Persistent Edema: Seeking Answers Beyond Normal Test Results

Edema issues

Hello Doctor: I previously inquired about edema and have since visited the Metabolism Department at Shuanghe Hospital.
My hormone levels and thyroid function are normal.
(I had my heart, liver, and kidney blood tests done at the Family Medicine Department last August and September, and all results were normal.) Even the doctor in the Metabolism Department could not determine the cause of my edema.
She simply stated that I am not ill and mentioned that she does not believe I have edema.
During my first consultation, I pressed my face to show her, and it took a long time for it to swell.
She also pressed her own face and experienced similar swelling, yet she insisted that it is not edema?! Just a few days ago, I consulted with an ophthalmologist about this issue, and he advised me to see a specialist at a larger hospital.
He confirmed that my face is indeed swollen.
However, the Metabolism Department doctor firmly insists that this is not edema.
I showed her photos of my face before and during the worst of the swelling, which are drastically different, yet she remained unconvinced.
She even mentioned that I am getting older, my metabolism is slowing down, and that I have gained weight, also bringing up collagen...
(I have three colleagues who also have facial swelling: one born in 1970, another in 1978, and one in 1982.
I wonder why there are so many people with edema in this company, while my other friends rarely experience it.
Two of them have gastrointestinal absorption issues leading to facial swelling, and another born in 1982 has a tendency to gain weight.
Although swollen, their faces are quite rosy.) I informed her that I inherited my father's lean physique, and another more noticeable area of swelling is my calves.
Before the edema, my calves measured 10.2 inches.
During the edema in 2013, they increased to 10.5 inches, and in 2015-2016, they reached 10.7 inches.
In 2016, I developed varicose veins.
After seeing a doctor in September and following their advice to wear compression stockings, my swelling worsened.
Currently, my calves have swollen to 11.6 inches, and the varicose veins have become more severe.
I have a job that requires me to be active and I regularly elevate my legs.
I have always been mindful of my leg activity, and my work over the past few years should not have contributed to the development of varicose veins.
I also maintain good health practices, urinating at least eight times a day, and my water intake is consistently around 3000cc.
Since January, my walk from the parking lot to my workplace takes only five minutes, and I consistently sweat a lot, even in temperatures below 10 degrees Celsius.
The heat sensation is such that I do not feel cold, and it increases rapidly.
Colleagues have asked if I sweat a lot.
To provide more detail, I hope this helps the doctor better understand and identify where the issue may lie.
The ophthalmologist mentioned that if my weight increases by several kilograms in a short period, it could indicate a health problem.
This was also mentioned by my teacher in elementary school, which is why the ophthalmologist urged me to get checked again.
However, all my test results are normal! Additionally, my activity level has increased due to a job change, and I walk about 10,000 steps daily.
It has been nearly five months, and I hope the doctor can assist me in identifying the underlying issue.
My face has become even more swollen in the past two days, and I have 60-70 pairs of pants that I can no longer wear.
I am running out of clothes...
Even those who are overweight can control their weight, let alone someone like me who has been thin since childhood...
Thank you for your help, Doctor!

aki, 30~39 year old female. Ask Date: 2017/05/04

Dr. Wu Jiyu reply Internal Medicine

Hello! Based on the information you provided, I can sense your concerns about your current physical condition.
However, there are many causes of edema, and clinical judgment is necessary; written communication may not accurately address your concerns.
If you have previously consulted a metabolic specialist, it may be worthwhile to consider further examination at a medical center to clarify the underlying cause.
Additionally, based on the information you provided in your previous and current inquiries, I suggest evaluating whether you have experienced any instances of being underweight in the past.
If your BMI (BMI = weight (kg) / height squared (m)) is below 18, or even below 16, it may indicate that you were too thin in the past.
However, these conditions should be assessed by a qualified physician based on clinical manifestations.
If there are underlying health issues, it is essential to identify the cause and treat it accordingly.
If the changes in body composition are due to age-related metabolic changes, excessive correction may actually be detrimental to your health.

Reply Date: 2017/05/04

More Info

Persistent edema, or swelling, can be a perplexing condition, especially when standard tests yield normal results. Your experience reflects a common frustration among patients who feel their symptoms are not being adequately addressed. Let's delve into the potential causes of edema, the importance of thorough evaluation, and possible next steps.

Edema can occur for various reasons, and understanding the underlying mechanisms is crucial. It can be classified into two main types: localized and generalized. Localized edema typically affects a specific area, such as a limb or the face, while generalized edema affects the entire body. Common causes of edema include heart failure, kidney disease, liver disease, venous insufficiency, and certain medications. However, in your case, where hormonal and metabolic evaluations have returned normal, we need to consider other factors.

1. Dietary Factors: High sodium intake can lead to fluid retention. Even if you are drinking a lot of water, excessive salt can cause your body to hold onto that fluid. It might be beneficial to assess your diet for hidden sources of sodium, such as processed foods.

2. Hormonal Influences: Although your hormonal tests came back normal, hormonal fluctuations can still play a role in edema. Conditions like premenstrual syndrome (PMS) or thyroid dysfunction (even if tests are normal) can sometimes lead to fluid retention.

3. Venous Insufficiency: Given your history of varicose veins and the increase in calf circumference, venous insufficiency could be a contributing factor. This condition occurs when the veins cannot effectively return blood to the heart, leading to fluid accumulation in the lower extremities. Compression stockings can help, but they need to be fitted correctly, and sometimes, more aggressive treatments are necessary.

4. Lymphatic Issues: Lymphedema, which is swelling due to lymphatic system blockage, can also cause persistent edema. This condition may not always be evident in standard tests, and a specialist evaluation may be needed.

5. Medication Side Effects: Certain medications, including those for blood pressure, anti-inflammatories, and even some over-the-counter drugs, can cause edema as a side effect. Reviewing your medication list with your healthcare provider could uncover potential culprits.

6. Underlying Conditions: Conditions such as chronic kidney disease or heart failure can sometimes present with edema without other obvious symptoms. Even if your tests have been normal, it may be worth discussing with your doctor the possibility of more specialized tests, such as imaging studies or a referral to a specialist.

7. Lifestyle Factors: Your activity level and job can also influence fluid retention. Prolonged sitting or standing can exacerbate edema, especially if you have a job that requires you to be in one position for extended periods. Incorporating regular movement and elevating your legs when possible can help mitigate this.

Given your detailed account of symptoms and the lack of clear answers from multiple specialists, it may be beneficial to seek a second opinion or consult a specialist in a related field, such as a vascular surgeon or a nephrologist. They may provide additional insights or recommend further testing that could uncover less common causes of edema.

In conclusion, while your test results may appear normal, persistent edema warrants a comprehensive approach to diagnosis and management. It’s essential to advocate for your health and continue seeking answers until you find a satisfactory explanation for your symptoms. Keeping a detailed diary of your symptoms, dietary intake, and any changes in your condition can also be helpful for your healthcare provider in identifying patterns that may lead to a diagnosis.

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