Sounds like edema.  Have you taken courses of prednisone (other steroids too),
are you still?  Eventually prednisone will mess up your lymphatic system
(etc.).  Do not take any more prednisone, ever.

Keep your feet elevated as much as possible.  Do not wear any thing binding on
your feet/legs, don't even wear socks  Do not just sit in a chair or stand in
one place... between periods of foot elevation it's best to walk.  Keep the
skin on your feet and legs well lubricated to protect your skin (Aquaphor is
excellent).  Curb your salt intake, no cold cuts.  Eventually the swelling will
will lessen and the episodes will abate.  Good Luck.

---= BOYCOTT FRANCE (belgium) GERMANY--SPAIN =---
         ---= Move UNITED NATIONS To Paris =---
                                *********
"Life would be devoid of all meaning were it without tribulation."
Sheldon          
````````````  

and now

ruled out

I'm about to

because I'm

pulmonary.

having asthma

in my feet.

hot kitchen

me as odd,

swelling and

freakin 85

in a single

During the week I mostly access this group from google. It
seems that some people have not been archiving their
responses so I was getting a conversation that made no
sense. Now that I can read the whole thing I must say that
you have gotten some interesting advice. The nicest thing I
can say about Sheldon's post about asthma/COPD/prednisone is
that it is incoherent. If your renal function and cardiac
output (heart) are normal 40mg of Lasix should be plenty.
Advising a dose of 120mg based on body weight would only
make sense if you were three times larger than a normally
large individual.

In the normal course of circulation some fluid leaks out as
the blood passes from high pressure arteries across the
capillary bed and into the low pressure veins. The excess is
taken up into the lymph channels and eventually returned to
the blood circulation. So, generally speaking, there are
three things that can increase the swelling (edema):

1) Increased leakiness of the blood vessels leading to more
fluid escaping than can be returned through the lymph
system.

2) Increased pressure in the veins causing more fluid to
leak out driven byt he extra pressure.

3) Obstruction of the lymph channnels.

The first and third are not common causes of both legs
swelling in an ambulatory patient. Lymph channel obstruction
usually happens after surgery (commonly after surgery for
breast cancer in the arm on the same side) or some other
insult. Increased leakiness at the arterial capillary
junction is usually caused by systemic problems such as
anaphylaxis, infection, burns, and surgery/trauma.

The second can come from an obstruction in the veins, such
as from a blood clot or an intra-abdominal mass (like a
pregnant uterus) compressing the veins. It can also come
from the heart getting backed up by not being able to pump
out all the blood that is comming in. The veins return to
the right side of the heart which pumps the blood to the
lungs then to the left so the leg swelling is technically
caused by right heart failure when edema is seen. However,
the most common cause of right heart failure is left heart
failure. Most of the test we have to check the heart are
much better at looking at the left side of the heart so this
is probably what was checked. Severe lung disease,
especially if it is accompanied by low oxygen levels, can
cause right heart failure. If the daytime readings do not
look to bad (when it is eventually checked by the pulm) then
a sleep study to look for sleep apnea may be a good idea to
make sure the levels are not dropping at night.

The CT of the abdomen (I assume it is of the abdomen and
pelvis) is to check for blockages and things compressing the
veins. It sounds like you were already checked for other
causes of increased fluid volume like liver and kidney
disease. Many medications, especially NSAIDs like
Motrin/Advil/Aleve, etc can do it so a review of the med
list would be helpful. The D-dimer test is a sensitive test
for blood clots meaning that it rarely misses them.
Unfortunately, while a negative test would have been
reassuring, the positive test means only the need for more
testing. One thing I'm sure the pulmonologist will order is
a VQ scan of the lungs to look for clots there. Being heavy
also increased the venous pressure via pressure on the
abdomen and age and a history of a lot of standing can cause
the valves that keep the blood going in the right direction
as the muscles "milk"
it by contracting to become leaky and the blood to back up.

The difference between asthma and COPD is that asthma is
reversible by definition and also is an inflammatory
condition. COPD is classically described as a fixed defect
and is not classically associated with inflammation (a lot
of caveates here). In reality many people with COPD do have
some reverisbility and so will respond to inhaled dilators
and the flares are associated with inflammation and will
respond to steroids (but the chronic phase is not and so
will not). COPD is rare in children (other than premies and
kids with CF) so if you have had wheezing since early
chilhood it is almost certainly asthma. If x-rays or CT
imaging of the lungs suggests emphysematous changes (and
maybe even if not) then looking for causes of COPD, which I
agree can mimic asthma, like alpha one anti-trypsin
deficiency and CF (which can have a broad spectrum of
presentations) may be worthwhile.

I agree that prednisone can have many serious side effects,
including fluid retention, but if you need it to breath then
not taking it can kill you. Also if you have been on it
chronically then stopping it too quickly can cause a
deficiency that can also be serious. Mucomyst
(acetylcysteine) is a mucolytic that was once used a good
bit but has largely been abandoned in favor of guaifenisen
due to its tendancy to trigger bronchoconstriction - a
rather unfortunate side effect considering the target
population. I agree that often docs will use the word asthma
when they mean COPD because it is more familiar to most
patients. I think it has more to do with imprecision in
choice of words than misdiagnosis.

While yuo are trying to find a treatable cause, the
treatment of the edema is mostly leg elevation, compression
stockings, and avoidance of salt and medicines that cause
fluid retention. There is some role for diuretics but, as I
said before, if your heart and kidneys are normal 40 mg
should be more than enough (no matter how big you are).
After a point it may do more harm than good.