How to reduce pain and swelling in my elderly mother's ankles?

January 1, 2024 12:15 PM

Mom is 83 and back to walking with a walker after being bedridden for 1.5 years due to a now-healed stage 4 pressure wound. She is sore all over for known and unknown reasons and is on major pain meds. She has pre-existing back issues and a repaired hip fracture. The problem is that her ankles are sore and swollen and it is discouraging as well as stalling her progress. She has compression socks and takes a daily diuretic.

My 83 year old mother was bedridden for almost 1.5 years and started walking again about a year ago today. It was slow going and painful and her PT team was confoundingly bad. They told us that she would probably never walk again, but here she is. She has spinal stenosis, a repaired hip fracture, and potentially arthritis. She walks very slowly with a walker.

Mom is incredibly motivated, is on a number of pain meds (and regular epidural steroid injections) and has a decent doctor. She is now almost fully mobile but swollen and painful ankles are interfering with further progress. Her legs hurt too but only the ankles are swollen.

Doc prescribed a daily diuretic and elevated feet. She wears light compression socks. Some days are better than others.

We keep bringing this up to nurses, caregivers, doctors and are not getting any concrete or helpful feedback except to keep using the socks. They think it's just strain from all of the movement after so much time in bed.Obviously YANMD but has anyone here run into this kind of thing with an aging parent and have you found anything that works? Massage? Diet? I'm at a loss. I am a part time caregiver for mom and also her point person with the medical world. None of her docs/nurses are able to help us get things under control although the diuretic appears to be working most days.

Can you help? I will be around to answer any questions. Thank you!

posted by lakersfan1222 to Health & Fitness (28 answers total)

Have you tried heavier-duty compression socks? Prescription-level socks exist, as do custom-made compression garments. (I watched my friend with cancer use these during her treatment.) That may be overkill, but maybe as step one, try going up on the compression?

The warning I'll give you as that as the compression increases, it becomes harder to get them on/off. It may be more than your mom can handle, but still might be worth a try.
posted by BlahLaLa at 12:31 PM on January 1 [3 favorites]

How’s her blood pressure and pulse? Is she short of breath? Has she had a diagnosis of heart failure?
posted by cotton dress sock at 12:38 PM on January 1 [2 favorites]

Can you get her to a pool? Walking in water could be an easier way to get her mobile.
posted by computech_apolloniajames at 12:41 PM on January 1 [8 favorites]

One long-shot thing to throw out there: A few years ago I was prescribed amlodipine (calcium channel blocker) for high blood pressure and had (as a youngish, mobile, otherwise healthy person) significant ankle and foot swelling from it. My elderly mother-in-law had the same side effect. You don’t mention any such medication but I thought it was worth bringing up just in case.

Also, this is amazing! I can’t think of a single example in my experience of someone returning to walking after that duration of immobility at even close to that age. So, hats off to your mom!
posted by staggernation at 12:42 PM on January 1 [10 favorites]

For edema, my father's cardiologist swore by applying a lotion to the legs that includes Ammonium lactate 2 x daily (AmLactin is one that is available over the counter). Just don't use it between the toes. He also encouraged the exercising in water that my father was already doing. (If that lotion winds up not helping or causing irritation, then try pure organic cold pressed sunflower seed oil. If nothing else, the gentle massaging that goes along with applying lotion or oil might have a positive effect.)

Diuretics can sometimes throw off your electrolytes and cause some muscle cramping, so check the diuretic she is on and any possible side effects and check in with the doctors about that.
posted by gudrun at 1:26 PM on January 1 [1 favorite]

Response by poster: The question about her heart is interesting. I have not heard anyone mention this. She has a doc appointment tomorrow and I will ask about that. Since she has been bedridden and on pain meds, her blood pressure was verrry low and almost back to normal now. Maybe it is her heart.

Otherwise, we are going to look into all of the above. Mostly these ideas are all new to us. Please keep em coming.

And yes, she is amazing. A number of people have noted that she is a rare case!!! We are ecstatic, which is why we are hoping to help with the painful ankles! Many docs and aides told us that she would not walk again.
posted by lakersfan1222 at 1:50 PM on January 1

major pain meds
I was prescribed amlodipine

This. It would help a lot if you would give us her medications with dosages. Some medications can cause swelling, amlodipine being the most common. High dose opiates (over 100 mg-morphine-equivalent daily) actually increase pain.

Essential blood tests are: creatinine, albumin, BNP, TSH, uric acid.
posted by neuron at 1:55 PM on January 1 [2 favorites]

Response by poster: Morphine ER 30mg 2x
HCTZ diuretic 12.5mg 1x
Celecoxib 200mg 1x
Gabapentin 400mg 4x
Methocarbamol 500mg 2x (was a PRN, now scheduled)

She has a percoset PRN, I don't have that dosage on hand, she takes one maybe 2 out of 7 days..
posted by lakersfan1222 at 2:06 PM on January 1

The opiate doses are okay.

Celecoxib will sometimes cause ankle swelling, especially if there is poor kidney function (an 83 year old's kidney function is about half that of a young adult). If her eGFR (a number derived from her blood creatinine level) is below 50, consider replacing celecoxib with acetaminophen. Or replacing celecoxib with topical diclofenac (Voltaren) gel, although she might have difficulty applying that herself.
posted by neuron at 2:28 PM on January 1 [1 favorite]

Is she elevating her legs when not walking? I see you mention the doc recommended it. Mom's doc had suggested elevating for years but she hated it, so didn't do it until circumstances forced it, and now she's in so much better shape (as far as the ankles go). The other thing they recommended was walking as much as possible with the walker, but it sounds like your mom is rocking that part. Go her (and you for trying to help!).
posted by ldthomps at 2:42 PM on January 1

A couple more ancillary recommendations: mom is getting private-pay PT, and he's been Great. We found him through her elder-care social-worker that we found through the local senior services. It's frustrating how much knowing the good people helps, but the social worker has been very helpful on that and several other fronts.
posted by ldthomps at 2:45 PM on January 1 [2 favorites]

I am slowly recovering from swollen legs, ankles and feet following surgery and an extended stay in hopsital. I am only a daily diuretic. However my GP told me that recovery also requires compression stockings, elevation and massage. You can look up massage techniques for fluid retention. Elevation is really important. Not just off the feat - but getting the feet higher then your heart. I currently am elevating my feet for half an hour or so every 2-3 hours and I really feel the difference. Also avoid sitting on chairs with just the legs and feet hanging normally. Any time you are sitting the feet should be on some kind of footstole/rest.

My elderly aunty also has fluid retention problems, they dont think it is heart related for her. However she is on a diuretic indefinitely. It is really important when taking a diuretic that you drink lots. If you are not hyrdrated really well, your body doesnt really want to pee.

I hope your mum's feet start to feel better soon.
posted by daffodil at 2:53 PM on January 1 [1 favorite]

lower leg edema is a problem I suffer as well. Ask her PCP if she needs increased dose of diuretics (basically get the kidneys to make more urine). Lifting the legs does make a difference, but it won't be simple or comfortable, as I am 30 years younger than her! I was definitely not drinking enough liquids and I am trying to supplement with variety of tea, coffee, juice, and so on. (Even some diet sodas)
posted by kschang at 4:26 PM on January 1

Compression socks with zippers were a game changer for my spouse. I believe we ordered them on amazon.
posted by serendipityrules at 4:31 PM on January 1 [1 favorite]

She is on quite a low dose of diuretic - the HCTZ - so maybe upping that or adding a second at a low dose is a possibility. Kidney function is an important factor in making that decision, so pay close attention to her lab results. These include her eGFR and creatinine, as neuron mentioned above. Her doctor will also want to keep track of her potassium, as some diuretics reduce potassium levels, which is excreted in urine. Lower diuretic doses are less likely to cause a problem.

If she consistently elevates her legs while sitting, the fluid will gradually be released from the edematous tissue and can be absorbed by the fluid collection systems of the body (veins, lymphatic system) and then excreted by the kidneys (peed out). If it is trapped in her swollen tissues it is much more difficult to mobilize, though walking helps. It's being sedentary with her legs lower than her heart that encourages fluid collection.
posted by citygirl at 4:45 PM on January 1 [1 favorite]

Very gentle massage - lymphatic massage, I think I've heard it called? - can help with fluid flow and swelling. It's not like muscle massage, it's much lighter, but it may be worth a try
posted by Lady Li at 5:33 PM on January 1 [2 favorites]

For lower limb edema, an elderly relative was prescribed daily sessions (a.m. and p.m.) with an in-home pneumatic compression device ("half-leg" -- open-toed, zip-up inflating/massaging boots, just past the knee; example). Medicare covered this durable medical equipment, and the local contractor's tech delivered it in a couple of days, set it up, and demonstrated proper use. The sessions are done in a reclining lounge chair, to elevate the feet.
posted by Iris Gambol at 5:49 PM on January 1 [2 favorites]

>Since she has been bedridden and on pain meds, her blood pressure was verrry low and almost back to normal now.

How low?
posted by cotton dress sock at 6:19 PM on January 1

My buddy the kidney doctor thinks that physicians are way to prone to letting patients develop bad cases of swollen limbs (usually lower limbs) due to fluid retention, when that is bad for the patients and their health. And is (almost always) completely controllable via diuretics plus the other techniques mentioned upthread. Those include good-quality compression socks, keeping legs elevated above the heart at least part of each day and such.

But he tends to get appalled at doctors who see patients come in with legs as thicks as elephants' to the point it is having a huge impact on their daily mobility and general health, and they're just "whelp nothing we can do about that!!/!!!!11!!"

(He makes that point in at least a few of the videos linked above - sorry I don't know an exact link or timestamp for a specific one.)

So DEFINITELY have this discussion with the doctor at next and any future appointments. Follow up on this prett aggressively as it isn't just a ho-hum superficial problem, but something that affects quality of life (and health) in a pretty major way.

As others mentioned, 12.5mg HCTZ is a super low dose. I've been on 25mg for like the past 30 years. Even 25mg is on the medium end of things and the type of prescription you can take for 30 or 50 years (if needed) without negative health ramifications.

Often they'll give people something like lasix - not permanently, but for a week or two. It helps tremendously to get that fluid off and improve quality of life and mobility.

That is a specific thing you can ask the doctor about.

FWIW my dad has had situations like that twice in the past couple of years and is going through another one now. The swollen lower legs lead to skin lesions and infection, among other things. When things finally reach a breaking point they jump in with lasix and other "emergency" measures and suddenly the problem is solved. Why don't they do more to prevent it from becoming a problem in the first place? Like my friend the kidney doctor, I think too many doctors tend to underplay this as an issue in older people.
posted by flug at 9:54 PM on January 1 [2 favorites]

There's an Area Agency on Aging everywhere in the US. Look for a referral for a great visiting nurse or PT who can do therapeutic massage, chair exercise, gentle walking. My friend who is old and experiencing dementia has some caregivers who are especially good at providing mental and physical stimulation. Word of mouth may be the best way to find someone.

Also, make sure her diet has sufficient fruit, veg and fiber. Constipation weighs people down, makes the body slower and less effective. Morphine causes constipation, so it's even more important. As people age, it's really common and it can be resolved, with good allover health benefits.
posted by theora55 at 7:36 AM on January 2

Agreeing that changing up the dosage or type of diuretic might help. I've been on that level for blood pressure and it does relatively little for me as a diuretic, but when I was put on Diamox for IIH, it was like opening a tap. Not to say she should try that one specifically, but just to suggest that another might affect her differently.
posted by notquitemaryann at 9:22 AM on January 2

Response by poster: BP today at the doc office: 90/60
posted by lakersfan1222 at 9:24 AM on January 2 [1 favorite]

Has your mom been evaluated for lymphedema?
posted by Iris Gambol at 12:40 PM on January 2

Realized I forgot to mention that protein is important in reducing fluid. It plays a role in holding in the right place (sorry not a great technical description). If your protein level are low - they look at something called albion in my blood tests - it makes it harder to get rid of the fluid. I am trying to eat high protein at the moment and am also taking a hospital grade protein supplement.
posted by daffodil at 1:32 PM on January 2

What did the doctor say? What are next steps?
posted by cotton dress sock at 1:58 PM on January 2

High carb consumption makes my body sore and bloated. This goes double for places where I have arthritis, like my knees.

If I cut way back on the carbs, problem solved. I need do nothing else.

If your mom eats a lot of starchy carbs with little other nutritional content, like bread and potatoes, it's something to evaluate.
posted by rabia.elizabeth at 1:44 AM on January 3

FWIW, adding an egg or some chicken or other proteins to my meals as well as force myself to get off my butt and start walking has actually reduced my ankle edema. I still ache like a (bleep) when I tried to get up in the middle of the night by my midnight leak, and my lower calves felt like they're in a set of vices when I got up, but they went away once I woke up and started walking properly.
posted by kschang at 6:09 PM on January 4

Hope your mom's doing well, with the massage thingie and updated treatment and diet. I saw my doctor, and he just said, get out there and walk around, no change in meds, and I do feel a bit better. My ankle and lower leg edema is mostly gone, and only a tinge of ankle pressure when I wake up at night and need a midnight leak. I did make myself go out and walk around for 30 minutes or more, not just in the house, but outside, shoes, socks, and everything. Do what you can to keep your mom moving. Good luck and good health.
posted by kschang at 11:35 AM on January 16