Leg Swelling

If it's on your mind and it has to do with multiple sclerosis in any way, post it here.

Leg Swelling

Postby MaggieMae » Thu Jan 08, 2009 8:29 am

In the last month we noticed that my husband's right leg is swelling from the foot to the top of the leg. It is one to two inches bigger than the left leg. PCP doctor sent him for doplar which showed no blood clot and gave him lasik (sp?) which he could not take (can't get to the bathroom in time). MS nurse at infusion center said something about "nerve endings are not working properly; so veins are not working properly". Does anyone have any suggestions? PCP doesn't seem that concerned, nor is he giving any suggestions besides "try to put your leg up during the day". My husband has had MS for over 30 years and he does walk with assistance. This is a new occurrance.
User avatar
MaggieMae
Family Elder
 
Posts: 379
Joined: Wed May 23, 2007 3:00 pm
Location: Pennsylvania

Advertisement

Postby jimmylegs » Thu Jan 08, 2009 8:59 am

hi mm, what other symptoms does he have, all in all, and what medication is he on? does your hubby have a nutrition regimen for his ms? dietary preferences, quirks, allergies? what is lasik, can you check the spelling?

from what you've described, you could think about looking into supporting the nerves and the veins with vitamin e, c, and zinc, for starters. he may already take these, but a short term high dose boost could still be helpful.

vitamin e, see if you can find 'e-complex" one with 8 mixed tocopherols and tocotrienols. or you might have to get one e with the tocopherols and another with the tocotrienols. vit e is fat soluble, definitely one to take with meals. the klenner protocol for ms specifies 800IU before each meal, and at bedtime.

vitamin c, go for as much as 10g per day in divided doses.

zinc, 50mg per day. if you're interested, try to get a zinc test to see where he's at. ms patients have lower average zinc than healthy controls.

if this kind of plan is going to help i would expect it to make a noticeable difference in under a week. that means you don't have to worry about high-dosing fat soluble things like E.

i haven't personally had to deal with the specific kind of problem your husband is facing. but i have modified the klenner protocol for my own use before, and it was an amazing recovery.

if you have any more symptoms to relay, they might potentially indicate additional nutrition therapies that could help. if you can boost 'excellent sources' of various foods, both to augment a short term supplementation regimen, and to support better overall health in the long term, all the better :)
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 9225
Joined: Sat Mar 11, 2006 4:00 pm

Postby cheerleader » Thu Jan 08, 2009 11:01 am

Maggie-
You mention infusion...is your husband on ty?
Peripheral edema is a known side effect of Tysabri. Perhaps this is not the treatment for him. Peripheral edema (limb swelling) can cause serious nerve damage...this is not something he needs along with his MS.

Talk to your neuro and GP.
AC
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
User avatar
cheerleader
Family Elder
 
Posts: 4939
Joined: Mon Sep 10, 2007 3:00 pm
Location: southern California

Postby jimmylegs » Thu Jan 08, 2009 11:31 am

that's interesting... i can't find anything on natalizumab induced peripheral edema, but there is a chunk on the kinds of drugs that cause PE, and how

http://jaapa.com/issues/j20051101/artic ... ma1105.htm
Drug-induced edema: Certain medications can induce edema by enhancing sodium and water reabsorption by the kidneys. Potent vasodilators such as minoxidil and diazoxide are good examples. Other drugs that can cause edema include calcium channel blockers, which lead to capillary leakage due to dilation of the precapillary sphincter,13 and the NSAIDs, which induce edema formation through different mechanisms by inhibiting renal prostaglandin synthesis. They can also exacerbate edema in patients with underlying HF or cirrhosis.14 Antidepressants, estrogens, corticosteroids, and COX-2 inhibitors can also cause peripheral edema.


Nippon Rinsho. 2005 Jan;63(1):102-6.
Kaizu K, Abe M.
It is well known that there are many drugs which induce edema. Drug-induced edema can be divided into three types by the mechanism as follows, 1) sodium overload, 2) renal dysfunction and 3) hyperpermeability of blood vessel.


you can combat sodium, if that does turn out to be a potential problem, with potassium rich foods. it's kind of a waste of time to supplement 100mg here and there for potassium, when you need 4700mg per day. go for swiss chard, it's a champ with a 3:1 potassium to sodium ratio. potassium also is good for renal issues.



arg i found a very specific article title, but no abstract..
http://www.ncbi.nlm.nih.gov/pubmed/2817637
Ann Intern Med. 1989 Nov 15;111(10):859.
Vitamin E deficiency and peripheral edema.


also this:
http://www.springerlink.com/content/pk4012k4w7w38141/fulltext.pdf?page=1
Peripheral edema due to increased vascular permeability: a clinical appraisal


and this, weird context, but nonetheless zinc is helping keep vascular membranes impermeable:
Comp Biochem Physiol C. 1992 Jun;102(2):325-7.Links
Effects of copper, iron and zinc on oedema formation induced by phospholipase A2.
Ferrer X, Moreno JJ.
1. Intradermal or subplantar injection of soluble snake venom phospholipase A2 (PLA2) evoked a brisk inflammatory response, with cutaneous vascular permeability increase and paw oedema. 2. These inflammatory processes are mainly the result of arachidonic acid cascade activation and mast cell degranulation. 3. Copper, iron and zinc have an inhibitory effect on vascular permeability increase and paw oedema induced by PLA2. 4. Copper and iron could have not only a direct effect on PLA2 but on enzymes of arachidonic acid cascade. 5. However, zinc have a moderate antiinflammatory activity. This effect could be the result to inhibit PLA2 induced mast cell degranulation.
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 9225
Joined: Sat Mar 11, 2006 4:00 pm

Postby cheerleader » Thu Jan 08, 2009 12:21 pm

The edema was noted in the Sentinel study of ty w/avonex. Still worth looking into, since this is a new complication-

http://www.thisisms.com/ftopict-2089.html
The adverse events most strongly associated with TYSABRI therapy compared to placebo in AFFIRM were fatigue and allergic reaction. Adverse events in SENTINEL associated with add-on therapy compared to AVONEX alone were anxiety, pharyngitis, sinus congestion and peripheral edema.
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
User avatar
cheerleader
Family Elder
 
Posts: 4939
Joined: Mon Sep 10, 2007 3:00 pm
Location: southern California

Postby jimmylegs » Thu Jan 08, 2009 12:28 pm

for sure, don't doubt it i just didn't find anything quickly. nor for tysabri and nutrient depletion. is sentinel just another brand name for natalizumab or something?
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 9225
Joined: Sat Mar 11, 2006 4:00 pm

Postby MaggieMae » Fri Jan 09, 2009 6:55 am

Sorry about the spelling. I should have looked it up before I posted. The correct spelling is Lasix.

"Lasix is a loop diuretic (water pill) that prevents your body from absorbing too much salt, allowing the salt to instead be passed in your urine."

Yes, he is a Tysabri patient since September 2007.
We did mention it to his MS nurse (who does the infusion). She explained that the nerves to the veins are no longer working properly and so the fluid is being retained. Something just doesn't seem right to me. This is not in both legs - just his right leg. He has never had a problem before. His does not follow a good diet. As I told you in my last post, his PCP doesn't seem very concerned either. I'm concerned.

We see his MS doctor next month and I will mention to him also.
User avatar
MaggieMae
Family Elder
 
Posts: 379
Joined: Wed May 23, 2007 3:00 pm
Location: Pennsylvania

Postby jimmylegs » Fri Jan 09, 2009 8:08 am

okay so potassium has the sodium combating properties of lasix then, but potassium also works on maintaining the correct blood vessel pressure. also, i understand that lasix drains potassium, and magnesium, so he will have protection against sodium from the med, but no potassium support for the blood vessels or general magnesium support.

i gather you won't be able to get chard into hubby (it has mg and k). would he drink a high potassium fruit smoothie drink? i convinced a picky-eater friend who recently dealt with a gout episode to try arthur's very berry, it's got a few different fruits and no added sugar. i wonder if something like that could at least help your hubby restore lost potassium.

i thought a bit about the unilateral aspect of his problem. i have run across the odd reference to "sided-ness" of certain nutrients and thought i'd have a quick google on that.
this next thing i'm going to say is not something i've investigated for any kind of validity and i have to say that i am skeptical about a preference of a nutrient to affect one side of the body or the other. but here goes
For instance, phosphorus and zinc have both left-sided cell receptors, so if either level is low in ratio to calcium, calcification would only take place on the left side of the body, whereas the cell receptors of manganese or magnesium are right-sided, as a result, any calcification would develop on the right side of the body only.


and
Many therapeutic agents cause renal Mg wasting and subsequent deficiency. These include loop and thiazide diuretics, aminoglycosides, cisplatin, pentamidine, and foscarnet... Refractory hypokalemia [jl: low potassium] and hypocalcemia can be caused by concomitant hypomagnesemia and can be corrected with Mg therapy. The dose and route of administration of Mg in the treatment of hypomagnesemia is dictated by the clinical presentation, the degree of Mg deficiency, and the renal function.

so even though my initial thought was to go for e, c, and zinc for the vessels, and after the tysabri/edema info and loop diuretic treatment adding the potassium/magnesium twist, plus the right-sidedness according to that quote...

i would probably see if i could get him to try the E C and zinc to combat the edema, and probably also magnesium and potassium if only to replenish from the lasix treatment - but that also might help with the swelling too.

magnesium and vascular health..
Magnesium affects blood pressure by modulating vascular tone and reactivity. It acts as a calcium channel antagonist, it stimulates production of vasodilator prostacyclins and nitric oxide and it alters vascular responses to vasoactive agonists. Magnesium deficiency has been implicated in the pathogenesis of hypertension with epidemiological and experimental studies demonstrating an inverse correlation between blood pressure and serum magnesium levels.


tt: i read that snippet about mg and BP and thought of you!

maggie mae i don't know if you saw the last few posts on the CCVI thread too, there was an article that reminded me of your hubby's case too.
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 9225
Joined: Sat Mar 11, 2006 4:00 pm

Postby jimmylegs » Fri Jan 09, 2009 8:14 am

one more bit
http://www.renalandurologynews.com/Magn ... le/112426/
july 15 2008
A small pilot study suggests that magnesium may prevent or delay progression of vascular calcification in hemodialysis patients without a detrimental effect on bone, researchers reported here at the 2008 Annual Dialysis Conference...
When used as the principal phosphate binder for 18 months, Dr. Spiegel concluded, magnesium carbonate/calcium carbonate provided excellent control of serum phosphorus, prevented progression of vascular calcification and did not worsen BMD.
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 9225
Joined: Sat Mar 11, 2006 4:00 pm

Postby MaggieMae » Fri Jan 09, 2009 8:57 am

Just a quick note. He only took the lasix for two days because he could not make it to the "john" in time. He refuses to take it. He takes the following vitamins: 4000iu vitamin d3; calcium/magnesium; omega 3's; b12 (occassionally). I've had him on the D3 for over two years because his levels were low. His levels are checked twice a year and still remain in the low normal.

Besides his Tysabri, he takes meds for his prostate; provigil; and another for his legs (neurontin); vicodin (once daily for his back pain) and he had been on a blood pressure medicine which his doctor took him off of about five months ago because his pressure was low. He was on it for years. He is back on it as of yesterday but at a low dose.
User avatar
MaggieMae
Family Elder
 
Posts: 379
Joined: Wed May 23, 2007 3:00 pm
Location: Pennsylvania

Postby cheerleader » Fri Jan 09, 2009 9:42 am

Maggie-
It was my husband's legs that sent me searching. Check out the endothelial dysfunction thread and paper on the regimens section and the chronic cerebrospinal thread in the general forums. Your instincts are right. Something is going on.
Talk to his neuro about the Tysabri infusions and risk of edema.
Wishing you well as you sort it all out.
AC
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
User avatar
cheerleader
Family Elder
 
Posts: 4939
Joined: Mon Sep 10, 2007 3:00 pm
Location: southern California

Postby jimmylegs » Fri Jan 09, 2009 9:51 am

ah okay. i'm not too surprised that 4000IU D3 per day doesn't boost him far above low normal. 4000 is a daily maintenance dosage according to, i believe, vieth. if you want to get hubby up over 100nmol/L he might need a week of megadosing.

how much calcium and magnesium per day?

i definitely recommend looking into his zinc status esp if he has prostate concerns. ideally you want his level to be 18 [mu]mol/L. try a week of 50mg zinc per day, and some vit E at every meal. and something, anything, with a high potassium:sodium ratio.

omega 3s are great, and an occasional b12 certainly doesn't hurt either :)
HTH!
JL
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 9225
Joined: Sat Mar 11, 2006 4:00 pm


Return to General Discussion

 


  • Related topics
    Replies
    Views
    Last post

Who is online

Users browsing this forum: No registered users