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Old 09-04-2013, 08:32   #31
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I would say try a day or two worth of diuretics like hydrochlorthalizide or furosemide (lasix). Be sure to drink lots of water and keep your electrolytes up with some Gatorade or such.
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Old 09-04-2013, 09:07   #32
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Re: swollen ankles

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Originally Posted by johna View Post
Im a longtime sailor and am planning my retirement cruising the islands on my vessel. For the life of me I can't stop the swelling on my ankles after the 3rd day afloat. I'm 61. I know it's related to blood pressure, salt intake, lack of water, bare feet, etc. I'm looking for the right combination/cure to prevent this problem. Any thoughts?
I have suffered from this also.

On different occasions the causes have been:
  • Too much sitting and lack of standing
  • Not drinking enough water
  • Membranes old and too much salt in watermaker product water
  • Too much MSG because the "flour" we bought in Malaysia was really MSG

Hope this helps

Bill
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Old 09-04-2013, 09:55   #33
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Originally Posted by TacomaSailor View Post
TI get the same swelling anytime I don't walk enough or get enough exercise. When I am stuck on the boat for more than two days my ankles balloon and my feet swell.
I'm not 'on in years' and I do the same. When at he helm for many hours for multiple days I see it. I rehydrate and put my feet above my heart for a while. I do agree that I should be checked by a doctor to rule out other causes. I get it only on the boat on longer trips. My doctors have checked me over head to toe and do so regularly for other issues that are monitored closely.

If you have had this done then I'd guess dehydration, electrolyte imbalance or just not used to standing long hours but I'm not a medical professional. I am however a seasoned patient. :-)
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Old 09-04-2013, 10:02   #34
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Re: swollen ankles

Are you taking Ibuprofen?
Taking too much of this caused swelling in my ankles once upon a time.
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Old 09-04-2013, 14:11   #35
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Re: swollen ankles

The problem with all the dire prognoses of cancer, hyperthyroidism, etc., is that the OP experiences this condition only after some time on the sailboat. If the swelling were due to some chronic underlying condition, chances are this would also be an issue on land.

So the question is, what is so different on the boat that would cause this. The two things that immediately come to mind is a change in the diet and a lack of mobility.

I would do the following to reduce the problem:

1. Eliminate all salt from the diet. That does not mean “reduce the salt”, it means eliminate the salt from both food and drink. Preferably at least one day prior to going on the boat and for the entire duration of the boat trip.

2. Drink plenty of salt-free fluids. If need be, take along some jugs of distilled water. The idea is to flush as much salt out of the body as possible. Drink not only ad libitum, but drink even when not thirsty. Ordinarily, this is not a good idea since when done to the extreme, it can produce hyponatremia, which can be life-threatening. But if you know your body well and watch for the signs, hyponatremia can be prevented. Just be careful with this.

3. Get as much physical movement as possible. That means no lying or sitting around, keep the legs moving, keep the blood circulating. Take any opportunity for exercise, such as swimming, shore trip walks, jogs, or just going up and down the companionway steps. If no movement is possible, at least do frequent leg isometrics, maybe for a couple minutes every ten minutes. Set a timer buzzer as a reminder.

4. Whenever sitting down, elevate your legs. Not necessarily to the level of the heart, just to the level of the waist. Essentially, prop up your feet.

5. If the above doesn’t work, consider taking some diuretics as a last recourse.
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Old 09-04-2013, 14:21   #36
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Re: swollen ankles

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Originally Posted by Adamante View Post
The problem with all the dire prognoses of cancer, hyperthyroidism, etc., is that the OP experiences this condition only after some time on the sailboat. If the swelling were due to some chronic underlying condition, chances are this would also be an issue on land.

So the question is, what is so different on the boat that would cause this. The two things that immediately come to mind is a change in the diet and a lack of mobility.

I would do the following to reduce the problem:

1. Eliminate all salt from the diet. That does not mean “reduce the salt”, it means eliminate the salt from both food and drink. Preferably at least one day prior to going on the boat and for the entire duration of the boat trip.

2. Drink plenty of salt-free fluids. If need be, take along some jugs of distilled water. The idea is to flush as much salt out of the body as possible. Drink not only ad libitum, but drink even when not thirsty. Ordinarily, this is not a good idea since when done to the extreme, it can produce hyponatremia, which can be life-threatening. But if you know your body well and watch for the signs, hyponatremia can be prevented. Just be careful with this.


5. If the above doesn’t work, consider taking some diuretics as a last recourse.
As a Registered nurse, this is terrible advice and possibly life threatening. Please see a doctor. Forget about the internet for medical advice.
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Old 09-04-2013, 14:24   #37
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Quote:
Originally Posted by Adamante View Post
The problem with all the dire prognoses of cancer, hyperthyroidism, etc., is that the OP experiences this condition only after some time on the sailboat. If the swelling were due to some chronic underlying condition, chances are this would also be an issue on land.

So the question is, what is so different on the boat that would cause this. The two things that immediately come to mind is a change in the diet and a lack of mobility.

I would do the following to reduce the problem:

1. Eliminate all salt from the diet. That does not mean “reduce the salt”, it means eliminate the salt from both food and drink. Preferably at least one day prior to going on the boat and for the entire duration of the boat trip.

2. Drink plenty of salt-free fluids. If need be, take along some jugs of distilled water. The idea is to flush as much salt out of the body as possible. Drink not only ad libitum, but drink even when not thirsty. Ordinarily, this is not a good idea since when done to the extreme, it can produce hyponatremia, which can be life-threatening. But if you know your body well and watch for the signs, hyponatremia can be prevented. Just be careful with this.

3. Get as much physical movement as possible. That means no lying or sitting around, keep the legs moving, keep the blood circulating. Take any opportunity for exercise, such as swimming, shore trip walks, jogs, or just going up and down the companionway steps. If no movement is possible, at least do frequent leg isometrics, maybe for a couple minutes every ten minutes. Set a timer buzzer as a reminder.

4. Whenever sitting down, elevate your legs. Not necessarily to the level of the heart, just to the level of the waist. Essentially, prop up your feet.

5. If the above doesn’t work, consider taking some diuretics as a last recourse.
I would think having a no salt diet especially in hot humid climates would cause more issues than solve but then I'm not a medical professional. I certainly couldn't do this but I have extenuating circumstances that most do not. I could see maybe limit and monitor but that is just my thoughts. I would expect potassium to go up as sodium to go down which to a point is ok but after that you are in deep yogurt. These minerals operate together and too much of either isn't a good thing. My very non scientific rule of thumb is if I'm craving it I address it but I also have to be extra cautious with my circumstances. Maybe others have better tolerances to mineral imbalance than I.
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Old 09-04-2013, 14:54   #38
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Re: swollen ankles

Talk about bad advice - discontinue salt intake in the tropics? That is plain crazy. Many cruisers when arriving in the tropics suffer from heat exhaustion. Drinking fresh water is not nearly enough to counter it - rehydration formula to replace electrolytes (sodium and potassium) is required. Failure to keep up the electrolytes and hydration can have serious effects.

I was just in Thailand and Malaysia for a month on friends' boat. It only took a few days of drinking water without electrolytes for heat exhaustion to hit. Fortunately they had some rehydration formula so I was able to get back on my feet. This is important stuff.

I say again: don't look to the internet for your answers - talk to your doctor!

Greg
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Old 09-04-2013, 17:51   #39
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Re: swollen ankles

Quote:
Originally Posted by sailcruiser View Post
I would think having a no salt diet especially in hot humid climates would cause more issues than solve...
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Originally Posted by CarinaPDX View Post
Talk about bad advice - discontinue salt intake in the tropics? That is plain crazy.
It’s interesting how this “hot and humid tropics” has crept into the discussion. I don’t recall any mention of “hot and humid tropics” in the OP’s post. Fascinating how some people will insist on creating a strawman and then proceed to demolish it with gusto.

Until informed otherwise, I am assuming the OP is in a temperate climate. But even if the OP were in a “hot tropical” climate, it is unlikely there would be any swelling due to that climate (despite the mythology, there is no backup for this claim). On the contrary, the problem in such a climate would be exactly opposite of what the OP described.

In a hot climate the body will naturally sweat more, taking proportionally greater amounts of salts out along with the water. So in a tropical climate, one indeed needs to take supplemental salt, along with the water, to keep the blood osmolality in balance.

Of course, this incremental hydration will do very little for an overheated organism, as you point out. However, once again, the OP was not asking about surviving a heat stroke in a hot climate. The OP wanted to know how to prevent ankle swelling on a boat.

In a normal and otherwise healthy human being, the ankles will swell due to the reasons I listed in my post – namely, abnormal fluid retention in the cells of the body tissues. What happens is that as some people age, the capillary cell walls become weaker and more permeable to water ingress. This can be OK as long as the individual maintains a normal level of mobility as the circulating blood takes this extra water away. But if you reduce the mobility and consequently the blood flow, there is not enough of this natural flushing action, and the water begins to pool up in the tissues.

In addition to older people, some athletes also suffer from this condition. I am one of them and I think there was a post from an amateur athlete earlier in the thread that described something similar.

So to reduce the ankle swelling, water must be purged from the system. This can be done by increasing the volume of blood circulation (difficult to do, unless you are willing to run or bike a couple of hours a day), or by reducing sodium levels in the blood. When we have a greater than normal blood osmolality, we have greater than normal sodium levels and we become thirsty. When we drink in response to this, we are flushing this extra salt out.

As I pointed out in my original post, this can be a somewhat risky proposition, because if you go too far and flush too much sodium out of the system, you can become hyponatremic, i.e., too low on sodium. This condition can cause mental confusion, delirium and eventually even death, as I pointed out.

The best way to prevent this would be to have your blood osmolality checked regularly. Unfortunately, that is not an easy thing to do without having a continuous access to a medical lab. A portable osmometer would be another solution, but I don’t know if those are available.

But again, as I pointed out, if you know your body well, you can pretty much tell how much sodium you have. For instance, in my particular case, I start getting muscle cramps in my lower legs if I go too low on sodium. A more severe depletion results in general body muscle cramps, including upper legs, hands, arms and finally the chest muscles. That’s when I reach for the bag of potato chips.

So once again, despite the insistence on discussing unrelated situations and expressing indignation over advice I did not offer, please note that my recommendations were simply based on a direct response to the OP’s original question.

Couple of more points:

- I left out #6 from my list, which would be to “reduce or eliminate the intake of carbohydrates while on the boat, especially the simple carbs, such as sugar, white bread, pasta, etc. Carbohydrates combine with water in the body and until they are burned off with vigorous physical activity, they will cause you to bloat.”

- And secondly, if this topic interests you, look up the works of Dr. Noakes, a South African physician who has done a lot of convincing research in this area. He has analyzed tens of thousands of the Comrades endurance race runners and has written what is today considered to be the runners hydration bible. Of course, he came to the problem from the other end, namely runners drinking too much and becoming hyponatremic, but the principles he describes of how the body processes fluids are the same.
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Old 10-04-2013, 14:25   #40
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Re: swollen ankles

Its "Doctor addiction" Adamante, it blocks the brain and prevents the study of diet.

Side affects are obesity, diabetes and stressed out health system.
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Old 10-04-2013, 15:00   #41
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Re: swollen ankles

The OP didn't say whether he was in a warmer climate on the boat, but my feet always swell when I go to the tropics--its worse for the first 2-3 weeks, then I get acclimated. I also spend as little time as possible with my feet dangling down, and wear socks at night if the feet are swollen. For my condition, which I have never consulted a quack about, it helps to go swimming, walking, or bicycling.
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Old 10-04-2013, 15:53   #42
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Re: Swollen Ankles

I'm no expert or doctor, but I wonder if a joint would help, as I'm trying to have a plan to smoke (legally) some dope on my boat some day.
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Old 10-04-2013, 16:17   #43
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Re: Swollen Ankles

I am impressed by the number of folks who have a low regard for doctors' abilities. I can see, and share, a dislike for the greed, and the dysfunctional system in the US, but for doctors' medical advice? That attitude probably cost my father his life (due to a delayed diagnosis of cancer), so I am no fan. Of course we all need to take ownership for the care of our own bodies, and a few of the posters clearly understood their problems and the necessary response. But self-diagnosis of such a complaint seems pretty irresponsible to me. Most likely it is not life-threatening, but the point is that it can be so someone who knows the difference should have a look. For example, a man on the next dock recently had edema in his lower leg; it turns out he needed surgery to replace a long section of a blood vessel in the leg. I don't know what would have happened without treatment, but I suspect if it went far enough amputation would be the result (which is what did happen to my grandfather). I wonder if the distrust in doctors has something to do with the appalling health outcomes in the US?

Don L - Move to Washington and you will be able to keep the boat in the water year 'round, sail a beautiful area, and get legal weed. Problem solved...

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Old 10-04-2013, 16:25   #44
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Re: Swollen Ankles

For all of you well meaning sailors, this guy really really needs to see a doctor. His heart is "over-stressed" and his kidneys are not working as they should, to name a few things that are affecting him. Please, just encourage him to seek the advice of a doctor. County hospitals are great, for those with no insurance or with modest means. Please do not recommend any medications, diets or exercises for him; they could worsen his situation, as no one knows for sure what is causing the edema. Just encourage him to seek a medical doctor's advice. Thank you! <Pharmacy - US Board Certified> Mauritz
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Old 12-04-2013, 13:04   #45
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Re: swollen ankles

[QUOTE=boatman61;1206239]
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Originally Posted by delmarrey View Post
Ditto!
When I go to the Philippines and sit around too much both my wife and my feet swell up.
QUOTE]

Now THAT would worry me... how big does she swell up to...
That's nothing, you should see her sister, who lives there.
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