Sorry if this is not articulate. My encephalopathy is making itself know in a big way so please bare with me...here goes.
From what I understand, you seem to be saying that you have edema but not ascites? And you are only taking Lasix now. So apparently your illness has progressed and needs more help eliminating the edema?
(Check out the articles below that explain how ascites and (perhaps more useful) edema develops and functions).
A couple of dumb questions first.
1. How is your salt intake? The only reason I ask is that if I have too much salt in my diet the meds don't work as effectively. Remember to stay under 2000 mg. sodium per day. Read labels on processed food and avoid salty foods.
2. Do you have "pitting".
1. Other meds similar to Lasix are torsemide (Demadex) and butethamine (Bumex). I never tried these and everyone I know is taking the standard Spironlactone and Lasix combo as we all have both symptoms which seem to occur in tandem.
(There is another med for Spironolactone, Aldactone, but it is not as effective for me and many others. I tried it for a month or two but didn't control my ascites as well as the Spironolactone. I am back on Spironolactone. I had switched because of the "tender and enlarged breasts" but would rather deal with that then ascites and edema).
2. It eliminates the fluid in the same way. It is nothing to worry.
Remember that Spiron and Lasix are normally use in combination in order to keep Potassium levels in balance. Spironolactone and Aldactone cause the body to retain potassium Lasix decreases potassium. That is why there is a formula for for how much dosage should be taken of each. Together they work to keep potassium levels normal.
Which diuretics are used to treat edema?
Edema can become a problem in systemic diseases of the heart, liver or kidneys. Diuretic therapy can be initiated, often alleviating the edema. The most potent diuretics are loop diuretics, so-called because they work in the portion of the kidney tubules referred to as the loop of Henle. The kidney tubules are small ducts that regulate salt and water balance, while transporting the forming urine. Clinical loop diuretics available are:
* furosemide (Lasix),
* torsemide (Demadex), and
* butethamine (Bumex).
The doses of these diuretics vary depending upon the clinical circumstances. These drugs can be given orally, although seriously ill patients in the hospital may receive them intravenously for more prompt or effective response. If one of the loop diuretics is not effective alone, it may be combined with an agent that works further down (more distally) in the tubule. These agents include the thiazide type diuretics, such as hydrochlorothiazide (HydroDIURIL), or a similar but more potent type of diuretic called metolazone (Zaroxolyn). When diuretics that work at different sites in the kidney are used together, the response often is greater than the combined responses to the individual diuretics (synergistic response).
Some diuretics frequently cause an excessive loss of potassium in the urine, leading to the depletion of body potassium. These drugs include the loop diuretics, the thiazide diuretics, and metolazone. Patients on these diuretics are commonly advised to take potassium supplements and/or to eat foods high in potassium. High potassium foods include certain fruits such as:
* orange juice,
* tomatoes, and
As cirrhosis of the liver develops, signals are sent to the kidneys to retain salt and water. This excess fluid first accumulates in the tissue beneath the skin of the ankles and legs (due to the pressure of gravity). This accumulation of fluid is called edema or pitting edema. Pitting edema refers to the observation that pressing a fingertip against a swollen ankle or leg causes an indentation that persists for some time after release of the pressure. Actually, any type of sufficient pressure, such as from the elastic part of socks, can produce pitting edema. The swelling often is worse at the end of the day and may lessen overnight. As more salt and water are retained and liver function decreases, fluid may also accumulate in the abdomen. This accumulation of fluid (called ascites) causes swelling of the abdomen.
"Peripheral edema, which is usually seen as pitting edema of the legs and feet, also occurs in cirrhosis. The edema is a consequence of the hypoalbuminemia and activation of the renin-angiotensin-aldosterone hormonal system, which prompt the kidneys to retain salt and water".
If the diuretic isn't helping the swelling, could the swelling from another cause, such as osteoarthritis?
I'm pretty sure that if lasix "stops working" they can prescribe a diuretic pill for you that contains more than one type of diuretic. There are 3 basic types of diuretics; each of which work in a different way. Attached is a link describing diuretics by Mayo Clinic.
Good luck with this.
Maybe you could find someone who does Manual Lymph Drainage. It works well for edema, burn victims, patients who have had lymph nodes removed and it feels wonderful, it is so gentle and rhythmic. Anyone who is certified has had extensive training and is competent to work with serious illness. with consent from Dr.
I believe it is out of Austria, and Germany, where they do extensive manual therapies.
In addition to what Hector said, watch the foods you buy as they always
seem to have salt,sodium in them. You have to be very careful.
Stay clear of MSG also. You have to read the labels of everything you purchase for
food with edema.
Consult with your hepatologist also, as they can change your diuretic or up the dose.
Also, what helped my son a lot is.....after being on your feet all day.....try and
elevate your legs and feet at the end of the day, if possible raise them above the heart.
It really does help. His team also said to raise the mattress at the end of the bed at night.
(he tried that, however , could not sleep)
We went from boots to sandals to socks to nothing...as the feet and legs swelled and
sometimes cracked. Some of these little things in addition to the advice of your hepatologist
I sincerely wish you the very best.
Hector , it looks like you're doing OK from here !!! all my very best to you as well Hector.
Keep me informed:)
Another thing that helps move lymph is a bouncing motion, like a physioball, or a mini trampoline. very gently, very consistently,
Hector: My doc recently switched me from Spironolactone to inspra (eplerenone) due to the breast enlargement issues. The tenderness has subsided and, so far, the edema is under control. Hopefully, this will prevent me from graduating to a b cup :0. I'm not sure if this combo will work for you, but it may be worth checking into. Be well!
Fretboard: As usual, Hector has pretty much covered everything. I'm not sure what dose you are on, but it may need to be increased. Whatever you do, please make sure to keep an eye on your potassium levels when taking diuretics.
I wasn’t aware you were cirrhotic, Fretboard. Has this edema been formally attributed to liver disease?
Other possible causes of edema are right side heart failure, kidney issues, and DVT of the legs (especially if only apparent on one side).
Is the edema painful? It’s my understanding that edema itself isn’t damaging, but that it can be flagging something potentially more serious.
Others have given you some really good thoughts; I just had to butt in myself :o).
Oops, rereading, it looks like Hector pretty much covered everything I mentioned.
"graduating to a b cup" hmmmm...I think I'm still an "A' cup. (Any ladies that can tell me the difference between "A" and "B" cups would be appreciated). I figure it makes be look more muscular in the chest. Buff. Maybe the encephalopathy is worse then I know? ha ha
The sensitivity is what drives me crazy. If anything just pushes on my nipples it gets my attention real fast. Biting? Forget about it. I will hit the ceiling. But not in a good way, if you know what I mean. ;-)
Ah, the many joys of decompensated cirrhosis.
If you are able to bite them, you've obviously grown beyond an A cup ;)
Seriously, though, the change in meds has dramatically improved the sensitivity issue for me!!!
I appreciate the comments friends!. I guess I better start taking my fully prescribed dosage levels, it just seems like way to much for me and I've been really leery about taking the spironlactone. I'm supposed to take 3 of those spironlactones a day of the 25mg tablets and a 20 mg lasix. I'm gonna talk to my doctor again too b/c I think I was doing better when I was on 40mg lasix. I didn't need 40 mgs every single day but I think I need more than the 20mgs that's for sure. I work hard to stay away from salt but I guess I'll have to get even more aggressive. anyways, thanks again gang!!
Trying to stay away from salt is a full-time occupation. But it s a must! The meds won't be effective if you are taking in too much sodium. Sodium is everywhere! After awhile you'll get used to it. No processed food. No restaurant food (loaded with salt for flavor). Just a can of soup can be 40% of your daily intake. Just look on the labels at sodium. What out for the "Reduced salt" labels. They still have a lot of salt. You must look at sodium per serving. Also remember edema doesn't change in a day. It is like HCV treatment, it builds up in the body. If I become bloated it take me 2 weeks to get it back under control. So you need to be consistent day to day with your sodium intake and meds.
The good news is you live in California. Look in health food stores. They usually will have foods with a ton of salt. But be careful. It may be organic, healthy etc. but they still put as much sodium in many of the foods as the regular brands.
Remember to increase the effects of the dialectics, your doctor will increase BOTH meds. I currently take Spiro 100 mg and Lasix 40 mg. Used to take 200 & 80. They work in combination. Now that you will be talking both together the diuretic effect will be more then Lasix alone. This is what you want. You should notice your peeing more then before.
Gotta go an have endoscopy...later
Good luck. Let us know how it goes.