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(Water / Fluid Retention / Dropsy)
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Edema, formerly called dropsy, is the accumulation of fluid in spaces between the cells of the soft tissues of the body (body tissues or interstitial spaces) which causes the tissues to swell and expand in size. Most of the body's fluids that are found outside of the cells are normally stored in two spaces; the blood vessels (where the fluids are called the blood volume) and the interstitial spaces (where the fluids are called the interstitial fluid).
Edema most often occurs in the feet, ankles, and legs, but any part of the body may develop edema. In various diseases, excess fluid can accumulate in either one or both of these compartments. The swelling can be localized in the face, arms and neck, or may involve the legs, ankles and feet, known as dependent edema. The body's organs also have interstitial spaces where fluid can accumulate. For example, an accumulation of fluid in the interstitial air spaces (alveoli) in the lungs occurs in heart failure and is called pulmonary edema. In addition, excess fluid sometimes collects in what has been called the third space, which includes cavities in the abdomen (abdominal or peritoneal cavity) or in the chest (lung or pleural cavity). The term anasarca refers to the severe, widespread accumulation of fluid in the various tissues and cavities of the body.
The bloating and swelling of edema in turn cause muscle aches and pains.
TYPES OF EDEMA
Anasarca Edema: Generalized swelling all over the body. Dependent or Peripheral Edema: Swelling in the feet, ankles, and legs. Peri-orbital Edema: Swelling around the eyes. Corneal Edema (Corneal Stroma): Swelling in the cornea of the eye. Preeclampsia: A condition that occurs in 5 percent of pregnant women that results in high blood pressure, edema (fluid accumulation in the tissues) and protein (albuminuria) in the urine. For more information see:
MoonDragon's Pregnancy Information: Preeclampsia-Eclampsia-Toxemia
PITTING EDEMA VS NON-PITTING EDEMA
Pitting edema can be demonstrated by applying pressure to, for example, the skin of a swollen leg or foot, by depressing the skin with a finger. If the pressing causes an indentation in the skin that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Actually, any form of pressure, such as from the elastic part of socks, can induce the pitting of this edema.
In non-pitting edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a radical mastectomy, or congenital lymphedema. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shins that occurs in some patients with hypothyroidism (underactive thyroid gland). Non-pitting edema of the legs is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling.
Pitting edema is caused by either systemic diseases, that is, diseases that affect the various organ systems of the body, or by local conditions involving just the affected extremities. The most common systemic diseases that are associated with edema involve the heart, liver, and kidneys. In these diseases, edema occurs primarily because of the body's retention of too much salt (which is the chemical compound sodium chloride). The excess salt holds excess water in the interstitial tissue spaces, where the retained surplus of fluid is recognized as edema. Idiopathic (of unknown cause) edema, also sometimes called cyclical edema, occurs most often in women and just prior to each menstrual period. The most common local conditions that cause edema are varicose veins and thrombophlebitis (a blood clot with inflammation of the veins) of the deep veins of the legs. These conditions can cause inadequate pumping of the blood by the veins (venous insufficiency). The resulting increased back-pressure in the veins forces fluid to leak into the interstitial tissue spaces, where the retained excess fluid is recognized as edema.
EDEMA FREQUENT SIGNS & SYMPTOMS
Swelling of extremities. Unexplained weight gain. Tightness of ring on fingers or shoes. Puffiness of face. Enlarged abdominal girth. Persistence of indentation of skin following pressure (pitting edema).
Edema can occur anywhere in the body, so consider these factors when assessing your client or patient. Disorders such as heart failure and cirrhosis, or local conditions such as venous stasis and poor lymphatic drainage, can cause edema. Edema may be visible and measurable, as in localized or pitting edema, or it may be generalized.
Certain signs and conditions may signal edema. Begin your assessment by asking the following questions:
"Have you recently gained any weight?""
"Are your shoes or rings tighter than usual?"
"Does your face feel swollen?"
"Have you had to loosen your belt or waistband recently?"
"Have you developed a cough?"
"Have you recently had surgery?"
"Are you pregnant?"
Next, look for edema in dependent body parts, such as the legs or the sacrum. Any position that is comfortable for your client/patient is acceptable. Explain what you are doing as you assess her.
Pitting may or may not occur with edema. To assess for pitting, press your fingertip against a bony prominence for 5 seconds, then remove your finger. If the tissue rebounds immediately, the client/patient does not have pitting edema. An indentation indicates pitting edema, which you will grade according to your institution's policy or on a scale of 1 to 4. However, these grades are subjective and may not be a sensitive indicator of the severity of edema. Here are other factors to consider:
Weight. Daily weights are more sensitive indicators of water gain or loss. Client/Patient position. Does edema shift after lying down all night or been up for several hours? Pattern. Does the extent of edema vary over a 24-hour period? Are changes unilateral or bilateral? Extent. Is the edema limited to one area, such as the foot, or does it extend beyond that area, such as to the knee?
If the patient has edema, the health care team or midwife should determine and treat the cause. Check her pulses, heart sounds, breath sounds, and level of consciousness to assess for a life-threatening problem, such as heart or kidney failure.
EDEMA PITTING TEST
To check if swelling is edema (such as found in the feet, ankles, and legs), press firmly with your finger against swollen area (A). Hold finger for 5 seconds and release (B). With edema (as compared to fatty tissue), there will remain an indentation remaining in the tissue (C).
This test is often used for testing for pregnancy-related edema.
DEGREE SCALE FOR ASSESSING PITTING EDEMA
To assess for pitting edema, gently press the skin on the affected extremity for at least 5 seconds. Release and grade pitting as follows:
0 No indentation No pitting edema +1 2-mm or less indentation. Mild pitting edema that disappears rapidly. +2 2 to 4-mm indentation. Moderate pitting edema that disappears in 10 to 15 seconds. No readily detectable distortion. +3 4 to 6-mm indentation. Moderately severe pitting edema that may last more than 1 minute. Dependent extremity looks fuller and swollen. +4 6 to 8-mm indentation. Severe pitting edema that can last more than 2 minutes, as long as 5 minutes. Dependent extremity is grossly distorted.
The most accurate way to determine the degree of non-pitting edema is to measure the circumference of the extremity and compare measurements versus the other extremity and subsequent measurements. Measure at the point of edema, then mark the point with a skin marker so everyone will assess the same area. Accuracy is greatest if you take measurements at the same time every day, preferably in the morning before the patient gets up.
The underlying causes of edema may be serious. Edema can indicate a much more profound illness, such as AIDS, cirrhosis of the liver, congestive heart failure, diabetes, or vena cava syndrome (narrowing of the vein that supplies blood from the upper body to the heart). More simply, edema can occur as the result of infection or prolonged bed rest. Fluid retention can also be caused by allergies.
Edema (fluid retention) may be caused by allergies.
Edema may also occur as a result of trauma or surgical procedures.
Many women develop some degree of edema during pregnancy. When combined with other symptoms (such as abnormally high blood pressure, excessive weight gain, protein in the urine, blurred, vision, headache, irritability and abdominal pain), preeclampsia/eclampsia (toxemia of pregnancy also called pregnancy induced hypertension) may be diagnosed.
Persistent edema may be caused by kidney, bladder, heart, liver disorders.
Poor diet; protein deficiency; sodium retention; poor magnesium/calcium balance; high carbohydrate diet. For more information about nutrition and diets see:
Drug abuse; over use of laxatives or diuretics; oral contraceptives.
Premenstrual syndrome (PMS).
EDEMA DISEASE SUMMARY
Edema is a swelling, usually of the legs, due to the accumulation of excessive fluid in the tissues. The edema that occurs in diseases of the heart, liver, and kidneys is mainly caused by salt retention, which holds the excess fluid in the body. In certain liver and kidney diseases, low levels of albumin in the blood can contribute to fluid retention. Heart failure, cirrhosis of the liver, and a kidney disease called nephrotic syndrome are the most common systemic diseases that cause edema. Excess fluid that accumulates in the lungs is called pulmonary edema. Excess fluid that accumulates in the abdominal cavity is called ascites. Edema of unknown cause occurs primarily in women. Varicose veins or thrombophlebitis (a blood clot in an inflamed vein) of the deep veins in the legs causes edema that is localized to the legs. Therapy for edema consists of treating the underlying conditions, restricting salt intake, and often using diuretics (medicines to induce urination).
PREGNANCY & NORMAL EDEMA
Why are my ankles and toes so swollen? What you are experiencing is edema - that is the medical term for when excess fluid collects in your tissue. It is normal to have a certain amount of this swelling during pregnancy because you retain more water while you are pregnant, and certain changes in your blood chemistry cause some fluid to shift into your tissue.
Why does it collect in the legs and feet? When you are pregnant, your growing uterus puts pressure on your pelvic veins and on your vena cava (a large vein on the right side of your body that receives blood from your lower limbs and carries it back to the heart). The pressure slows down circulation and causes blood to pool in your legs, forcing fluid from your veins into the tissues of your feet and ankles. This increased pressure is relieved when you lie on your side. And since the vena cava is on the right side of your body, left-sided rest works best.
Edema is most likely to be an issue during your third trimester, particularly at the end of the day, and it may be worse during the summer. After you have your baby, the swelling will disappear fairly rapidly as your body eliminates the excess fluid. As a result, you may find yourself urinating frequently and sweating a lot in the first days after childbirth.
When should I be concerned about swelling? A certain amount of edema is normal in the ankles and feet during pregnancy. You may also have some mild swelling in your hands. However, call your midwife or health care provider if you notice swelling in your face or puffiness around your eyes, more than slight swelling of your hands, or excessive or sudden swelling of your feet or ankles. It could be a sign of preeclampsia, a serious condition. Also call your caregiver if you notice that one leg is significantly more swollen than the other, especially if you have any pain or tenderness in your calf or thigh. See MoonDragon's Pregnancy Concerns: Preeclampsia/Eclampsia (Toxemia of Pregnancy/Pregnancy Induced Hypertension) for more information.
MINIMIZING EDEMA PUFFINESS DURING PREGNANCY
Here are a few tips:
And try not to let it get you down. Although the sight of your swollen ankles will probably add to your feelings of ungainliness, edema is a temporary condition that will pass soon after you give birth.
- Put your feet up whenever possible. At work, it helps to keep a stool or pile of books under your desk; at home, lie on your left side when possible. Don't cross your legs or ankles while sitting.
- Stretch your legs frequently while sitting: Stretch your leg out, heel first, and gently flex your foot to stretch your calf muscles. Rotate your ankles and wiggle your toes.
- Take breaks from sitting or standing. Take a short walk every so often to keep your blood circulating.
- Wear comfortable shoes that stretch to accommodate the swelling. Do not wear socks or stockings with tight bands around your ankles or calves.
- Try waist-high maternity support stockings. Put them on before you get out of bed in the morning, so blood has no chance to pool around your ankles.
- Drink plenty of water. Surprisingly, this helps your body retain less water.
- Exercise regularly, especially by walking, swimming, or riding an exercise bike. Or try a water-aerobics class - immersion in water can help reduce swelling, particularly if the water level is up near your shoulders.
- Eat well, and avoid junk food. See MoonDragon's Nutritional Pages with Dietary Guidelines for more information.
SALT INTAKE & EDEMA
The body's balance of salt is usually well-regulated. A normal person can consume small or large quantities of salt in the diet without concern for developing salt depletion or retention. The intake of salt is determined by dietary patterns and the removal of salt from the body is accomplished by the kidneys. The kidneys have a great capacity to control the amount of salt in the body by changing the amount of salt eliminated (excreted) in the urine. The amount of salt excreted by the kidneys is regulated by hormonal and physical factors that signal whether retention or removal of salt by the kidneys is necessary. One of the most important hormonal factors is the renin-angiotensin-aldosterone hormonal system. An important physical factor is the flow of blood to the kidneys.
If the flow of blood to the kidneys is decreased by an underlying condition such as heart failure, the kidneys react by retaining salt. This salt retention occurs because the kidneys perceive that the body needs more fluid to compensate for the decreased blood flow. If, on the other hand, the client/patient has a kidney disease that impairs the function of the kidneys, the ability to excrete salt in the urine is limited. In both of these conditions, the amount of salt in the body increases, which causes the client/patient to retain water and develop edema.
People experiencing a disturbance in their ability to normally excrete salt may need to either be placed on a diet limited in salt and/or given diuretic medications. In the past, patients with diseases associated with edema were placed on diets that were very restricted in salt intake. With the development of new and very potent diuretic agents, this marked restriction in dietary salt intake is generally no longer necessary. These diuretics work by blocking the reabsorption and retention of salt by the kidneys, thereby increasing the amount of salt and water that is eliminated in the urine.
Unless otherwise recommended by your health care provider or midwife, pregnant women should not limit their salt intake since they need the sodium for the expansion of their blood volume which occurs during their pregnancies. However, this does not mean that they should overdo it. Pregnant women should use salt in moderation during their pregnancies and follow a pregnancy diet especially designed for a pregnant women with sufficient protein intake and nutrients. See MoonDragon's Nutritional Pages with Dietary Guidelines and MoonDragon's Pregnancy Information: Toxemia of Pregnancy (Preeclampsia-Eclampsia) for more information.
HEART DISEASE & FLUID RETENTION
Heart failure is the result of poor cardiac function and is reflected by a decreased volume of blood pumped out by the heart, the so-called cardiac output. Heart failure can be caused by weakness of the heart muscle, which pumps blood out through the arteries to the entire body, or by dysfunction of the heart valves, which regulate the flow of blood between the chambers of the heart. The diminished volume of blood pumped out by the heart (decreased cardiac output) is responsible for a decreased flow of blood to the kidneys. As a result, the kidneys sense that there is a reduction of the blood volume in the body. To counter the seeming loss of fluid, the kidneys retain salt and water. In this instance, the kidneys are fooled into thinking that the body needs to retain more fluid volume when, in fact, the body already is holding too much fluid.
This fluid increase ultimately results in the buildup of fluid within the lungs, which causes shortness of breath. Because of the decreased volume of blood pumped out by the heart (decreased cardiac output), the so-called effective blood volume in the arteries is decreased, despite the actual increase in the body's total fluid volume. An associated increase in the amount of fluid in the blood vessels of the lungs causes shortness of breath because the excess fluid from the lungs' blood vessels leaks into the airspaces (alveoli) in the lungs. This accumulation of fluid in the alveoli is called pulmonary edema. At the same time, accumulation of fluid in the legs causes pitting edema. This edema occurs because the build-up of blood in the veins of the legs causes leakage of fluid from the legs' capillaries (tiny blood vessels) into the interstitial spaces.
An understanding of how the heart and lungs interact will help you to better comprehend how fluid retention works in heart failure. The heart has four chambers; an auricle and a ventricle on the left side of the heart and an auricle and ventricle on the right. The left auricle receives oxygenated blood from the lungs and transfers it to the left ventricle, which then pumps it through the arteries to the entire body. The blood then is transported back to the heart by veins into the right auricle and transferred to the right ventricle, which then pumps it to the lungs for reoxygenation.
Left-sided heart failure, which is due primarily to a weak left ventricle, usually is caused by coronary artery disease, hypertension, or disease of the heart valves. Typically, when these people initially come to their health care provider, they are troubled by shortness of breath with exertion and when lying down at night (orthopnea). These symptoms are due to pulmonary edema that is caused by pooling of the blood in the vessels of the lungs. In contrast, right-sided heart failure, which often is due to chronic lung diseases such as emphysema, initially causes salt retention and edema. Persistent salt retention in these clients/patients, however, may lead to an expanded blood volume in the blood vessels, thereby causing fluid accumulation in the lungs (pulmonary congestion) and shortness of breath. In patients with heart failure due to weak heart muscle (cardiomyopathy), both the right and left ventricles of the heart are usually affected. These clients/patients, therefore, can initially suffer from swelling both in the lungs (pulmonary edema) and in the legs and feet (peripheral edema). The health care provider examining a patient who has congestive heart failure with fluid retention looks for certain signs. These include pitting edema of the legs and feet, rales in the lungs (moist crackle sounds from the excess fluid that can be heard with a stethoscope), a gallop rhythm (three heart sounds instead of the normal two due to muscle weakness), and distended neck veins. The distended neck veins reflect the accumulation of blood in the veins that are returning blood to the heart.
LIVER DISEASE: DEVELOPING ASCITES & EDEMA
In people with chronic diseases of the liver, fibrosis (scarring) of the liver often occurs. When the scarring becomes advanced, the condition is called cirrhosis of the liver. Ascites is fluid that accumulates in the abdominal (peritoneal) cavity. It is a complication of cirrhosis and appears as an abdominal bulge. The peritoneum is the inner lining of the abdominal cavity, which also folds over to cover the organs inside the abdomen such as the liver, gallbladder, spleen, pancreas, and intestines. Ascites develops because of a combination of two factors:
(1) Increased pressure in the vein system that carries blood from the stomach, intestines, and spleen to the liver (portal hypertension)
(2) A low level of albumin in the blood (hypoalbuminemia).
Albumin, which is the predominant protein in the blood and which helps maintain blood volume, is reduced in cirrhosis primarily because the damaged liver is not able to produce enough albumin.
Other consequences of portal hypertension include dilated veins in the esophagus (varices), prominent veins on the abdomen, and an enlarged spleen. Each of these conditions is due primarily to the increased pressure and accumulation of blood in the abdominal blood vessels. Other signs of chronic liver disease are spider nevi (distinctive vascular malformations) on the skin, certain characteristic changes in the nails, gynecomastia (enlarged breasts), and shrinkage of the testicles (testicular atrophy). The fluid of ascites can be removed from the abdominal cavity by using a syringe and a long needle. This procedure is called paracentesis. Analysis of the fluid can help differentiate ascites that is caused by cirrhosis from other causes of ascites, such as cancer, tuberculosis, congestive heart failure, and nephrosis. Sometimes, when ascites does not respond to treatment with diuretics, paracentesis can be used to remove large amounts of the ascitic fluid.
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. The presence or absence of edema in patients with cirrhosis and ascites is an important consideration in the treatment of the ascites. In people with ascites without edema, diuretics must be given with extra caution. The reason for this is that a diuresis (induced increased volume of urine) that is too depleting or rapid in these people can lead to a low blood volume (hypovolemia), which can possibly be followed by kidney and liver failure. In contrast, when people who have both edema and ascites undergo diuresis, the edema fluid in the interstitial space serves as somewhat of a buffer against the development of low blood volume. The excess interstitial fluid moves into the blood vessel spaces to rapidly replenish the depleted blood volume.
EDEMA & KIDNEY DISEASE
Edema forms in people with kidney disease primarily for one of two reasons: either a heavy loss of protein in the urine or impaired kidney (renal) function. In the first situation, the people have normal or fairly normal kidney function. The heavy loss of protein in the urine (over 3.0 grams per day) is termed the nephrotic syndrome and results in a reduction in the concentration of albumin in the blood (hypoalbuminemia). Since albumin helps to maintain blood volume in the blood vessels, a reduction of fluid in the blood vessels occurs. The kidneys then register that there is depletion of blood volume and, therefore, attempt to retain salt. Consequently, fluid moves into the interstitial spaces, thereby causing pitting edema.
The treatment of fluid retention in these people is to reduce the loss of protein into the urine and to restrict salt in the diet. The loss of protein in the urine may be reduced by the use of ACE inhibitors and angiotensin receptor blockers. Both categories of drugs, which ordinarily are used to lower blood pressure, prompt the kidneys to reduce the loss of protein into the urine. Examples of ACE inhibitors drugs are enalapril (Vasotec), quinapril (Accupril), captopril (Capoten), benazepril (Lotensin), lisinopril (Zestril or Prinivil), and ramapril (Altase). Examples of angiotensin receptor blockers are losartan (Cozaar), valsartin (Diovan), candesartin (Atacand), and irbesartan (Avapro). Certain kidney diseases may contribute to the loss of protein in the urine and the development of edema. A biopsy of the kidney may be needed to make a diagnosis of the type of kidney disease, so that specific treatment, if available, can be given.
In the second situation, people who have kidney diseases that impair renal function develop edema because of a limitation in the kidneys' ability to excrete sodium into the urine. Thus, people with kidney failure from whatever cause will develop edema if their intake of sodium exceeds the ability of their kidneys to excrete the sodium. The more advanced the kidney failure, the greater the problem of salt retention is likely to become. The most severe situation is the people with end-stage kidney failure who requires dialysis therapy. This person's salt balance is totally regulated by dialysis, which can remove salt during the treatment. Dialysis is a method of cleansing the body of the impurities that accumulate when the kidneys fail. Dialysis is accomplished by circulating the person's blood over an artificial membrane (hemodialysis) or by using the person's own abdominal cavity (peritoneal membrane) as the cleansing surface. Individuals whose kidney function declines to less than 5 to 10-percent of normal may require dialysis.
Idiopathic edema is a pitting edema of unknown cause that occurs primarily in pre-menopausal women who do not have evidence of heart, liver, or kidney disease. In this condition, the fluid retention at first may be seen primarily pre-menstrually, which is why it sometimes is called cyclical edema. Subsequently, however, it can become a more constant and severe problem. Idiopathic edema is a poorly defined syndrome in which emotional factors may play a role. People with idiopathic edema understandably often take diuretics to decrease the edema in order to improve their appearance. Paradoxically, however, the edema in this condition can become more of a problem after the use of diuretics. Thus, the people can develop fluid retention as a rebound phenomenon each time they try to discontinue the diuretics. Taking diuretics for cosmetic reasons only, therefore, is inappropriate in this syndrome.
People with idiopathic edema appear to have a leak in the capillaries (tiny peripheral blood vessels that connect the arteries with the veins) so that fluid passes from the blood vessels into the surrounding interstitial space. Thus, a patient with idiopathic edema has a decreased blood volume, which leads to the typical reaction of salt retention by the kidneys. The leg edema in these people is exaggerated in the standing position, since edema tends to accumulate in those parts of the body that are close to the ground at the time. Likewise, these individuals often have edema around the eyes (periorbital edema) in the morning because the edema fluid accumulates during the night around their eyes as they lay sleeping flat. In contrast, edema around the eyes does not tend to develop in cardiac patients who keep their heads elevated at night because of shortness of breath when they lie flat. These patients characteristically experience varying amounts of edema in different parts of the body at different times of the day.
The dependence on diuretics that people with idiopathic edema often develop is difficult to interrupt. A period as long as three weeks off diuretics may be required to break the dependency cycle. The withdrawal from diuretics, however, may lead to fluid retention that produces major cosmetic problems. Furthermore, there are definite risks associated with the prolonged use of diuretics in these individuals, which risks are compounded by the tendency to increase the doses of the diuretics. As a result of chronic diuretic use and abuse, people may develop a deficiency of potassium, depletion of blood volume in the blood vessels, and kidney insufficiency or failure. Other side effects of diuretics include high blood sugar (diabetes), high uric acid (gout), muscle cramps, tender enlarged breasts (gynecomastia), and pancreatitis (inflammation of the pancreas).
Although withdrawal from diuretics is the most important factor in treating these individuals, other medications have been used to try to minimize the fluid retention. These medications include ACE inhibitors, low-dose amphetamines or ephedrine, bromocriptine, or levodopa-carbidopa in combination. However, their effectiveness is uncertain and side effects of these drugs may occur. For example, hypotension (low blood pressure) may be seen with the use of ACE inhibitors, especially if the person is also taking diuretics.
VENOUS INSUFFICIENCY & EDEMA
The veins in the legs are responsible for transporting blood up to the veins of the torso, where it is then returned to the heart. The veins of the legs have valves that prevent the blood from backing up in the veins. Venous insufficiency is incompetence of the veins that occurs because of dilation, or enlargement, of the veins and dysfunction of their valves. This happens, for example, in people with varicose veins. Venous insufficiency leads to a backup of blood and increased pressure in the veins, thereby resulting in edema of the legs and feet. Edema of the legs also can occur with an episode of deep vein thrombophlebitis, which is a blood clot within an inflamed vein. In this situation, the clot in the deep vein blocks the return of blood and consequently causes increased back-pressure in the leg veins.
Venous insufficiency is a problem that is localized to the legs. One leg may be more affected than the other (asymmetrical edema). In contrast, systemic diseases that are associated with fluid retention generally cause the same amount of edema in both legs, and can also cause edema and swelling elsewhere in the body. The response to therapy with diuretic drugs in patients with venous insufficiency tends to be unsatisfactory. This is because the continued pooling of fluid in the lower extremities makes it difficult for the diuretics to mobilize the edema fluid. Elevation of the legs periodically during the day and the use of compression stockings may alleviate the edema. Some people, however, require surgical treatment to relieve chronic edema that is caused by venous insufficiency.
Edema can become a problem in systemic diseases of the heart, liver or kidneys. Diuretic therapy then can be initiated, which often alleviates the edema. The most potent diuretics are the loop diuretics, so-called because they work in that 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. These loop diuretics are clinically available as furosemide (Lasix), torsemide (Demedex), and butethamide (Bumex). The doses of these diuretics vary depending upon the clinical circumstances. These agents 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 hydrochlorthiazide (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, therefore, are commonly advised to take potassium supplements and/or to eat foods that contain a lot of potassium. High potassium foods include certain fruits, orange juice, tomatoes, and potatoes. Patients with impaired kidney function, however, often do not require potassium supplements with their diuretics because their damaged kidneys tend to retain potassium. In certain instances, the volume of urine that is induced by the diuretic can be improved by adding a potassium-sparing diuretic, that is, one that does not cause depletion of potassium. These diuretics include spironolactone (Aldactone), triamterene (Dyrenium, which is a component of Dyazide), and amiloride (Midamor). Adding one of these diuretics to the patient's diuretic regimen may preclude the need for potassium supplements. Another diuretic that can be used is acetazolamide (Diamox), which counteracts the development of a high concentration of bicarbonate (too much alkali) in the blood. A high bicarbonate sometimes occurs in patients receiving other diuretics.
Diuretics have several other uses besides treating edema. A diuretic may be used as part of the treatment program for patients with hypertension, because retention of salt may be part of the cause of the hypertension or may be caused by some anti-hypertensive medications. In fact, most medications that dilate the blood vessels and reduce blood pressure, except for ACE inhibitors and angiotensin receptor blockers, lead to secondary salt retention by the kidneys. Thiazide diuretics also have been used to prevent the formation of kidney stones. These drugs reduce the urinary excretion of calcium, which is a component of the kidney stone. Finally, acetazolamide (Diamox) taken a few days before going to high altitudes appears to reduce the tendency for people to develop altitude sickness.
MEDICATIONS ASSOCIATED WITH EDEMA
Antidepressants: Monoamine oxidase inhibitors, trazodone. Antihypertensives: Beta-adrenergic blockers, calcium channel blockers, clonidine (Catapres), hydralazine, methyldopa, minoxidil. Antivirals: Acyclovir (Zovirax). Chemotherapeutics: Cyclophosphamide, cyclosporine (Sandimmune), cytosine arabinoside, mithramycin. Cytokines: Granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, interferon alfa, interleukin-2, interleukin-4. Hormones: Androgen, corticosteroids, estrogen, progesterone, testosterone. Nonsteroidal & Anti-inflammatory Drugs: Celecoxib (Celebrex), ibuprofen.
EDEMA MEDICAL DIAGNOSIS
To understand what might be causing your edema, your health care provider will perform a physical exam and ask you questions about your medical history. This information is often enough to determine the underlying cause of your edema. In some cases, X-rays, ultrasound exams, blood tests or urine analysis may be necessary.
The medical history should include the timing of the edema, whether it changes with postion, and if it is unilateral or bilateral, as well as a medication history and an assessment for systemic diseases. Acute swelling of a limb over a period of less than 72 hours is more characteristic of deep venous thrombosis (DVT), cellulitis, ruptured popiteal cyst, acute compartment syndrome from trauma, or recent initiation of calcium channel blockers. The chronic accumulation of more generalized edema is due to the onset of exacerbation of chronic systemic conditions, such as congestive heart failure (CHF), renal disease, or hepatic disease.
The history should also include questions about cardiac, renal, thyroid, or hepatic disease. Graves disease can lead to pretibial myxedema, whereas hypothyroidism can cause generalized myxedema. Although considered a diagnosis of exclusion, obstructive sleep apnea has been shown to cause edema. One study evaluated the apnea-hypopnea index in patients with obstructive sleep apnea and found that even when adjusted for age, body mass index, and the presence of hypertension and diabetes mellitus, the index was higher in patients who had edema.
The physical examination should assess for systemic causes of edema, such as heart failure (e.g., jugular venous distention, crackles), renal disease (e.g., proteinuria, oliguria), hepatic disease (e.g., jaundice, ascites, asterixis), or thyroid disease (e.g., exophthalmos, tremor, weight loss). Edema should also be evaluated for pitting, tenderness, and skin changes.
Pitting describes an indentation that remains in the edematous area after pressure is applied. This occurs when fluid in the interstitial space has a low concentration of protein, which is associated with decreased plasma oncotic pressure and disorders caused by increased capillary pressure (e.g., DVT, CHF, iliac vein compression).4,16 The physician should describe the location, timing, and extent of the pitting to determine treatment response. Lower extremity examination should focus on the medial malleolus, the bony portion of the tibia, and the dorsum of the foot. Pitting edema also occurs in the early stages of lymphedema because of an influx of protein-rich fluid into the interstitium, before fibrosis of the subcutaneous tissue; therefore, its presence should not exclude the diagnosis of lymphedema. Tenderness to palpation over the edematous area is associated with DVT and complex regional pain syndrome type 1 (i.e., reflex sympathetic dystrophy). Conversely, lymphedema generally does not elicit pain with palpation.
Changes in skin temperature, color, and texture provide clues to the cause of edema. For example, acute DVT and cellulitis may produce increased warmth over the affected area. Because of the deposition of hemosiderin, chronic venous insufficiency is often associated with skin that has a brawny, reddish hue and commonly involves the medial malleolus. As venous insufficiency progresses, it can result in lipodermatosclerosis, which is associated with marked sclerotic and hyperpigmented tissue, and characterized by fibrosis and hemosiderin deposition that can lead to venous ulcers over the medial malleolus. These ulcers may progress to deep, weeping erosions. Myxedema from hypothyroidism presents with a generalized dry, thick skin with nonpitting periorbital edema and yellow to orange skin discoloration over the knees, elbows, palms, and soles. Localized pretibial myxedema may be caused by Graves disease. In the late stages of complex regional pain syndrome, the skin may appear shiny with atrophic changes. In the early stages of lymphedema, the skin has a doughy appearance, whereas in the later stages, it becomes fibrotic, thickened, and verrucous.
SYSTEMIC & LOCALIZED EDEMA SYSTEMIC CAUSE MECHANISM OF ACTION
Increased capillary permeability.
Increased capillary permeability from systemic venous hypertension.
Increased plasma volume.
Increased capillary permeability from systemic venous hypertension.
Decreased plasma oncotic pressure from reduced protein synthesis.
Reduced protein synthesis leading to decreased plasma oncotic pressure.
Obstructive Sleep Apnea
Pulmonary hypertension resulting in increased capillary hydrostatic pressure.
Increased plasma volume.
Increased plasma volume.
Decreased plasma oncotic pressure from protein loss.
LOCALIZED CAUSE MECHANISM OF ACTION
Increased capillary permeability.
Chronic Venous Insufficiency
Increased capillary permeability caused by local venous hypertension.
Increased capillary permeability caused by local venous hypertension.
Complex Regional Pain Syndrome Type 1
(Reflex Sympathetic Dystrophy)
Neurogenically mediated increased capillary permeability.
Deep Venous Thrombosis
Increased capillary permeability.
Iliac Vein Obstruction
Increased capillary permeability caused by local venous hypertension.
Accumulation of fluid in adipose tissue.
- Primary: congenital lymphedema, lymphedema praecox, lymphedema tarda
- Secondary: from axillary lymph node dissection, surgery (e.g., coronary artery bypass graft, inguinal lymphadenectomy), trauma, radiation, tumor, filariasis
(Compression of left iliac vein by right iliac artery)
Increased capillary permeability caused by local venous hypertension from compression.
CHRONIC VENOUS INSUFFICIENCY: Chronic onset begins in middle to older age. Location includes lower extremities; bilateral distribution in later stages. Examination findings include soft, pitting edema with reddish-hued skin, predilection for medial ankle/calf. Associated findings include venous ulcerations over medial malleolus; weeping erosions. Evaluation method includes duplex ultrasonography ankle-brachial index to evaluate for arterial insufficiency. Treatment includes compression stockings, pneumatic compression device if stockings are contraindicated, Horse Chestnut Seed Extract, and skin care with emollients, topical steroids.
COMPLEX REGIONAL PAIN SYNDROME TYPE 1: Also known as Reflex Sympathetic Dystrophy. Chronic onset follows trauma or other inciting event. Location includes upper or lower extremities; contralateral limb at risk regardless of trauma. Examination findings include soft tissue edema distal to affected limb. Associated findings include (early) warm, tender skin with diaphoresis; (late) thin, shiny skin with atrophic changes. Evaluation method includes medical history and examination, radiography, three-phase bone scintigraphy, and magnetic resonance imaging. Treatment includes systemic steroids, topical dimethyl sulfoxide solution, physical therapy, tricyclic antidepressants, calcium channel blockers.
DEEP VENOUS THROMBOSIS (DVT): Acute onset, Location includes upper or lower extremities. Examination findings include pitting edema with tenderness, with or without erythema; positive Homans sign. Evaluation Findings include d-dimer assay, duplex ultrasonography, magnetic resonance venography to rule out pelvic or thigh DVT (if clinical suspicion is high), or extrinsic venous compression (May-Thurner syndrome in patients with unexplained left-sided DVT). Treatment includes hypercoagulability workup, anticoagulation therapy, compression stockings to prevent postthrombotic syndrome, and thrombolysis in select patients.
LYMPHEDEMA: Chronic onset is insidious, often following lymphatic obstruction from trauma or surgery. Location includes upper or lower extremities; bilateral in 30-percent of patients. Examination findings in early symptoms include dough-like skin, pitting. Late findings include thickened, verrucous, fibrotic, hyperkeratotic skin. Associated findings include inability to tent skin over second digit, swelling of dorsum of foot with squared off digits, painless heaviness in extremity. Evaluation findings include clinical diagnosis, lymphoscintigraphy, T1-weighted magnetic resonance lymphangiography. Treatment includes complex decongestive physiotherapy, compression stockings with adjuvant pneumatic compression devices, skin care, and surgery in limited cases.
LIPEDEMA: Chronic onset begins around or after puberty. Location includes predominantly lower extremities; involves thighs, legs, buttocks; spares feet, ankles, and upper torso. Examination findings include nonpitting edema; increased distribution of soft, adipose tissue. Associated findings include medial thigh and tibial tenderness; fat pad anterior to lateral malleoli. Evaluation findings include clinical diagnosis. No effective treatment. Weight loss does not improve edema.
MEDICATION INDUCED EDEMA: Onset occurs weeks after initiation of medication; resolves within days of stopping offending medication. Location includes lower extremities. Examination findings include soft, pitting edema. Evaluation findings include clinical history suggesting recent initiation of offending medication. Treatment includes cessation of medication.
OBSTRUCTIVE SLEEP APNEA: Chronic onset with location in lower extremities. Examination findings include mild, pitting edema. Associated findings includes daytime fatigue, snoring, obesity. Evaluation findings include suggestive clinical history. polysomnography, echocardiography. Treatment includes positive pressure ventilation, treatment of pulmonary hypertension if suggested on echocardiography.
DIAGNOSTIC TESTS & PROCEDURES
The following laboratory tests are useful for diagnosing systemic causes of edema: brain natriuretic peptide measurement (for CHF), creatinine measurement and urinalysis (for renal disease), and hepatic enzyme and albumin measurement (for hepatic disease). In patients who present with acute onset of unilateral upper or lower extremity swelling, a d-dimer enzyme-linked immunosorbent assay can rule out DVT in low-risk patients. However, this test has a low specificity, and d-dimer concentrations may be elevated in the absence of thrombosis.
ULTRASONOGRAPY: Venous ultrasonography is the imaging modality of choice in the evaluation of suspected DVT. Compression ultrasonography with or without Doppler waveform analysis has a high sensitivity (95-percent) and specificity (96-percent) for proximal thrombosis; however, the sensitivity is lower for calf veins (73-percent). Duplex ultrasonography can also be used to confirm the diagnosis of chronic venous insufficiency.
LYMPHOSCINTIGRAPHY: Lymph flow cannot be detected with ultrasonography. Therefore, indirect radionuclide lymphoscintigraphy, which shows absent or delayed filling of lymphatic channels, is the method of choice for evaluating lymphedema when the diagnosis cannot be made clinically.
MAGNETIC RESONANCE IMAGING: Magnetic resonance venography of the lower extremity and pelvis should be obtained in patients with unilateral left leg swelling and negative results on duplex ultrasonography if there is high clinical suspicion for deep venous thrombosis. Patients with unilateral lower extremity edema who do not demonstrate a proximal thrombosis on duplex ultrasonography may require additional imaging to diagnose the cause of edema if clinical suspicion for DVT remains high. Magnetic resonance angiography with venography of the lower extremity and pelvis can be used to evaluate for intrinsic or extrinsic pelvic or thigh DVT. Compression of the left iliac vein by the right iliac artery (May-Thurner syndrome) should be suspected in women between 18 and 30 years of age who present with edema of the left lower extremity. Magnetic resonance imaging may aid in the diagnosis of musculoskeletal etiologies, such as a gastrocnemius tear or popliteal cyst. T1-weighted magnetic resonance lymphangiography can be used to directly visualize the lymphatic channels when lymphedema is suspected.
ECHOCARDIOGRAPHY: Echocardiography should be performed in patients with obesity, obstructive sleep apnea, and edema to evaluate pulmonary arterial pressures. Echocardiography to evaluate pulmonary arterial pressures is recommended for patients with obstructive sleep apnea and edema. In one study of patients with obstructive sleep apnea, 93-percent of those with edema had elevated right arterial pressures. Pulmonary hypertension has long been thought to be the cause of edema associated with obstructive sleep apnea. However, one study found that although a high proportion of patients with edema had obstructive sleep apnea (more than two-thirds), nearly one-third of these patients did not have pulmonary hypertension, which suggests a stronger correlation between edema and obstructive sleep apnea than can be explained by the presence of pulmonary hypertension alone.
ANKLE-BRACHIAL INDEX: Ankle-brachial index should be measured in patients with chronic venous insufficiency and cardiovascular risk factors before initiation of compression therapy, which is contraindicated in peripheral arterial disease. The ankle-brachial pressure index (ABPI) or ankle-brachial index (ABI) is the ratio of the blood pressure at the ankle to the blood pressure in the upper arm (brachium). Compared to the arm, lower blood pressure in the leg is an indication of blocked arteries due to peripheral artery disease (PAD). The ABPI is calculated by dividing the systolic blood pressure at the ankle by the systolic blood pressure in the arm.
EDEMIA CONVENTIONAL MEDICAL TREATMENT
The human heart pumps about 5 quarts of blood per minute, circulating nutrients, water and oxygen into even the tiniest capillaries. There, the blood permeates the vessel walls to reach all the body's tissues. When circulation is poor, for whatever reason, fluid builds up in the tissues, a condition called edema. It may the result of blocked venous or lymphatic flow, extreme metabolic wastes or an injury to the lymphatic or blood vessels, which can occur with a burn - even a bad sunburn. Radiation, surgery and trauma to the blood vessels may also cause edema. Circulatory or kidney disease, metabolic disorders and tumors can impede blood flow and cause edema, too. The most common cause of edema, however, is cardiac insufficiency, which is curable. If edema is found early and treated throughout life, improving venous tone, heart-muscle function and fluid excretion may help the condition.
If you experience edema swelling, you need to find out the reason for the edema. Check with your health care provider or midwife to determine the cause of your edema. An early diagnosis is important. Do not limit your water intake; that overworks the kidneys, leads to dehydration and makes the heart work harder. Treatment for the condition includes promoting water excretion and improving circulation. You may need to make some lifestyle changes or take medication to help relieve edema. Edema can be a symptoms of heart failure as well as many other disorders involving the liver and kidneys.
MEDICAL TREATMENT RECOMMENDATIONS
Management of edema should be guided by the underlying etiology, which commonly includes chronic venous insufficiency, lymphedema, DVT, and medication-induced edema, among others. Mild edema usually goes away on its own, particularly if you help things along by raising the affected limb higher than your heart. More severe edema may be treated with drugs that help your body expel excess fluid in the form of urine (diuretics). One of the most common diuretics is furosemide (Lasix). Long-term management typically focuses on treating the underlying cause of the swelling. If edema occurs as a result of medication use, your health care provider may adjust your prescription or check for an alternative medication that doesn't cause edema.
GENERAL TREATMENT OPTIONS
Daily hydration with emollients and short courses of topical steroid creams for severely inflamed skin should be used to treat eczematous (stasis) dermatitis associated with chronic venous insufficiency.
Pneumatic compression devices should be used in conjunction with standard therapy in patients with lymphedema.
Compression stockings should be used in patients following deep venous thrombosis to prevent postthrombotic syndrome.
Dependent edema caused by venous insufficiency is more likely to improve with elevation and worsen with dependency. Edema ossociated with decreased plasma oncotic pressure (e.g., malabsorption, liver failure, nephrotic syndrome) does not change with dependency.
Unilateral swelling from compression or compromise of venous or lymphatic drainage can result from DVT, venous insufficiency, venous obstruction by tumor (e.g., tumor obstruction of the iliac vein), lymphatic obstruction (e.g., from a pelvic tumor or lymphoma), or lymphatic destruction (e.g., congenital vs. secondary from a tumor, radiation, or filariasis). Bilateral or generalized swelling suggests a systemic cause, such as CHF (especially right-sided), pulmonary hypertension, chronic renal or hepatic disease (causing hypoalbuminemia), protein-losing enteropathies, or severe malnutrition.
Edema can be an adverse effect of certain medications. The mechanism often includes the retention of salt and water with increased capillary hydrostatic pressure. Diuretic use may cause volume depletion and reflex stimulation of the reninangiotensin system.
CHRONIC VENOUS INSUFFICIENCY MANAGMENT
In patients with chronic venous insufficiency, diuretic therapy should be avoided unless a comorbid condition requires it (e.g., CHF). Mechanical therapies, including leg elevation and compression stockings with 20 to 30 mm Hg for mild edema and 30 to 40 mm Hg for severe edema complicated by ulceration, are recommended. Compression therapy is contraindicated in patients with peripheral arterial disease. A study of 120 patients with venous ulcers showed that 6-percent had mixed arterial-venous ulcers. In another study, a higher prevalence of peripheral arterial disease was found in women with symptoms of chronic venous insufficiency vs. those without symptoms. Thus, measurement of ankle-brachial index should be considered in patients with risk factors for peripheral arterial disease before prescribing compression therapy.
Mixed evidence exists for the use of pneumatic compression devices in patients with chronic venous insufficiency. However, these devices should be considered for patients in whom compression stockings are contraindicated. For mild to moderate chronic venous insufficiency, oral Horse Chestnut Seed Extract may be an alternative or adjunctive treatment to compression therapy.
Local skin and wound care of venous ulcers is essential in preventing secondary cellulitis and dermatitis. Eczematous (stasis) dermatitis, characterized by dry, inflamed, scaling skin overlying superficial varicose veins, often occurs in patients with chronic venous insufficiency. Treatment includes daily hydration with emollients and short courses of topical steroid creams for severely inflamed skin.
The mainstay of lymphedema treatment involves complex decongestive physiotherapy, which is composed of manual lymphatic massage and multilayer bandages. The initial goal is to improve fluid resorption until a maximum therapeutic response is reached. The maintenance phase of treatment includes compression stockings at 30 to 40 mm Hg. Pneumatic compression devices have been shown to augment standard therapies. One randomized controlled trial of women with breast cancer–related lymphedema showed statistically significant improvement in lymphatic function following one hour of pneumatic compression therapy. In a study of 155 patients with cancer- and non-cancer-related lymphedema, 95-percent of patients noted reduction in limb edema after using pneumatic compression devices at home.40 Surgical debulking or bypass procedures are limited to severe refractory cases. Diuretics do not have a role in the treatment of lymphedema.
DEEP VENOUS THROMBOSIS MANAGEMENT
Acute thrombotic events are treated with anticoagulation therapy (unfractionated or low-molecular-weight heparin or warfarin [Coumadin]) to prevent progression of a clot or the development of postthrombotic syndrome. Postthrombotic syndrome is characterized by chronic leg swelling, pain, cramping, and skin changes including telangiectasias, which occur in 20 to 50-percent of patients within five years of a thrombotic event. In addition to anticoagulation, compression stockings should be used after a DVT to prevent postthrombotic syndrome. In a Cochrane review of two randomized controlled trials comparing elastic compression stockings (20 to 30 mm Hg) with placebo in patients with DVT, those who wore compression stockings had a statistically significant reduction in the risk of developing postthrombotic syndrome (odds ratio equals 0.39; 95-percent confidence interval, 0.20 to 0.76) after two years. A randomized controlled trial of 209 patients with proximal DVT showed that those who received catheter-directed thrombolysis in addition to conservative therapy with compression stockings and anticoagulation had a lower prevalence of postthrombotic syndrome after 24 months compared with conservative therapy alone, suggesting that thrombolysis may be a treatment option for select patients.
MEDICATION-INDUCED EDEMA MANAGEMENT
In patients with suspected medication-induced edema, the offending medication should be discontinued if possible. In patients taking calcium channel blockers to treat hypertension, use of an angiotensin-converting enzyme inhibitor may be more beneficial than angiotensin receptor blocker therapy in reducing calcium channel blocker-induced peripheral edema.
OTHER EDEMA CAUSES
There is no treatment for lipedema. Weight loss does not affect this condition. Complex regional pain syndrome is treated with physical therapy in combination with medications such as systemic steroids and tricyclic antidepressants. Obstructive sleep apnea is treated with positive pressure ventilation.
Take Care! - As with all diseases related to your heart and kidneys, it is important to have a health care provider monitor your heart on a regular basis. You should never try to self-treat edema.
HOME THERAPY CONSIDERATIONS
Some simple natural therapies, such as hot baths, will also aid circulation.
According to traditional Chinese medicine, avoiding raw foods, cold drinks, and fatty foods helps to prevent water retention.
Food allergy testing is recommended. See Allergies for more information.
If you are pregnant, see Pregnancy Concerns and Preeclampsia/Eclampsia (Toxemia of Pregnancy/Pregnancy Induced Hypertension) for more information.
Alfalfa is a good source of important minerals. It also contains chlorophyll, a potent detoxifier. Take 2,000 to 3,000 mg daily, in divided doses.
DIURETIC MEDICINAL PLANTS - If you suffer from cardiac insufficiency, or if you want to try combining herbs with pharmaceuticals, it is best to work with a Naturopath or another health professional. Nature offers an abundance of diuretic medicinal plants to choose from. Horsetail, Goldenrod, Dandelion and Parsley promote drainage of the tissues by increasing urine output. Prepare a tea from any of these plants for best results, or take them in the form of tincture drops or tablets available from health food stores or online. Drink 3 cups of the tea a day.
A Cornsilk Herbal Blend containing cornsilk and other herbs that aid the body in expelling excess fluids. Take 2 capsules three times daily. Do not use if you are pregnant or breastfeeding.
Hawthorn Berries, Horsetail, Juniper and Uva Ursi are diuretic herbs. By increasing the output of urine, they help to counteract edema.
HAWTHORN TEA - Hawthorn Berries, leaves and flowers can improve heart-muscle function and vascular tone. Brew 1 tablespoon of Hawthorn plant parts in 1 cup of hot water. Steep for 15 minutes. Drink 3 cups of the tea a day.
Water Retention Tea containing Cornsilk, Parsley, Uva Ursi, Cleavers, Juniper Berries and Queen of the Meadow (Meadowsweet) root can be made from herbs or a commercial formula may be purchased. Do not use water retention tea if you are pregnant, breastfeeding or have kidney problems. While taking this tea, reduce salt and fluid intake and eat a diet rich in Potassium. For short-term use only.
JUNIPER WINE - Crush 3.5 ounces of Juniper Berries, and pour 1 bottle of white wine over them. Let stand tightly covered for 24 to 48 hours and then filter off the solids. A coffee filter is ideal for the job. Drink 4 ounces before lunch and dinner. Note: Juniper should be avoided if you have kidney inflammation, stones or disease.
If edema is caused by a loss of tone in the veins, which can occur with varicose veins, a Horse-Chestnut Seed Therapy may be helpful. Horse chestnut can help strengthen the resilience of the vessel walls. Horse Chestnut has been shown to reduce postsurgical edema. Extracts and capsules of the dried seeds are available in most health food stores and online.
A tea blend consisting of 1 ounce each Nettle, Dandelion, and Peppermint leaves can be used to promote urine flow. Pour 1 cup of water over 1 tablespoon of the blend. Steep for 20 minutes and then strain. Drink 1 cup 3 times daily.
Other herbs that can be beneficial if you are suffering from edema include Butcher's Bloom, Dandelion root, Horsetail, Juniper Berries, Lobelia, Marshmallow, Parsley, and Pau D'Arco tea. Caution: Do not take lobelia internally on an ongoing basis. Do not take any herbal supplement while pregnant without consulting with your midwife.
Rose Hips contain bioflavonoids helpful in the treatment of edema.
DIET & NUTRITION RECOMMENDATIONS
A stroking massage promotes the elimination of excess water, so it can be a very helpful treatment for lymphatic blockages that result from injury, surgical damage or venous complaints, including varicose veins. Since lymph vessels collect fluid from tissues and conduct it back to the veins near the collar bone, always direct your massage from the hands and feet toward the chest. Do not use massage if you have a risk of blood clots.
Exercise daily and take hot baths or saunas twice a week. caution: Do not take hot baths or use a sauna while pregnant.
Avoid stress. See MoonDragon's Information About Stress & Stress Management for more information.
Follow a fasting program to flush excess water from the tissues. See Fasting for more information. Do not follow a fasting program if you are pregnant unless you consult with your midwife.
If pressing with fingers on your feet and ankles results in the formation of small "pits," you will need to consult with your midwife or health care provider. This can be a sign of a serious health problem.
Avoid alcohol, animal protein, beef, caffeine, chocolate, dairy products (except for those listed above), dried shellfish, fried foods, gravies, olives, pickles, salt (unless pregnant, then you will need some salt for your expanding blood volume), soy sauce, tobacco, white flour, and white sugar.
Increase your intake of raw foods. Eat plenty of Apples, Beets, Garlic, Grapes, and Onions. A high Fiber diet is important. If you are pregnant, follow a healthy pregnancy diet and nutritional program as outlined by your midwife.
Low-Salt Diet: The presence of Sodium makes it harder for the kidneys to excrete water. Eat a nutritious diet rich in fresh vegetables and low in fat. Avoid meat, dairy products and processed foods high in sugar, white flour, fat and salt. If you are pregnant, salt to taste. Do not overdo it, but you do need some sodium for your expanding blood volume during the last trimester of your pregnancy.
MoonDragon's Nutrition Guidelines: Cholesterol & Sodium Restricted Diet
MoonDragon's Nutrition Guidelines: Sodium Controlled Diet
MoonDragon's Nutrition Guidelines: Pregnancy Diet
Alfalfa (Medicago sativa) has a deep root system that pulls valuable minerals from the soil. With the aid of sunlight, nutrients including Beta Carotene and Chlorophyll are made available to the body in a usable form.
Branched Chain Amino Acid Complex. Studies on people with alcoholic cirrhosis have shown a benefit to consuming L-valine, L-leucine, and L-isoleucine. These branched-chain amino acids enhance protein synthesis in liver cells, help restore liver function, and prevent chronic encephalopathy.
Bromelain is a proteolytic digestive enzyme that can enhance absorption of protein. Bromelain may also affect protein turnover in the body including proteins found in joint tissue.
Buckthorn Bark has been one of the few herbs to be used consistently throughout history for the same ailment: constipation and its by-products, hemorrhoids and anal irritation.
Carnitine is an amino acid that can reduce edema caused by weak heart action. Research has shown that by taking 500 mg of Carnitine 3 times daily, you can often help to improve heart-muscle strength.
Celery Seed, an arthritis herbal remedy, also has an ancient reputation for treating muscle spasms, high blood pressure, gout, sleeplessness, depression, and anxiety.
Coenzyme Q-10, part of the family of B-Vitamins, also seems to promote heart-muscle function by improving the energy production in the heart-muscle cells. Try taking 100 to 300 mg of Coenzyme Q-10 a day to help reduce the symptoms of cardiac insufficiency, including edema.
Cornsilk, a natural diuretic, is used to soothe the urinary tract and can give relief to the bladder, kidneys and small intestines.
Dandelion Root is known as a blood purifier for liver and kidney disorders. Dandelion root also contains nutritive salts to build up the blood. Dandelion root is a natural diuretic and improves appetite and minor digestive problems. Dandelion leaves are commonly recommended as a food supplement for pregnant and post-menopausal women.
Chaste Tree Berry combined as clinically proven standardized Vitex Chaste Tree Berry extract with Vitamin B-6 to help alleviate the bloating, breast tenderness and mood changes associated with premenstrual syndrome.
Fluid Retention Wellness Oil is a formula designed to accelerate the body's fluid drainage system.
Gravel Root is used for kidney stones, cystitis, and pelvic inflammatory disease. Because it encourages the excretion of excess uric acid, it is also used to treat rheumatism and gout.
According to overwhelming research results, Kelp has become an effective treatment for hyperthyroidism. Norwegian Kelp seaweed contains nearly thirty minerals which nourish the glands, especially the thyroid and pituitary. Kelp, also known as seaweed, grows in the rich ocean beds, far below surface pollution levels. Use Kelp to supply needed minerals, including Iodine for healthy thyroid function and multiple Trace Minerals.
Kidney & Bladder Formula tincture is used for Auto-immune Diseases, Bladder, Cancer, Cold Sores and deposits. Kidney Bladder Formula contains Uva Ursi (Bearberry) and Juniper Berry, two historically popular for kidney and bladder complaints.
Parsley Root is considered a strong diuretic, useful against fluid retention, urinary/kidney stones and urinary infections. Strengthening to the digestion.
Patchouli Essential Oil is used in inhalation, baths, and massage has an uplifting effect on depression and anxiety, and can help alleviate fluid retention.
Potassium aids rheumatic or arthritic conditions and is vital for the elimination of wastes. The use of diuretics can deplete potassium. A potassium supplement may be needed to replace lost potassium.
For Protein, eat eggs, broiled white fish, and broiled skinless chicken or turkey. Consume small amounts of buttermilk, cottage cheese, kefir, and low-fat yogurt.
Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.
Vitamin E has potent antioxidant activity, supplies oxygen to the blood, aids in strengthening capillary walls, and plays a beneficial role in cancer and cardiovascular disease prevention, anti-aging benefits, circulation, wound-healing, immune function, nervous system function, PMS, hot flushes, diabetes, vascular disease, eye health, tissue repair, athletic performance, leg cramps, skin and hair health, and alleviating fatigue.
BENEFICIAL DIETARY SUPPLEMENTS - A QUICK SUMMARY
Vitamin B-Complex reduces water retention. Vitamin C with Bioflavonoids improves adrenal function. Calcium, Magnesium and Zinc complex replaces minerals lost when fighting edema. Kelp improves thyroid function and supplies needed minerals. Bromelain is an enzyme that aids digestion and metabolism. Vitamin E aids circulation. Potassium helps keep body fluids in the cell walls. Gravelroot, Cornsilk, Dandelion Root, Butcher's Broom and Marshmallow Root are beneficial in treating edema.
Unless otherwise specified, the dosages recommended in this section are for adults. For a child between the ages of 12 and 17 years, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.
NUTRIENTS Supplement Suggested Dosage Comments Very Important Free-Form Amino Acid Complex As directed on label. Sometimes edema is caused by inadequate protein assimilation. Protein deficiency has been linked to water retention. Cornsilk Complex 2 Capsules 3 times daily or as directed on label. Contains cornsilk, a natural diuretic, and other herbs that aid in the body in expelling excess fluids. Vitamin B-Complex 50 to 100 mg twice daily, with meals. All B Vitamins work best when taken together. Plus Extra
50 mg 3 times daily. Reduces water retention. Important Alfalfa 2,2000 to 3,000 mg daily. In divided doses. Good sources of minerals. Contains Chlorophyll, a potent detoxifier. Calcium 1,500 mg daily. To replace mineral loss with correction of edema. Magnesium 1,000 mg daily. To replace mineral loss with correction of edema. Helps uptake of calcium. Silica As directed on label. A natural diuretic. Helpful Bromelain As directed on label, 3 times daily. An enzyme derived from fresh pineapples that help digestion and allergies. L-Carnitine 500 mg 3 times daily. Reduce symptoms of cardiac insufficiency. CoEnzyme Q-10 As directed on label. Promote heart muscle function. Garlic
2 Capsules 3 times daily, with meals or as directed on label. A detoxifier. Kelp 1,000 to 1,500 mg daily. Supplies needed trace minerals. Kidney-Bladder Formula 8 to 12 drops, 3 times daily, or as instructed on label. Contains soothing and diuretic herbs to help fight infection of the kidneys and bladder. Potassium 99 mg daily. Very important if taking diuretics to replace lost potassium. Pycnogenol As directed on label. A powerful antioxidants that also strengthen the tissues of the circulatory system. SuperoxideDismutase
As directed on label. Antioxidant properties. Helpful in heart and liver disorders. L-Taurine As directed on label. Aids heart function. Vitamin C
3,000 to 5,000 mg daily, in divided doses. Essential for adrenal funtion and production of adrenal hormones, which are vital for proper fluid balance and control of edema. Vitamin E 200 to 400 IU daily. Aids circulation. Use d-alpha-tocopherol form.
NOTIFY YOUR HEALTH CARE PROVIDER
If you or a family member experience edema without a known cause. This may be a symptom of a more serious problem with your heart, liver or kidneys. This could be life threatening. You need to find out the cause of your edema.
If you or a family member need to obtain allergy testing for food sensitivities.
If you or a family member is pregnant, experiencing edema in association with high blood pressure, sudden excessive weight gain, blurred vision, irritability, protein in the urine, and any other signs of preeclampsia/eclampsia (toxemia of pregnancy). Always check with your midwife before taking any supplement or herbal formula or beginning any nutritional program.
If you or a family member experience any sudden, unexplained symptoms or your symptoms get worse despite treatment. Some sensitive individuals may experience allergic reactions to some herbal formulas. Discontinue use immediately and consult your health care provider.
HELPFUL RELATED ONLINE LINKS
Family Practice Notebook.com: Nephrology - Edema The Internet Stroke Center: Ischemic Brain Edema E-Medicine: Congestive Heart Failure & Pulmonary Edema Medline-Plus: Pulmonary Edema Symmetry: Edema - Treatment and Information
EDEMA & WATER RETENTION RELIEF SUPPLEMENTAL PRODUCTS
Information on edema and water retention, swelling associated with the accumulation of fluid in spaces between the soft tissues of the body. Consult with your health care provider or midwife before using any supplements or products for edema. You need to be evaluated for the underlying cause of your edema.
QUALITY PRODUCTS & SUPPLEMENTS
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DIURETIC FORMULA SUPPLEMENT PRODUCTS
Diuretic formulas remove unwanted fluid from the body by increasing urination. Herbs often found in natural diuretic formulas include Uva Ursi to treat infections of the lower urinary tract and vaginitis. Uva Ursi is also used with good results for cystitis, dysuria, pyelitis and lithuria. Nettle is used as a diuretic, astringent and blood builder, and to treat anemia (due to its high iron content). Nettle has been applied to cuts to stop bleeding or taken in tea to reduce excessive menstrual flow, as well as to treat nosebleeds and hemorrhoids. Nettle has been used to stimulate blood circulation and as a spring tonic for chronic skin ailments. Dandelion is used as an appetite stimulant, digestive aid, and for liver and gallbladder function. Dandelion is used as a diuretic to stimulate the excretion of urine. Juniper is a diuretic and as a treatment in various conditions of the kidneys and bladder. Juniper Berries are also recommended for their carminative action in cases of indigestion and flatulence. Marshmallow has a soothing effect on inflamed and irritated tissues of the alimentary canal, and urinary and respiratory organs. Marshmallow Root eases the passage of kidney stones and is used in combination with other diuretic herbs for kidney treatments which assist in the release of gravel and stones. It works very well for urinary problems. Horsetail is used as a diuretic for the treatment of edema (swelling/fluid retention). Horsetail is also occasionally used for osteoporosis, nephrolithiasis, urinary tract inflammation, and wound healing (topical). Ginger's diuretic properties help increase the flow of urine. It protects the liver and is beneficial for hemorrhoids. Suggested dosage for extract-tinctures: 30 to 60 drops in water or juice 2 to 3 times daily or as needed.
HerbsPro: Diuretic Formula, Liddell Laboratories, 1 oz. (108758)
HerbsPro: Herbal Diuretic, Gaia Herbs, 60 Caps (91212)
HerbsPro: Watershed Diuretic Formula, Absolute Nutrition, 60 Tabs (23787)
HerbsPro: Water Factors (Diuretic Factors), Country Life, 60 Tabs (37589)
HerbsPro: Diuretic II, Thompson, 60 Tabs (35580)
HerbsPro: Diuretic I, Thompson, 90 Caps (35579)
HerbsPro: Diuretic II, Thompson, 90 Tabs (35581)
HerbsPro: Water Factors (Diuretic Factors), Country Life, 90 Tabs (37590)
HerbsPro: Natural Herbal Diuretic, Solgar, 100 VCaps (36487)
HerbsPro: Water Out Herbal Diuretic, Now Foods, 100 VCaps (75309)
HerbsPro: KB-11 Herbal Diuretic, Naturade, 120 Tabs (61625)
Kalyx: Diuretic Kb 11 Formula With Calcium, Naturade, 120 Tabs: HF
Kalyx: Super Diuretic Formula, Dr. Venessa's Formulas, 60 Tabs: HF
Amazon: Diuretic Supplement Products
Nutrition Basics: Kidney Formula Supplement Information
EDEMA RELIEF PRODUCTS
Amazon: Edema Relief Products
Amazon: Edema Supplements & Wear Products
Amazon: Edema Compression Products
Amazon: Fluid Retention Wellness Oil, 2 fl. oz.
This formula oil is designed to accelerate the body's fluid drainage system.
Nutrition Basics: Kidney Formula Supplement Information
FLUID RETENTION SUPPLEMENT PRODUCTS
Amazon: Fluid Retention Wellness Oil, 2 fl. oz.
This formula oil is designed to accelerate the body's fluid drainage system.
Amazon: Fluid Retention Relief Supplement Products
Nutrition Basics: Kidney & Bladder Formula Information
KIDNEY CARE FORMULA SUPPLEMENT PRODUCTS
Kidney Formula Supports Proper Function of the Kidneys & Adrenals. Kidney Formula (Banyan) is a rejuvenating tonic for the kidneys and adrenals. It promotes healthy urinary flow and composition, assisting in the natural cleansing of the blood. This energizing combination of herbs aids in the dissolution and elimination of urinary stones, as well as decreasing the risk factors involved in their formation. Kidney Formula works to cool and soothe the entire urinary system, including membranes inflamed from urinary tract infections. Stress and toxins from food and the environment can be debilitating to the kidneys and adrenals over time, causing low energy and increased fatigue. Kidney Formula cleanses and nourishes these organs, infusing strength and improving resilience to such challenges. Other brands of Kidney Formulas have also been listed.
AYURVEDIC HERBS DIRECT PRODUCTS
Ayurvedic Herbs Direct: Kidney Formula, Kidney & Adrenal Function Support, Banyan Botanicals, 500 mg, 90 Tabs
HerbsPro: Bladder Irritation Relief, NatraBio, 1 fl. oz. (16467)
HerbsPro: Bladder & UTI Spray, Liddell Labs, 1 fl. oz. (84844)
HerbsPro: Kidney Bladder Complex, Supports Urinary Tract Health, BioForce USA, 1.7 fl. oz. (33911)
HerbsPro: Kidney Formula Extract, Dr. Christophers Formulas, 2 fl. oz. (39802)
HerbsPro: Blood & Kidney Detox, Homeopathic Blend, King Bio Natural Medicines, 2 fl. oz. (49935)
HerbsPro: Bladder Incontinence, King Bio Natural Medicines, 2 fl. oz. (49879)
HerbsPro: 4Kidney Bladder & Urinary, Genesis Today, 8 fl. oz. (100331)
HerbsPro: Cranberry Bladder Defence, Planetary Herbals, 30 Tabs (20700)
HerbsPro: Better Bladder For Women, Enzymatic Therapy, 30 Tabs (66535)
HerbsPro: Raw Kidney Glandular, Synergistic Complex, Natural Sources, 60 Tabs (27815)
HerbsPro: Kidney Care, Multi-Homeopathic Therapy, Natural Care, 60 Caps (49743)
HerbsPro: KidneyAid, Ridgecrest Herbals, 60 Caps (29166)
HerbsPro: UT Intensive, Ridgecrest Herbals, 60 Caps (89045)
HerbsPro: Cranberry Bladder Defence, Planetary Herbals, 60 Tabs (20699)
HerbsPro: Best Bladder Support Featuring Urox, Doctors Best, 60 VCaps (69106)
HerbsPro: Kidney Clean, Balanceuticals, 60 Caps (111337)
HerbsPro: Liver Kidney Care Biochemical Support, Organic India, 90 Caps (86750)
HerbsPro: Kidney Cleanse, Synergistic Blend For Healthy Kidney Function, Health Plus, 90 Caps (15453)
HerbsPro: Natural Glandular Beef Kidney, Nutricology Allergy Research Group, 100 Caps (89406)
HerbsPro: Bladder Irritation, Hylands, 100 Tabs (15748)
HerbsPro: Kidney Bladder Blend Formula, Natures Way, 310 mg, 100 Caps (17959)
HerbsPro: Bladder Formula, Dr. Christophers Formulas, 475 mg, 100 VCaps (109464)
HerbsPro: Kidney Formula, Urinary System Support, Dr. Christophers Formulas, 1000 mg, 100 VCaps (39801)
HerbsPro: Kidney Flush, Ion Labs, 120 Tabs (15937)
HerbsPro: Cranberry Bladder Defence, Planetary Herbals, 120 Tabs (20698)
HerbsPro: Kidney Fortifier Herbal Tea, TCM Blend, Health King, 20 Tea Bags (51181)
Amazon: Kidney Formula Supplement Products
Amazon: Kidney Care Formula Supplement Products
Amazon: Kidney-Bladder Formula Supplement Products
Amazon: Kidney Support Wellness Oil, Nature's Inventory, 2 fl. oz.
Nutrition Basics: Kidney Formula Supplement Information
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
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MOONDRAGON'S REALM - WEBSITE DIRECTORY
A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.