DEAR DR. ROACH: My husband takes the following medicines: lisinopril for his blood pressure, levothyroxine for his thyroid, an aspirin and a B-complex vitamin, all in the morning.

He had his aorta replaced in 2012 and has trouble with sink-in marks on his legs at the bottom. It doesn’t matter how much I pay for a pair of socks for him, or how loose they fit, his legs still get the marks. He is 79 and has no other health problems.

Would you happen to have any idea what could be causing this? His heart doctor thought it was his blood pressure medicine, and at that time, he was taking 10 mg of amlodipine in the morning. — R.M.M.

ANSWER: When you can see the imprint of the socks, it means that there is some swelling (edema) in the loose tissues of the legs. Although leg edema can result from serious problems with the heart, kidneys or liver, or even from blood clots, it is far more likely that it is not any of these serious conditions. After a major vascular surgery, it is common to have a bit of swelling in the legs. In fact, most people nearing their 80s have some degree of swelling, usually from imperfect valves in the veins or lymphatic vessels that don’t work as well as they did 50 years earlier.

Amlodipine (Norvasc) and medicines like it often cause a degree of swelling that is not dangerous.

A careful physical exam and a few blood and urine tests are all that’s necessary to be sure that the leg swelling isn’t being caused by a potentially dangerous condition.

DEAR DR. ROACH: I am 71, with high blood pressure, COPD, diabetes and spinal stenosis. I smoke. After I eat breakfast or lunch, I rapidly fall into a daze during which I can hardly hold my head up. Sleep seems to be the only solution, but I still feel tired and listless the rest of the day. I have had this condition for over a year, and it is making me very depressed. I have read about CFS and autoimmune conditions, and the prognosis is not good. There must be some treatment for me. — A.P.

ANSWER: Fatigue is a common symptom, but it is perhaps the most nonspecific one we deal with in medicine. Many conditions primarily cause fatigue. The specific condition of chronic fatigue syndrome, by definition, is unexplained after a clinical evaluation. In your case, I would consider some important possible causes.

Although COPD and even spinal stenosis certainly can cause fatigue, the association with eating makes me wonder about your blood sugar levels, since poorly controlled diabetes can cause fatigue. Smoking doesn’t cause fatigue, but quitting smoking certainly will help your COPD from progressing. All sleep disorders, but especially obstructive sleep apnea, cause fatigue that might not improve with sleeping.

I always consider thyroid disease, hemochromatosis and multiple sclerosis in anyone with profound fatigue. This list is only a small part of the many conditions a clinician is on the lookout for in someone with fatigue.

Depression certainly may cause fatigue, but it is also common in people whose primary issue is a medical cause of fatigue.

If after a thorough evaluation your diagnosis turns out to be chronic fatigue syndrome, the most effective therapies are cognitive behavioral therapy and a graded exercise program.

Since your symptoms happen after eating, it might be wise to see if certain foods are more likely to cause it by keeping a food diary. Many people find sugary foods cause loss of energy.

Many people have come down with the mysterious illness chronic fatigue syndrome. The booklet on it explains the illness and its treatment. To obtain a copy, write: Dr. Roach — No. 304, 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.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from

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