Why couldn’t this woman go to church?

Several years ago I landed at Nairobi airport in Kenya after many hours in the air. It was an uneventful flight, but one elderly traveller had encountered an embarrassing problem. On arrival, she could not put on her shoes due to swelling (edema) of her feet. So why do legs and feet swell in flight, and when is it dangerous? Also what prevented one woman from going to church?

Nearly everyone encounters swollen legs and feet following a long car or plane trip. It’s also more likely to occur on a hot day and to surgeons when standing for prolonged surgical procedures.

Normally edema is prevented because our bodies maintain a delicate balancing act between the pressure inside and outside of the veins. Large proteins in the blood exert osmotic pressure to prevent leakage from veins. Edema occurs when too much fluid leaves veins and enters body tissues.

The most common cause for increased hydrostatic pressure are varicose veins. Healthy veins have one-way valves that keep pressure under control in each part of the leg. But multiple pregnancies and aging cause valves to break down. When this happens the entire weight of the blood increases pressure in the veins, causing edema.

Couch potatoes are prime candidates for edema. Walking results in contraction of muscles which acts as a pumping mechanism for blood flow. Immobile people, on the other hand, lack this physical support, resulting in pooling of blood and edema.

Another factor is diet. The body contains a constant concentration of salt in its tissues. But if you consume more salt-rich foods than you need, your body dilutes it by retaining fluids and making you thirstier. Swelling results.

Commonly used drugs such as steroids, blood pressure medication, antibiotics, hormone replacement therapy and nonsteroidal anti-inflammatory medication can affect the flow of fluid from veins. And any woman reading this column knows that menstruation and pregnancy often cause edema.

But edema can also be associated with serious medical problems that require prompt attention. Long plane flights can trigger the formation of a blood clot in the leg. This often causes pain and swelling of the lower leg. Every month at London’s Heathrow airport someone suddenly collapses from a pulmonary embolism (blood clot). When the clot travels to the lungs it can cause death.

Getting older has always been dangerous. We all see what is happening to us when our hair turns gray and skin wrinkles. But there are also many invisible changes which sooner or later kill us. For instance, the heart beats 42 million times a year and eventually starts to fail. Kidneys also get worn out after years of work. And whenever one or both of these organs fail, blood pressure is affected and legs become swollen.

But what prevented one religious woman from attending church? Early in my surgical career a 45-year-old woman was referred to me. She had major swelling of both legs which had been present for several months. In addition, she had also noticed a slow, but steady swelling of her abdomen for several years. But in spite of these problems her only complaint was that she could no longer attend church services. She could not squeeze between the pews!

On examination her abdomen was the size of a full term twin pregnancy. But she was not pregnant. Rather, studies revealed she had an enormous ovarian cyst which on removal weighed 33 pounds. Fortunately it was benign.

This massive cyst was gradually obstructing the normal flow of blood from her legs. Once the cyst was removed, edema disappeared. Similarly, cancers that occur in the pelvic area can obstruct the normal flow of blood and cause swelling of legs.

Fortunately, we do not see edema due to the protein-starved diet in the third world, the emaciated child with a distended pot belly. We have much to be thankful for living in this country.

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