DEAR DR. DONOHUE: By the end of the day, my feet are so swollen that I can’t keep my shoes on. My ankles are swollen, too. In the morning, they are back down to normal. What’s causing this? What can I do for it? — N.W.

ANSWER: That swelling goes by the name “edema.” It’s fluid that has leaked out of blood vessels. The greatest leakage occurs in the vessels of the lower leg and feet.

Causes? There are many. Varicose veins are one cause. Not the varicose veins that you can see beneath the skin, but the varicose veins that are deep in the tissues, buried from view. Blood pools in those veins, and the fluid part of blood is forced out.

Heart failure is a more serious cause of edema. Here a feeble heart pumps only a little blood out with each heartbeat. Blood backs up in the circulation. Pressure within the blood vessels rises, and once again fluid seeps out into the tissues. Fluid seeps into the lungs, too. It makes it hard for people to get enough oxygen when they’re active. They become short of breath on slight exertion.

Peripheral artery disease is another edema cause. Here obstruction in the leg arteries encourages fluid to escape from them.

If only one leg swells, a likely cause is a blood clot in the veins of that leg. Obstructed lymphatics are another cause of single-leg swelling. Normally, some fluid escapes from the circulation to feed cells. That escaped fluid finds its way back into the circulation through lymphatic channels. If they’re blocked, tissues swell.

The only one who can identify the cause of your edema is your family doctor. While you’re waiting to see the doctor, do some things that can help control swelling. Elevate your legs many times during the day. By elevate, I mean that your legs have to be higher than your heart. You can do that only by lying down with your legs propped up on pillows. Go easy on salt use. These aren’t cures. Eliminating the cause will affect a cure.

The booklet on edema and lymphedema provides information on the causes of foot and ankle swelling. Readers can order a copy by writing: Dr. Donohue — No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Old age has given me bruises up and down my arms. I’m attributing this to old age. Is it? — N.G.

ANSWER: Older people do suffer from easy bruising. The protective padding around delicate blood vessels has thinned out, the tissues that support blood vessels have weakened and blood vessels have become fragile. All of those factors cause vessels to break and create a bruise. I have only a lame solution to this problem: Protect your arms with long-sleeved garments.

It’s a good idea to mention this to your doctor, who can decide if an investigation should be made into your ability to form clots and seal off any broken vessel immediately, before much blood has a chance to leak into surrounding tissues. Do you take any blood-thinning medicines, like aspirin or Coumadin?

DEAR DR. DONOHUE: In the battery of blood tests I had done, one was for iron. I am low in iron. The doctor wants me on iron medicine. As a child, my mother fed us blackstrap molasses as an iron tonic. Is it reasonable for me to take that? — G.G.

ANSWER: It’s not reasonable. First off, you have to find out why your iron count is low. Blood loss is usually responsible for that.

As for blackstrap molasses, it contains only 3.5 mg of iron in one tablespoon. The usual dose of iron used to correct a deficiency is 325 mg taken three or four times a day.

You’re not going to get anywhere with blackstrap molasses.

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. Readers may also order health newsletters from

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