Saturday 4 January 2014

New Words in My Vocabulary - Hypoalbuminemia

About mid-October, while I was on the waiting list to see the IBD clinic, I noticed that my feet and ankles were puffy. At first I didn’t think anything of this. I had been standing in the kitchen all day cooking up a storm for a Thanksgiving feast for 6 adults and 1 darling 6 ½ year old, and figured it was just standing too much. So I put my feet up and ignored it.


Not my normal feet!

But it didn’t seem to go away. In fact, I started having trouble getting my boots on in the morning (I almost always wear boots).

So I went to the GP, who looked puzzled, and sent me for more blood work. Kidney and liver function came back fine, but my albumin levels came back a bit low. Albumin is related to the absorption of protein http://en.wikipedia.org/wiki/Hypoalbuminemia, so effectively, I wasn’t absorbing protein. This causes a change in the oncotic pressure http://en.wikipedia.org/wiki/Oncotic_pressure, which is what causes the fluid to build up in the legs and feet. It’s not an unusual complication with Crohn's as the inflammation in your guts prevents the proper absorption of nutrients.

The GP kind of shrugged his shoulder and said to wait until I saw the GI doctor. He hasn’t done much about it either.

So I went to the most sensible health professional I know I went to my (brilliant) osteopath, who actually explained this all in English to me while beating the hell out of massaging the fluid out of my legs, which he admitted would only likely be of temporary help.

He suggested compression stockings as this would help force the fluid back up the legs to where the lymphatic system can take care of it. The problem with that is having size 3 (UK) feet and really big calf muscles. Commercial manufacturers automatically assume that if you have small feet, you must have skinny skirt calves. I don’t. I walk everywhere, and have the calf muscles to prove it. I also come by having large calves naturally (thanks for those genes, Mom!). When I needed compression stockings when I had my hysterectomy (standard procedure to prevent DVT), the poor health care assistant tasked with fitting me ended up all over the hospital trying to find some that would be a suitable size. I still have them as some kind of weird souviner of that surgery.

The osteopath suggested trying a running shop for the calf supports that marathon runners wear as they don’t have feet in them. The scene of being in a running shop with a svelte, athletic 22 year old sales assistant looking at my tiny feet in amazement as I was unable to get a men’s extra large running cuffs over my calves was absolutely hilarious!

By this point, my feet were very swollen and painful, and wearing boots was no longer an option. I ordered a new pair of shoes, and found an old pair of shit kickers steel toed shoes in the wardrobe which have always been super comfy. I ended up with very lengthy and unwieldly physio bandages, which my osteopath showed me how to wrap around my feet and ankles.

And you know what? Last Sunday I was up in the night repeatedly going to the loo. And now the swelling is mostly gone. Figure that one out.

I’m hoping this means that I’m beginning to absorb protein again. And either way, I’m thankful to be able to get my shoes on again!

 

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