To elevate or not to elevate that is the question Part 2 ( Mick not Mike sorry)

Continued - this is taking ages , please read part 1 first!
So we have gotten to the bit about about elevating , at last I hear the collective sigh. Most em patients find elevation works simply by countering the effects of gravity on decreased vasomotor tone . Raising the feet allows the pooled blood to circulate back toward the heart . This helps relieve the feeling of heat and pressure - allowing sensation to return toward normal . If the flare hasn’t completely faded, or its later in the day ,or if your Em is particularly bad then lowering your feet will cause the blood to rush back and many patients end up back to square one.

If you get good relief from what you are doing -keep going ,but if you find you need to elevate most of the day , I would like you to consider this theory.I think that the body adjusts very quickly to new norms , so that if continual elevation happens ,then perhaps loss of vasomotor tone is exacerbated.Just as a muscle weakens when it is not used . Your legs are used to being exposed to changes in blood flow and pressure almost constantly in a normal day , elevation exposes them to only one state. My concern is that it will ultimately impossible to lower your legs unless they are exposed to changes. Most of you are probably moving in and out of leg elevation through the day and thats good .

Those patients who are stuck elevating and find lowering very painful , I sympathise as you are probably the worst affected. But you can try to retrain a bit, especially if you haven’t been doing this for too long . If you need to raise your legs above 90degrees then just try going from whatever elevation you are using and return one leg at a time to horizontal. REPEAT THIS LIKE AN EXERCISE . Alternate legs up to usual height and down to 90 degrees , move your ankles up and down firmly to encourage the calf pump to assist circulation .Initially you will be very aware of blood rush , try not to panic - pump those ankles up and down. Do this as often as you can tolerate maybe 20 times every 30min . Once you feel confident and hey ,may take weeks, leave your legs at 90 degrees as long as you are able - try and increase the time . Use your foot and ankle exercise once discomfort creeps in to see if you can increase your time with legs lower. Repeat frequently eg every 30min.

For those of you who use a recliner ( at approx 90 degees)- don’t get too comfortable.Getting up and down frequently will encourage vasomotor tone . While you recline do some foot and ankle movements - pump up and down , circle feet - you don’t get to sit for hours - scrunch your toes down , move them back . Keep your circulation going as you sit - you my even find it REDUCES A FLARE MORE QUICKLY.For those with difficulty lowering feet to the floor ,do your foot and ankle exercises as you practice lowering each leg to the floor in turn. DO this frequently as an activity and try to build up time spent with legs down.

My general rule is not to elevate for more than 30min without some foot and ankle exercise or more than an hour without getting up for a short walk - I find a SIGNIFICANT increase in pain otherwise. I DO RETURN TO ELEVATING after my little stretch and walk(just a few steps around the house even)

Elevation is vital to reduce swelling but more about that another day.
I think its almost impossible to manage EM without elevation ,but just balance it with as much or as little activity as possible ,so that vascular tone is maintained . This is not going to make EM go away - it is a way to manage it.

If you are attempting to increase time with your legs down I am sure you can succeed even if its baby steps to start with - good luck

Please ask any questions and I will do my best to answer -Tizzy

Hi Tizzy,

Thank you for taking the time to writing all this out. I can relate to all of the conditions however often times have a hard time putting it into words which you do well.

To piggyback on this, what are your thoughts on compression socks? At one point I wore them all the time but have reduced them to only at night when I go out to an event because I wanted not to be dependent on them.

Hi Tizzy,

Wow, brilliant. Thanks so much for all the information. That's going to be a great help, I'll let you know how I get on.

Hi scanfield1,

I got myself a pair of Jobst 30-40 mmgh after you suggested them, and they have been a help, so thanks for the idea.

I wore a pair on my last visit to the hospital, and although they didn't stop my feet flaring, they felt less like they would explode, so quite a bit less painful. Also I found I recovered from the trip a lot better than the time before.

If anyone in the UK is looking for some, then they can be got from the UK distributor BSN Medical. You can order them over the phone with a card, and they're not so expensive as other places I've seen.

Tel. + 44 (0) 845 122 3600
Fax + 44 (0) 845 122 3666
BSN medical Limited
PO BOX 258
HU10 6WT

I also discovered that UK docs can prescribe compression socks (though not this brand), so if anyone thinks they might help then talking to the doc might be a good idea.

Hi Tizzy,

Yes, I imagine it must be really difficult living in such a hot country with EM. I don't know how you do it.

I hope it cools down soon there for you.