Trump's Swollen Ankles

The cane sugar coke isn't helping

EverythingHealth is back by popular demand! In keeping with current events, let's review Chronic Venous Insufficiency (CVI) because it is in the news since Mr. Trump was seen with thick and swollen ankles.

I suspect this is not a brand new finding for him at age 79. Chronic means it has come on gradually. But ankle swelling can appear suddenly and can be caused by serious conditions such as heart disease and heart failure, liver or kidney disease, arterial blood clots or deep venous thrombosis or even pregnancy.

Think of chronic venous insufficiency as a venous valve dysfunction. The veins push our circulation blood back to the lungs and heart to get oxygen. Tiny valves do the pushing and over time these can become obstructed, stretched or damaged. When blood flow can't be fully pushed upward to the heart, gravity pulls it down and swelling accumulates and pools in the legs and ankles. Fluid leaks into the tissue and causes edema. In serious, chronic cases the skin turns red and purple and can look thickened and leathery.

Over time if left untreated, skin breakdown can occur and advanced CVI requires a full team for wound therapy and even skin grafts in severed cases.

This condition can be diagnosed with duplex ultrasound and venous pressure studies. Internal medicine and primary care physicians can usually make the diagnosis visually and by getting a history from the patient. I knew immediately when I saw thge photo that he had edema. It's not normal to have spongy fat ankles or calves and it needs medical attention.

What causes CVI? Obesity, smoking, prolonged standing, pregnancy, varicose veins or a history of deep venous thrombosis (DVT). Trauma or leg injury can affect the venous valves and sedentary lifestyle (couch potato) coupled with aging is a culprit. We know Mr. Trump doesn't smoke and he has never reported having a serious leg injury or DVT. He does stand a lot but he's also obese and riding in a golf cart is not being active. Our veins work best when the muscles around them pump the blood so regular physical activity can prvent CVI. Walking, hiking or playing sports is the best prevention. Even non impact activities like Tai Chi or Yoga movements are good for muscles and veins. The main prevention is to keep moving as you age. but avoid prolonged standing or sitting in one position.

It's not a surprise that societies where people are more active have lower rates of CVI. The following is a picture of advanced disease. Avert your eyes if you are squeamish.