DEAR DR. DONOHUE: My mother wakes up with swollen feet. She wraps her feet at night, with no effect. She is on hydrochlorothiazide for blood pressure, CombiPatch (an estrogen patch), Tricor for cholesterol and Bextra for arthritis. Her doctor is blowing this off, but I don’t think it is normal. What is your opinion? – A.A.

A unique angle to your mother’s swelling is the fact that it happens at night, and I don’t have a good explanation for that. Foot (and/or ankle) swelling usually occurs at the end of the day, after a person has been up and about. Gravity contributes to the oozing of fluid from the circulation into the tissues of the feet. The gravity effect disappears when lying in bed.

Perhaps it’s her medicines. Swelling is listed as a side effect of both CombiPatch and Bextra. She can stop the Bextra for a few days and not suffer from doing so, apart from the possibility her joints will begin to hurt. Before she stops the CombiPatch, she should speak with her doctor. The drugs should not be stopped at the same time or she won’t know which, if either, is responsible.

Heart failure is a major cause of swelling. Another symptom that is a clue that the heart is involved is becoming short of breath when hurrying around or when performing high-effort household chores, such as scrubbing or vacuuming.

Did your mother ever have leg vein clots? After a bout of thrombophlebitis, as leg vein clots are called, the veins can leak fluid into the surrounding tissues.

Anything that damages lymph nodes or lymphatics is another possibility. Lymphatics are tiny vessels that return fluid to the circulation after it bathes tissues and cells.

While your mother and her doctor sort out this problem, tell her to sleep with her feet on three or four pillows and with compression hose that reaches beyond her knees. You’re right – this needs an explanation.

Readers who would like a lengthier discussion of swollen feet, ankles or legs can order the edema (swelling) pamphlet by writing: Dr. Donohue – No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have acid reflux. I cannot take any medicines for it because they do not agree with me. Could you make a list of food to avoid? – C.S.

‘m not being flippant when I say you are the one who must make the list. Foods that lead to acid reflux (heartburn) vary from individual to individual. Only you can competently identify those foods.

Foods that are on most heartburn patients’ lists include caffeine, chocolate, mints, alcohol, fatty and fried foods, onions, garlic, colas, citrus fruits and red wines.

If your reflux is bad, then you make an ideal candidate for surgical correction of acid reflux. Talk to your doctor about the many procedures available to stop acid from spurting from the stomach into the esophagus.

How about the nonfood, nonmedicine treatments for heartburn? Don’t lie down after eating. Prop the head of your bed up by placing 6-inch blocks under the bedposts. Don’t wear constricting garments, like a tight belt. Chewing sugarless gum promotes saliva production, and saliva is an antacid. Take advantage of it.

DEAR DR. DONOHUE: When I was 18 years old, I had rheumatic fever. Two years later I joined the Air Force. On my discharge it was noted that I had X-ray evidence of ankylosing spondylitis, and now I take medicine for it. You talked about this condition in a recent column.

Can my ankylosing spondylitis be traced back to the rheumatic fever I had? – C.J.

Rheumatic fever results from a strep infection. It can affect joints, heart and skin. Joint involvement almost always goes away. That is not true of heart involvement.

Ankylosing spondylitis is a special kind of spinal column (backbone) arthritis. Genes and an errant immune system are responsible for it. It’s is not likely that rheumatic fever leads to it – ever.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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