still can't figure out what's causing it any suggestions?
Wow! You really went through the whole differential diagnosis process. It's great that you have nothing going on with your heart and kidneys.
I would take a mild potassium-sparing diuretic like amiloride and see what happens.
Venous insufficiency: This condition occurs when your leg veins have problems sending blood back to your heart. This can cause blood to pool in your legs, leading to swelling.
Heart failure: Heart failure can cause fluid to accumulate in the body, leading to edema in the lower extremities, such as the ankles.
Kidney disease: Your kidneys remove waste and extra fluid from your body. If they're not functioning properly, fluid can build up, causing swelling in the legs and ankles.
Liver disease: Liver disease can also lead to fluid accumulation in the lower body, causing swelling in the ankles and legs.
Lymphedema: This condition, characterized by blockage in the lymphatic system, can cause swelling in the legs and ankles.
Medications: Certain drugs, including antihypertensives, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs), can cause ankle edema.
Pregnancy: Swelling in the ankles and feet is common in pregnancy due to increased body fluid and pressure on veins from the growing uterus.
Injury or infection: If the swelling is localized to one ankle, it may be due to an injury like a sprain, fracture, or infection.
Have you looked at liver and lymphatic tissue?
These are tests for lymphedema:
Imaging tests: These could include MRI (Magnetic Resonance Imaging), CT (Computed Tomography) scans, Doppler ultrasound, or lymphoscintigraphy (a special type of imaging that uses a radioactive dye to visualize the lymphatic system).
Bioimpedance analysis: This is a non-invasive method that measures the resistance to an electrical current passed through the body to detect fluid changes.
Lymphography: This is a less commonly used invasive method where a dye is injected into the lymphatic system and X-rays are taken to see the flow of lymph. This test has largely been replaced by lymphoscintigraphy.
The primary goal of lymphedema treatment is to reduce swelling and control discomfort and other symptoms. Although lymphedema is typically a chronic condition that can't be cured, it can often be managed effectively with a combination of therapies. Here are some commonly used approaches:
Compression therapy: Compression garments, such as stockings or sleeves, can encourage fluid to flow back out of the affected limb. Bandages might also be used for the same purpose, and they can be especially useful because they can be adjusted to fit areas of the body where the swelling is greatest.
Manual lymph drainage: This is a specialized form of massage where a trained therapist uses gentle, rhythmic pumping movements to stimulate the flow of lymph. This helps to move fluid from swollen areas to areas where the lymphatic system is working normally.
Exercise and physical therapy: Specific exercises can help improve lymph drainage. Physical therapy might also include range-of-motion exercises to improve mobility if the lymphedema is restricting movement.
Pneumatic compression: This therapy involves wearing a sleeve over the affected limb, which is connected to a pump that intermittently inflates to provide pressure and promote lymph flow.
Complete decongestive therapy (CDT): This is a comprehensive approach that includes a combination of manual lymphatic drainage, compression garments or bandaging, skin care, and exercises.
Skin care: Keeping the skin clean and moisturized helps prevent infections, which can worsen lymphedema.
Diet and lifestyle modifications: Maintaining a healthy weight and staying active can help manage lymphedema. It's also essential to avoid injury or infection to the affected limb, as these can exacerbate the condition.
In some cases, if conservative methods are not successful, surgery may be considered. There are several surgical options, including lymphatic bypass procedures, lymph node transplant, or procedures to remove excess tissue in severe cases of lymphedema.
Above content from ChatGPT.