DEAR DRS. DONOHUE AND ROACH: My wife, 77 years old, suffers from severe edema in both of her legs. She is a type 2 diabetic. During a recent hospital stay, her heart, liver and kidneys all checked out fine. She had an ultrasound performed on her legs, and had no blood clot. We have had three doctors tell her the only thing that can be done to reduce the swelling is to wear compression hose and keep her legs elevated, but to be blunt, it “ain’t workin’.” Are there medicines, surgery or something else that can be done? — R.H.

ANSWER: Edema is swelling, and it’s a very common finding in the legs, particularly as we get older. Fluid retention occurs when the forces pushing fluid out (mostly vein pressure) are higher than the forces keeping fluid in (mostly by proteins, which keep the fluid inside the veins).

You have mentioned three common causes. In heart failure, the heart is weak and unable to effectively pump all the blood needed by the body. This causes fluid to “back up.” Kidneys filter the blood to remove waste products and retain proteins, and they can cause edema by letting too much of the protein out. The liver can fail to make enough protein to keep the fluid in veins. But in your wife’s case, as in most people, none of these is the issue. So, what is?

Most commonly, the problem is leakage through the capillary walls. Veins have valves, but if these valves leak, then that increases edema flow into tissues. With time, the vessels are damaged further and fluid stays in the tissue longer. For the majority of people, the lymphatic system will suck up the extra fluid, especially when the legs are raised at bedtime. By the morning, the extra fluid in the legs is gone. This is not the case with your wife.

There is no cure. Diuretics like Lasix don’t work for more than a few days. Surgery tends to make it worse. But support stockings and elevation are helpful, and so is exercise. Support stockings need to be the appropriate size and strength, and that means careful measurement and possibly custom-made stockings. Elevation needs to take place at least three times a day, and the legs should be raised above the heart. This is more than propping your feet on a chair; your wife must lie down. And exercise uses muscles to take fluid out of the legs and bring it back to the circulation.

Finally, a supplement called horse chestnut extract has been shown to be helpful; however, my experience with it in my own patients has been less than spectacular.

DEAR DRS. DONOHUE AND ROACH: Could you please print something about lichen planus? Does it eventually kill you, or do you die from scratching yourself to death from the disease? — T.Y.

ANSWER: No, lichen planus doesn’t usually kill you. Nobody really knows where it comes from, but it seems to be another autoimmune disease. It causes a raised, purple or red rash, in the mouth (or other mucous membranes) or on the body. Mouth lesions can be painful, but the rash on the body can be, as you have suggested, quite itchy. Fortunately, there are effective treatments for almost everyone, which may include topical creams and medications by mouth. Ultraviolet light also is sometimes used. Most cases go away in 18 months to two years.

A dermatologist is the right person to see for symptoms of lichen planus.

TO READERS: Questions about the common problem of uterine fibroids are answered in the booklet of that name. To obtain a copy, write: Dr. Donohue — No. 1106, 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.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.

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