DEAR DR. DONOHUE: I have a problem with my feet swelling. They get so big that they hurt when I walk. My doctor is puzzled. He thinks maybe it’s due to my heart pills, but he can’t change them — my heart doctor has to. I have had two heart attacks, bypass surgery and a defibrillator put in my chest. When I’m in bed, the swelling goes down to almost normal. When I am up, it returns, even if I am sitting. I’d appreciate any suggestions. — E.L.
ANSWER: I believe I’m safe in saying your problem is chronic congestive heart failure. Your heart is pumping so weakly that blood circulates sluggishly. When you’re up or when you’re sitting, gravity pulls fluid out of your leg’s vessels, and it is the cause of your swelling. In the horizontal position in bed, gravity doesn’t have this effect, and the fluid stays in blood vessels. The swelling is called edema (e-DEE-muh).
During the day, take frequent breaks to lie down with your legs propped up higher than your heart. When you sit, rest your legs on the seat of a chair put in front of you. Walk as much as you can during the day. The contracting leg muscles push fluid back into circulation.
Limit the salt you eat; salt makes the body retain fluid. Read food labels. Most of our salt intake comes from the foods we eat, not from adding salt at the table or in cooking. But don’t do either. Your total daily salt intake should be less than 5,700 mg, preferably 3,800 mg. If salt is on the label as “sodium,” your total daily intake should be 2,300 mg or less. A better goal is 1,500 mg.
Tell your heart doctor about your swelling. He might make changes in your medicines either by increasing the dose or switching to other medicines that make the heart pump with more force.
There are other causes of edema, but this is the one that seems to fit you best.
The booklet on edema explains its causes and treatments. Readers can order a copy by writing: Dr. Donohue — No. 106W, Box 536475, Orlando, FL 32853- 6475. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: Several bouts of stomach pain brought me to the doctor. The pain is located in my upper right side. The doctor was certain I was having gallbladder attacks due to stones. She sent me for an ultrasound test of my gallbladder.
I don’t have stones. I have something called a liver hemangioma. My doctor says I don’t need any treatment. I never heard of this and wonder what your thoughts are. — P.K.
ANSWER: A hemangioma is a small, ball-shaped mass of blood vessels. If 100 people had a liver scan, seven would be found to have a hemangioma. Women develop them more often than men do. They do not become cancers. They’re rarely a source of constant pain, unless they grow quite large and press on adjacent tissue. They don’t cause attacks of pain. Have you found out what causes your pain?
Readers may write Dr. Donohue or request an order form of available health newsletters at P. O. Box 536475, Orlando, FL 32853- 6475. ©2011 North America Synd. produce enough acid in the stomach to extract the B12 in food,” Schardt explained.
— Pregnant women, who may need extra iron.
— Breastfed infants and possibly other infants concerning vitamin D.
Vitamin D is a nutrient many of us may need to supplement. Last fall, the Institute of Medicine, a panel of scientists who advise the government, raised the recommended amount but also warned against overdoing it. People ages 1 to 70 should get 600 international units a day, older folks 800 units.
If you do need a supplement, beware: Quality varies. Consumerlab.com, a company that tests supplements and publishes ratings for subscribers, has found a high rate of problems in the 3,000 products it has tested since 1999.
“One out of 4 either doesn’t contain what it claims or has some other problems such as contamination or the pills won’t break apart properly,” said company president Dr. Tod Cooperman.
For example, one gummy bear calcium product had 250 percent of the amount of vitamin D claimed on the label. Another liquid product made with rose hips had just over half the amount of vitamin C listed.
“You don’t have to pay a lot. Price is not necessarily linked to quality,” he said. “The quality doesn’t really relate to where you’re buying it. I know many people are surprised by that or don’t want to believe it, but that is the case. We find good and bad products in every venue.”
Mark Blumenthal, executive director of the American Botanical Council, suggests looking for “seals of approval” or certifications of quality from groups that spottest supplements such as the USP, or United States Pharmacopeia; NSF International and NPA, the Natural Products Association.
Experts offered this advice:
— Keep it simple. The more ingredients there are in a supplement combo, the more chance that one of them will not be the right amount, Cooperman said.
— Consider a supplement combo tailored to your gender and age, the Office of Dietary Supplements suggests. Multivitamins often contain little iron, and ones for seniors give more calcium and vitamin D than products aimed at younger adults.
— Take vitamin D with dinner. A study found signifi cantly more absorption of that nutrient when it was consumed at the largest meal, which tends to have more fat, than at breakfast, Cooperman said.
— Watch out for vitamin K — it promotes clotting and can interfere with common heart medicines and blood thinners such as warfarin, sold as Coumadin and other brands.
— Current and former smokers are advised to avoid multivitamins with lots of beta-carotene or vitamin A; two studies have tied them to increased risk of lung cancer.
— For cancer patients, “vitamins C and E might reduce the effectiveness of certain types of chemotherapy,” Engel said.
— People having surgery should know that some vitamins can affect bleeding and response to anesthesia.
With any supplement — ask your doctor.