DEAR DR. DONOHUE: I am a 42-year-old female and hope you can direct me to what kind of doctor I need. I have a problem with my ankles and feet swelling up. I don’t know where to turn. Should I just go for a complete physical? – P.O.

ANSWER: Let me answer your question right off. Your family doctor is qualified to begin the search for the many causes of swollen feet and ankles. Those causes vary from the innocent to the highly dangerous.

Sitting or standing in one place for too long can cause fluid to seep out of blood vessels and swell the feet and ankles. Hot weather contributes to the seepage. This is an innocent problem solved by moving around, letting leg muscles act as a pump to get blood flowing briskly back to the heart.

A serious cause of edema, as the swelling is called, is heart failure. A feebly beating heart cannot circulate blood with enough force. Blood stagnates in leg vessels, where fluid leaks out of those vessels and puffs up ankles and legs.

Liver disease can do the same, as can kidney disease.

Leg-vein blockage is another cause of ankle and foot edema, and it could be the cause in someone of your age who has few other complaints.

There are drugs that cause fluid retention and swelling. The popular anti-inflammatory medicines can do it, as can calcium-channel blockers – drugs used for heart conditions and blood-pressure control.

Although treatment for edema depends on finding the exact cause, some general principles help all cases of edema, regardless of cause. Elevate the legs and feet for as long as you can and as frequently as you can during the day. Walking helps mobilize the fluid. Cut down on the amount of salt you eat. Compression stockings minimize fluid accumulation.

DEAR DR. DONOHUE: A close friend of mine tells me she goes to a methadone clinic every morning to break her drug addition.

Will you tell me what methadone is, and how does the clinic help?. – R.B.

ANSWER: Methadone is an opioid drug – a drug derived from the poppy plant. Other opioid drugs include heroin, morphine and codeine. Heroin is an illegal drug and is highly addicting. It’s used to induce a state of euphoria – a feeling that all is well in the world and that the user can do just about anything.

Methadone is a long-acting opioid drug. It can help those with an addiction to heroin to stop using it without suffering withdrawal symptoms, which can be quite terrifying. Furthermore, maintenance use of the drug diminishes an addict’s craving for heroin. Methadone doesn’t induce such a high as heroin does, nor does it sedate people as much, so those on a detoxification program are able to be productive.

Methadone clinics are found in many metropolitan areas.

DEAR DR. DONOHUE: Is it better to sleep early and rise early or to go to bed late and rise late?

What does thinning your blood mean? I hear that garlic, tea, lemon and grapefruit thin the blood. Are they bad for someone with anemia? Is a face-lift recommended for any age group? What is too much fluid intake? – A.L.

ANSWER: Listen to your body. Some people are early risers, and some are late risers. If you’re retired and can get up when you like, your inner clock lets you know which to do. Thinning the blood doesn’t actually thin it. It’s a way of saying the blood is less likely to form clots, and some conditions call for the brakes to be put on clot formation. The foods you mention are not bad for anyone with anemia. Garlic can thin blood, so it should be used with caution if people are taking blood-thinning medicines like Coumadin. A face-lift is permissible for any age group so long as the person doesn’t have a health condition that would make such surgery dangerous. Kidneys can take care of excess fluid unless a person deliberately sets out to drink quart after quart of fluid all day long.

DEAR DR. DONOHUE: I have a granddaughter who is very special to me. She was an abused child and came to live with me at the age of 14. She is now 20 and has never given me a minute’s trouble. She does not like to eat much of anything. She cannot eat any kind of potato because they make her gag. She will not eat pasta, eggs or pizza because she can’t stand it when one food touches another. I believe her disorder stems from the sexual and physical abuse she suffered. I begged her to seek counseling, but she won’t. Do you have any suggestions? – R.P.

ANSWER: I suggest you show your granddaughter the letter you sent me as proof of your love and your concern. I share your anxiety and beg her to see a professional recommended by the family doctor. She has suffered too much already, and she has a condition that is treatable.

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 www.rbmamall.com.