June 16, 2014 at 1:00 am

Leg edema common after vascular surgery

Dear Dr. Roach: My husband takes the following medicines: lisinopril for his blood pressure, levothyroxine for his thyroid, an aspirin and a B-complex vitamin, all in the morning.

He had his aorta replaced in 2012 and has trouble with sink-in marks on his legs at the bottom. It doesn’t matter how much I pay for a pair of socks for him, or how loose they fit, his legs still get the marks. He is 79 and has no other health problems.

Would you happen to have any idea what could be causing this? His heart doctor thought it was his blood pressure medicine, and at that time, he was taking 10 mg of amlodipine in the morning.


Dear R.M.M.: When you can see the imprint of the socks, it means that there is some swelling (edema) in the loose tissues of the legs. Although leg edema can result from serious problems with the heart, kidneys or liver, or even from blood clots, it is far more likely that it is not any of these serious conditions. After a major vascular surgery, it is common to have a bit of swelling in the legs. In fact, most people nearing their 80s have some degree of swelling, usually from imperfect valves in the veins or lymphatic vessels that don’t work as well as they did 50 years earlier.

Amlodipine (Norvasc) and medicines like it often cause a degree of swelling that is not dangerous.

A careful physical exam and a few blood and urine tests are all that’s necessary to be sure that the leg swelling isn’t being caused by a potentially dangerous condition.

Dear Dr. Roach: Please address the possible health risks of using decaffeinated coffee. Is the process used harmful? Is the decaffeinated product approved by the Food and Drug Administration?


Dear R.F.: There are four ways to decaffeinate coffee: two use organic chemical sol­vents (methylene chloride and ethyl acetate), and there’s ca­rbon dioxide and water. Your question is about the amount of the organic solvents left in in the first two methods.

(Incidentally, “organic” has two meanings. To a chemist, “organic” means “carbon- and hydrogen-containing,” so both methylene chloride and ethyl acetate are organic compounds. The common use of “organic” now means foods grown without synthetic chemicals, and among other things, avoiding use of antibiotics, pesticides and prohibited fertilizers. These terms often are in direct conflict with one another.)

The amount of residual solvent in decaffeinated coffee and tea is set by the FDA at less than 10 parts per million; most commercial decaf coffee is closer to 1 ppm. The FDA has found that this level does not pose a threat to human health.

If you still are concerned, you can purchase coffee that has been decaffeinated by the water process (sometimes cal­led Swiss water process) or by carbon dioxide, neither of wh­ich leaves chemical residues.

Email questions to ToYourGoodHealth@med.cornell.edu.