contra Costa Times Posted on Sun, Jul. 11, 2004 By Dr. Stephen Daniels MS. NIX'S FEET are so swollen she can't fit in her shoes. I suggested that the salt in her diet might be contributing to her swelling (edema), but she doesn't think they are related. "Oh, doctor, I don't eat salt anymore. I haven't used a salt shaker in years. And my ankles are still swollen." Swelling usually comes from a combination of things that can include poor heart function, being overweight, weak leg veins, prolonged sitting, liver or kidney disease, certain medicines and salty food. "Let's talk about your diet. What did you have for dinner last night?" "Well, for dinner I had some greens and some delicious ham my sister sent from Virginia. My neighbor brought over biscuits and gravy. But I didn't add salt to any of it." Ms. Nix doesn't realize that much of the food she eats already has salt in it. Certainly the ham and probably the biscuits and gravy have enough salt to cause her swelling. We discuss some ways to reduce her ankle swelling, so she doesn't have to take more medicine:

REDUCE SALT INTAKE: If food tastes strong, it's probably too salty (for someone with swollen legs). At first, a low-salt diet is pretty bland to most people. After a while, though, it usually tastes fine, and most "normal" food, especially from restaurants or fast-food outlets, will taste too salty. WALK, ELEVATE YOUR FEET: In general, lying down with your feet elevated and walking are both good, while sitting and standing are bad. Lying down with your feet above the level of your heart will help drain excess fluid from your ankles and feet. Walking is good for your general health and uses your leg muscles, which helps pump excess fluid out of your legs.

Sitting and standing worsens ankle swelling. Sitting with your legs elevated on an ottoman doesn't help because it tends to kink your hip veins and doesn't elevate your legs enough. Of course you have to sit and stand sometimes, but do each as little as possible if you suffer swollen joints.

WEAR SUPPORT STOCKINGS: Thick, tight support stockings from your toes to your knees or thighs can help reduce swelling. These may require a prescription or instructions from your doctor. CONSULT YOUR DOCTOR: Your doctor will probably order diagnostic tests to determine the cause of the swelling and may prescribe diuretics (often called "water pills").

Swelling and pain in one leg can be caused by a blood clot, so talk to your doctor right away if you see an imbalance in the swelling. After Ms. Nix agrees to see a dietitian to talk about her diet, her swelling and shortness of breath improve for a while. But it is difficult for her to avoid salt because it appears in excess in everything she likes: soup, mayonnaise, French fries, salsa, ketchup, pickles, lunch meats, tuna, chips, salad dressing and Chinese food. She doesn't want to give up the foods she enjoys, so we discuss her options. On a combination of medications plus a reduced-salt diet and leg elevation, she improves. She has an especially difficult time during holidays. Ankle swelling can be a hard problem to fix, but reducing salt intake usually helps. Dr. Daniels practices family medicine at the Pittsburg Health Center. Healthy Outlook is a bi-weekly column written by the professional staff of Contra Costa Health Services, the county health department. Send comments and questions to Dr. Daniels, who coordinates the series, at sdanielsmd@aol.com.

Overview
You may experience ankle swelling at various points of your life, including after an injury, during pregnancy or after walking in hot weather. Sometimes eating too much salt can cause ankle swelling. Most of the time, swelling affects both feet or both ankles equally, but some health conditions can cause swelling in just your right or left ankle. Any unexplained swelling should be evaluated by your doctor.

Sodium and Edema

Having too much sodium in your diet can cause edema or swelling. This swelling can be in your legs and ankles, but usually it is not in only one ankle. You may also retain water in your abdomen, hands or face. If you are retaining water due to eating too much salt, ask your doctor about ways to reduce your sodium intake. You may see improvement if you follow the DASH diet, which stands for Dietary Approaches to Stop Hypertension.

DASH Diet
The DASH diet can help keep your daily sodium consumption under 2,300 mg. If you have hypertension or other risk factors, your doctor may prefer that you keep your sodium intake under 1,500 mg daily. Do this by eating fresh fruits and vegetables, low-fat dairy products, whole grains

and lean sources of protein. Cook without added salt whenever possible. Use herbs for flavoring instead of salt. Avoid processed foods, which often contain large amounts of salt. Talk to your doctor before beginning any new diet plan

Overview
The foods that you eat have an impact on the chemicals in your body, especially your blood. Sometimes, if the amount of sodium in your blood becomes imbalanced, it can lead to swelling of parts of your body, particularly your feet. Excessive salt consumption can contribute to this problem, which may be relieved by cutting back on how much salt you consume in your diet.

Edema
If your feet begin to swell, you may be suffering from a condition known as edema. Edema is caused by fluid getting trapped in the space between cells, also known as the extracellular space. This is most common in the extremities, particularly the ankles and feet, because gravity naturally pulls liquid down to these areas. Edema can cause the affected tracts of skin to look shiny and stretched, and pushing gently on the affected areas for 15 seconds can cause a visible dimple.

Salt Intake and Edema

Eating too much salt can result in mild cases of edema. When you eat too much salt, the amount of sodium in your body rises. Because abnormally high sodium concentrations can be dangerous, your body will hold onto more water in an attempt to dilute this excess sodium. The increased liquid volume causes small blood vessels, known as capillaries, to leak some of the excess fluid into the space between your cells, causing edema.

Complications
Although swollen feet may not seem like a serious medical problem, edema can cause a number of different complications. For one thing, the swelling can become painful and result in the joints in the feet becoming stiff, making it difficult to walk. The swollen parts of the body are also at risk of developing infection. Prolonged edema can also result in scarring and a loss of elasticity in the blood vessels, muscles and joints. Edema can also cause ulcers to form and poor circulation.

Treatment
If you have a high daily sodium intake and develop swelling in your feet, your doctor may tell you to decrease your salt consumption. You may also benefit from wearing special socks and hosiery known as support stockings and by elevating your legs when possible to help the fluid drain out of the extracellular space. Diuretics may also be prescribed to help you eliminate some of the excess fluid in your body, though they may not be appropriate for pregnant women.

Swollen Leg & Swelling of the Feet, Ankle & Toes

Swelling of the leg may involve a noticeable distension of the shin or calf, ankles, feet or toes. Foot swelling may be a common occurrence which most of us will experience at some point in life after a long day of standing or sitting but may also be an indication of a more serious pathology as in certain cardiovascular disorders. Recurrent or persistent swelling of the feet should be investigated by a medical practitioner especially if you have a history of cardiovascular disease or have noticed a change in color, sensation or mobility of the leg, foot or toe. Blood rich in oxygen and nutrients flow through the arteries to the target area. Blood carrying deoxygenated blood returns to the heart via the veins where it is quickly routed to the lungs to be replenished with oxygen. Blood flowing to the leg has to return to the heart through a group of veins with intermittent valves located throughout the course of the vein. This venous blood (blood in the veins that is returning to the heart) has to flow against gravity and since the pressure is usually lower at the feet, other muscles of the leg assist with pumping this blood back to the heart. This muscle pump is most active when we are walking and least when we are standing stationary or sitting. Blood travels short distances up the vein and back flow of blood is prevented by a series of valves in these veins. Working alongside the blood vessels are the lymphatic vessels which returns lymphatic fluid (lymph) back up the body to empty into the blood system. Swelling of the leg usually occurs as a result of inadequate flow of blood or lymphatic fluid back up to the torso of the body. However other localized causes may further contribute to swollen feet, ankles or toes.

Causes of a Lower Limb Swelling

1. Inflammation

Injury Allergies Insect bites Exertion Phlebitis Lymphedema Bakers Cyst

2. Infection

Cellulitis Venous ulcers Diabetic ulcers Athletes foot severe cases of tinea pedis followed by secondary bacterial infection may cause swelling of the feet.

3. Obstructed or Impaired Blood Flow

Varicose veins Peripheral vascular disease Thrombophlebitis Deep vein thrombosis (DVT)

4. Systemic & Miscellaneous Causes

Generalized Edema (edema throughout the body) or Idiopathic Edema (edema due to unknown cause) Congestive cardiac failure Kidney failure Liver failure or cirrhosis of the liver Rheumatoid Arthritis Gout (swelling of the toes) Pregnancy refer to Pregnancy Leg Swelling Immobility Prolonged standing or sitting

Symptoms
Swelling of the lower extremity may be clearly visible or detected as pitting edema and may be accompanied with other symptoms (concomitant).

Distortion of the anatomy of the leg, foot, ankle or toe. Pain (claudication is pain of the calf muscle upon strain or intermittent) Numbness or tingling. Pale, red, blue to purple or black discoloration. Itching with or without a rash. Excessive warmth or cold and clammy skin. Impaired mobility either due to loss of muscle control or weakness.

Diagnosis :
Swelling of the leg, foot, ankle or toes may be clearly visible and if one sided (unilateral), it should be compared to the other limb to verify the swelling. In cases of pitting edema, pressure with a finger on the swollen area will leave a finger imprint for a few seconds to

a few minutes after the finger pressure is discontinued. There are two pedal (foot) pulses that are palpable, the dorsalis pedis pulse can be felt on the top of the foot or the tibialis pedis pulse which can be felt on the inner ankle. Feint or absent pulses may assist with identifying any factors reducing or obstructing blood flow. A swollen leg may be indicative of other pathologies and further investigation may be required.

Treatment :
Treatment is dependent on the cause of the swollen legs, feet, ankle or feet.

Diuretics may be useful for water retention (edema) especially in generalized edema as it increases the passing out of fluid. It is not advisable for women who are pregnant or recently given birth to use diuretics unless advised by their medical practitioner. Antibiotics may be required for infections. Antimicrobial creams, gels or sprays may be useful for treating venous or diabetic ulcers. Anti-clotting or anti-coagulating agents like warfarin may be useful for thrombophlebitis and deep venous thrombosis (DVT). Anti-inflammatory drugs may assist with pain and inflammation or rheumatoid arthritis. Corticosteroids may be useful for allergic or autoimmune causes of a swollen leg, foot, ankle or toe. Anti-gout drugs are necessary for long term management of gout which can cause a painful swelling of the toe, especially the big toe.

Management :
Management should be directed at the causative factors and it is advisable that you seek advice from your medical practitioner before you attempt to manage your swollen legs conservatively.

Walking or moving your legs, feet or toes may assist with swelling when standing stationary or sitting for long periods. This is especially important for frequent flyers and those prone to deep venous thrombosis as the long flights and restricted space can aggravate DVT and swelling of the legs. Varicose vein sufferers may benefit from the usage of compression stockings. However it is usually not advisable to use compression stockings if you suffer with peripheral vascular disease as this may aggravate or complicate your condition. Consult with your medical practitioner before using compressions stockings for your swollen legs. Raising your legs to body level when sitting can assist with swelling but be cautious about elevating the legs significantly higher than the torso when sleeping. This is not advisable in certain conditions affecting the heart, liver or kidney. Medical advice should be sought.

Reducing your salt and electrolyte intake (low sodium diet) may be advisable in certain conditions (like kidney failure) although this diet may not directly reduce leg swelling.

Treatment Options: Treatment may involve using compression bandages and pressure sleeves tightened over swollen limbs to help force the body to reabsorb the fluid. Other options include a salt reduction diet, daily exercise, resting with legs elevated above the heart level, wearing support hose, taking a diuretic, and massage.

Drug Therapies

Medication for your underlying disorder -- talk to your health care provider. Diuretics -- for example, loop diuretics or potassium sparing diuretics. These medicines reduce body fluid levels, but they also deplete important vitamins and minerals, which can result in loss of bone mass. Diuretics may have several other possibly serious side effects.

Surgical Procedures
Surgery may be needed to remove fat and fluid deposits associated with a type of edema called lipedema, or to repair damaged veins or lymphatic glands to reestablish lymph and blood flow.

Complementary and Alternative Therapies

The following nutritional and herbal support guidelines may help relieve edema, but the underlying cause must be addressed.

Nutrition and Supplements Following these nutritional tips may help reduce symptoms:

Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies. Reduce salt intake. Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.

Natural diuretic vegetables include asparagus, parsley, beets, grapes, green beans, leafy greens, pineapple, pumpkin, onion, leeks, and garlic. Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). Avoid refined foods, such as white breads, pastas, and sugar. Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy), or beans for protein. Use healthy cooking oils, such as olive oil or vegetable oil. Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine. Avoid alcohol, and tobacco. Exercise lightly, if possible, 5 days a week.

You may address nutritional deficiencies with the following supplements:

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium. Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tbs. of oil daily, to help decrease inflammation and help with immunity. Vitamin C, 500 - 1,000 mg daily, as an antioxidant. Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support. If you use diuretics, your doctor may have you supplement with potassium aspartate (20 mg per day), since diuretics flush out potassium from the body and cause a deficiency. Do not take extra potassium without informing your doctor. Some diuretics do the opposite and cause potassium to accumulate in the body. Magnesium, 400 - 600 mg daily, for nutrient support.

Herbs Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to determine the best and safest herbal therapies for your case before starting any treatment. If you are pregnant or nursing, do not use herbs except under the supervision of a physician knowledgeable in herbal therapies. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise

indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 4 cups per day. You may use tinctures alone or in combination as noted.

Bilberry (Vaccinium myrtillus) standardized extract, 80 - 100 mg 3 times per day for antioxidant support. Do not use Bilberry if you are on blood thinning medications. Dandelion (Taraxacum officinale ), 4 - 10 g of dried leaf steeped in one cup hot water. Strain and cool. However, Dandelion leaf is itself a diuretic so it should not be used while taking diuretic medications. Speak with your doctor. Do not use andelion if you have gall bladder disease, take blood thinning medications, or have allergies to many plants. Grape seed extract (Vitis vinifera), standardized extract, 360 mg 2 times daily, for antioxidant support. Evidence suggests that using grape seed extract may improve chronic venous insufficiency, which causes swelling when blood pools in the legs.

Physical Medicine

Dry skin brushing. Before bathing, briskly brush the entire skin surface with a rough washcloth, loofa, or soft brush. Begin at your feet and work up. Always stroke in the direction of your heart. Cold compresses made with yarrow tea. Contrast hydrotherapy involves alternating hot and cold applications. Alternate 3 minutes hot with 1 minute cold. Repeat 3 times to complete one set. Do 2 - 3 sets per day. Put a pillow under your legs when you're lying down. Wear support stockings, which you can buy at most drugstores.

Acupuncture Acupuncture may improve fluid balance. Massage Therapeutic massage can help lymph nodes drain. Special Considerations: Excessive fluid retention during pregnancy (toxemia) is potentially dangerous to both you and your baby.

Alternative Names: Water retention

Reviewed last on: 3/9/2010 Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

Hypertension
Hypertension Description is a persistent or intermittent elevation of systolic arterial blood pressure above 140 mm Hg or diastolic pressure above 90 mm Hg. Hypertension is a chronic disease, primary goals in Hypertension Nursing Care Plan is to reduce the blood pressure to less than 140/90. Hypertension classified:

Primary (essential) accounts for over 90% of cases and is often referred to as idiopathic, since the underlying cause is not known. Secondary hypertension results from a number of conditions that impair blood pressure regulation, and accounts for only 5% to 8% of all cases of hypertension. Malignant hypertension, results from either type and can cause blood pressures as high as 240/150 mm Hg Cause of Hypertension:

Cause of primary Hypertension is not known. However, associated with risk factors such as genetic predisposition, stress, obesity, and a high-sodium diet. Secondary Hypertension results from disorders that impair blood pressure regulation, particularly renal, endocrine, vascular, and neurological disorders, hypertensive disease of pregnancy (toxemia) and use of estrogen-containing oral contraceptive Malignant Hypertension is also not known, but it may be associated with dilation of cerebral arteries and generalized arteriolar fibrinoid necrosis, which increases intracerebral blood flow. Ethnic/Racial African Americans and elderly people are most prone to hypertension and its complications. Physical Examination Nursing Care Plan for Hypertension

Appear symptom-free in early stages, although flushing of the face may be present Fundoscopic examination of the retina may reveal hemorrhage

Measure blood pressure in both arms three times 3 to 5 minutes apart. patient is at rest in the sitting, standing, and lying positions. Hypertension should not be diagnosed on the basis of one reading unless it is greater than 210/120 mm Hg.

Diagnostic

Highlights

Nursing

Care

Plan

for

Hypertension

Blood urea nitrogen Serum creatinine Total cholesterol Triglycerides Electrocardiogram

Nursing

diagnosis

Nursing

Care

Plan

for

Hypertension

Because Hypertension is chronic disease and a major cause of stroke, cardiac disease, and renal failure, Hypertension nursing diagnosis on nursing care plan for Hypertension many associated with the Knowledge deficit about Diet, Disease process, Health behaviors, Medication, prescribed activity, Treatment regime and lifestyle Primary Hypertension nursing diagnosis is knowledge deficit related to chronic disease management, Possible nursing diagnosis which is commonly found in nursing care plan for Hypertension

Fatigue Ineffective coping Ineffective tissue perfusion: Cardiopulmonary Noncompliance: Therapeutic regimen Risk for injury

Nursing

outcomes

Nursing

Care

Plan

for

Hypertension,

Patients

will:

Identify appropriate food choices. Express that he has more energy. Demonstrate adaptive coping behaviors. Maintain adequate cardiac output and hemodynamic stability.

Comply with his therapy regimen. Remain free from complications

Patient Teaching and Home Healthcare Guide, Nursing Care Plan for Hypertension

Teach the patient to use a self-monitoring blood pressure cuff and to record the reading at least twice a week. Tell the patient to take his blood pressure at the same hour each time, with out more than usually activity preceding the measurement. Tell the patient and family to keep a record of drugs used in the past. To encourage compliance with antihypertensive therapy, suggest establishing a daily routine for taking medication. Warn the patient that uncontrolled hypertension may cause stroke and heart attack. Tell him to report any adverse reactions to prescribed drugs. Advise him to avoid high-sodium antacids and over-the-counter cold and sinus medications containing harmful vasoconstrictors.

Help the patient examine and modify his lifestyle behavior. Suggest stress-reduction groups, dietary changes, and an exercise program. Encourage a change in dietary habits. Help the obese patient plan a reducing diet. Tell to the patients to avoid high-sodium foods, table salt, and foods high in cholesterol and saturated fat.