You may have noticed a trend in the content of my posts. I alternate between posts about: heart failure and related medical issues; posts about diet; posts about exercise; posts about faith; and posts that have a humorous tone. My heart may be “failing” but my humor appears to be in excellent health, and sometimes I just see the funny, even the zany in some of the topics I cover. So this post is about a condition associated with heart failure, but some points are related in a humorous fashion.
Let me just give you a quick refresher about the condition known as edema. According to the Mayo Clinic website edema is swelling caused by excess fluid trapped in your body's tissues. Although edema can affect any part of your body, you may notice it more in your hands, arms, feet, ankles and legs. This is referred to as peripheral edema. Edema can have a number of causes such as underlying diseases (congestive heart failure, kidney disease or cirrhosis of the liver), the result of medications (high blood pressure drugs, nonsteroidal anti-inflammatory medications, steroid drugs, estrogens, and certain diabetes drugs), or pregnancy.
The cause of my edema (also commonly referred to as water retention) is my heart failure. However, to my knowledge the water has never accumulated in my hands, arms, legs, feet or ankles. Instead, the water is trapped in my abdominal area. Abdominal edema is referred to as ascites.
Dropsy is an old fashioned term for edema. At first blush, both terms seem rather archaic and awkward. But I found that the Oxford Dictionary says that the origin of edema is: "late Middle English: modern Latin, from Greek oidēma, from oidein ‘to swell". In other words, the water that is accumulating is causing various parts of your body to swell. So edema is an apt term for the condition it describes. The Oxford Dictionary provides the following origin for the word dropsy: "Middle English: shortening of idropesie, earlier form of obsolete hydropsy, via Old French and Latin from Greek hudrōps ‘dropsy’, from hudōr ‘water". When you think about this, it is a very sensible word to describe a condition of water retention, because in essence, lots of drops of water are being retained in areas of your body.
The current treatment for edema is to take diuretics. For a while, I was prescribed two diuretics: Lasix (generic version furosemide) and aldactone (generic version spironolactone). The purpose of a diuretic is to help reduce the level of fluid and sodium in a patient’s body. The more powerful of the two diuretics, at least in my experience, is Lasix, and its use can cause the loss of potassium. On the other hand, aldactone is known as a potassium sparing diuretic. From the information I have found, it appears that doctors sometimes prescribe these diuretics together in order to achieve a more optimal level of potassium for the patient.
The bottom line is that you are taking two medications that cause you to pee in order to resolve your water retention issue. The conventional wisdom when you take diuretics is not to take them in the afternoon or evening, as they may cause you to have to continually visit the bathroom at night and disrupt restful sleep.
There are some other diuretic side effects that can be discouraging for the heart failure patient. The one that is the most problematic for me is the tendency to cause dizziness. I learned to manage this by making sure that I do not go to a fully standing position too quickly. Problem solved!
So overall, while inconvenient, I do not see the impact of the modern treatment for edema (i.e., the use of diuretics) as being intimidating or hideous. This is apparently in contrast to the impact of the treatment for dropsy/edema in prior centuries. When I was researching dropsy, I found that during the first season of the television show Downton Abbey, the local doctor wanted to treat a poor farmer’s dropsy by “old-fashioned methods”. A character known as Mrs. Crawley, had been a nurse during the Boer War. She insisted that the doctor perform a pericardiocentesis on the farmer to remove excess fluid from the sac around the heart.
The treatment of pericardiocentesis sounded a bit dramatic. But the reference in the Downton Abbey materials made me wonder what the “apparently dreaded old fashioned methods” were.
I found the following language from an abstract of an article on the NIH website. The article discussed the history of edema and its management:
According to the brittanica.com website, leeching involved the application of a living leech to the skin in order to initiate blood flow or deplete blood from a localized area of the body. Needless to say, I do not react well to the concept of applying an insect to my body to enhance blood flow or deplete blood. I also came across the following synopsis of an abstract of an article on NIH’s U.S. National Library of Medicine website called. The abstract is titled Bloodletting as a cure for dropsy:
(I heartily endorse the conclusion. However, I also have to wonder if the popularity of Vampire fiction in the 19th century was inspired by the revulsion women might have had to the prospect of applying leeches as a cure for water retention. I mean, think about it. Bloodletting via a vampire (say a Tom Cruise-like LeStat) had to be preferable to bloodletting by a long slimy leech.)
I also learned that the water retention problem is worse for other creatures. I began to consider what it would it be like to be a tropical fish or a goldfish with dropsy? I know. You’re wondering why my mind even goes to this place. Well, it goes to this place because I found quite a few articles on dropsy in fish. After reading these articles, I have concluded that it sucks to be a fish with dropsy.
Think about it. If you are a fish with dropsy, aren’t the odds stacked against you? You have an issue of water retention and where is your entire life spent? In the water!!! Maybe it’s different just living in the water versus drinking the water. From the articles I have examined, it appears that the condition can exist with fish living in aquariums. However, not all aquarium fish will fall victim to dropsy. Only those fish with immune systems compromised by a stress factor are at risk. (Stop the presses! Who knew that fish were under stress?)
Here are some other common symptoms: Grossly swollen belly; scales stand out (pinecone appearance); eyes bulge; gills become pale; ulcers form on the body; spine may become curved; fish becomes lethargic; and fish stop eating. Once the fish belly fills with fluids and becomes swollen, internal organs are damaged, and ultimately the fish will die. Yikes – and I thought it was bad because the abdominal bloat meant I could not wear some of my clothes. But that is it – no ulcers, no bulging eyes, no pale gills and no eventual death due to too much water. I guess I’ll stop complaining now!
In terms of treatment, it looks like it is curtains for the fish if the condition is not caught early. But if it is in the early stages, the treatment involves feeding the fish fresh quality food, treating with antibiotics, moving the fish to a hospital tank, and putting one teaspoon of salt in the tank.
Putting salt in the tank! Humans often end up with a dropsy dilemma when they eat too much salt. I figured that it might be a different kettle of fish, so to speak, if you are a fish with dropsy. But then I found an article on natural remedies/lifestyle changes for humans that suggest bathing in warm water infused with two cups of Epsom salts to eliminate toxins and excess fluid. That seems like odd advice to me. But again, maybe humans soaking in water is different than humans than drinking it, and maybe Epsom salt doesn't have the type of sodium that is contained in table salt.
Whatever the case, I have come to the conclusion that things could be worse. Those pioneering doctors and patients in previous centuries have made my treatment much easier. I also am grateful that God put me on this earth as a human and not a fish!
Melanie discovered that she had heart failure in 2013. She spent the next 7 years learning how to live with the condition, and how to achieve balance and personal growth. Then in October 2020, she received a heart transplant. This blog is about her journey of the heart.