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Swollen Ankles
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Swollen Ankles

Dear Doctor,


Thanks for taking my question. Male 37 years old. 5'9" 210 lbs.


A week ago today my wife noticed that both my ankles were swollen. I thought nothing of it and went to work the next day assuming they would just go away. While at work I noticed that my ankles were even more swollen that the previous day. I showed co-workers my ankles and they were all concerned and suggested that I go to the ER after work.

I went to the ER and was admitted to the hospital. Bloodwork showed normal kidney and liver function. The next morning I had a stress test, a Nuclear medicine scan and an echo which were all normal. They injected Lasix through my IV and my ankles returned to normal. I was discharged the next day with no known cause for my edema. They did give me Lasix 20mg and Potassium Chloride 20mg. I have not filled them, however, because my ankles have remained normal.

The Cardiologist at the hospital was stumped. The only thing I can think of is the night before my ankles swelled, I had eight beers to drink and ate a bunch of McDonald's food.

Do you have any ideas as to what could have caused my ankle edema?


THANK YOU!

Erik
Tags: swollen, Heart
Related Discussions
239757_tn?1213813182
erik,

Thanks for the post.

Edema is caused when fluid leaks out of the vessels into tissues surrounding the vessels. There is a relationship that maintains the balance of fluid between the two that when peturbed can lead to edema. The variables in the relationship involve the amount of fluid and salts in the blood, the leakiness of the blood vessel, and the amount of proteins in the bloodstream.

Im not sure what caused the transient swelling. It was probably related to the excessive volume and salt ou took in. The good news is the rest of your workup was negative.

good luck
19 Comments
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Avatar_m_tn
I have been suffering some edema also.  I checked my med literature and pretty much all of them said this was a possible side effect.  I had jacked up my Norvasc last fall to deal with escalating BP and this seemed the most likely culprit.

I stopped it for a couple of days and, sure enough, no edema in the afternoon.  Problem is that my BP went sky high so I need to find a new drug for that.  In the meantime, I've gone back on the Norvasc and lately the edema only seems to be occasional.

Problem with me is that I am a maintenance alcoholic and drink at least 3 strong beers (microbrew tap) per evening.  Between this and overeating, I'm trying pretty hard to kill myself, but thanks to my agressive cholesterol medicating, I have outlived my expiration date and continue to have good physical ability, despite end stage CAD.

I would check your meds as a first course of action.
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Avatar_n_tn
Good to hear from you. I'm glad to hear that you are still doing well despite the eating and drinking. I have had the same problem of needing to drink strong beer such as Heineken several days a week and have been over-eating myself. I am now trying to diet and lay low on the beer for a while. I do take Cardizem CD 180mg. Maybe that and the beer combined caused my edema?

Last I knew you were on a statin and Niaspan and doing some hiking and that seemed to have stopped your CAD in its tracks, possibly even regressed it a bit. I give you a lot of credit for how you've kept CAD at bay with your determination.

My Cardio wants to take me off Zocor and put me on Antara (which is a new Fibrate similar to Tricor) for my low HDL(29).I am afraid to do so because I've heard that Fibrates can cause Pancreatic and Liver cancer. My HDL remains low while my LDL is in the 60's and total is 140's.


Talk to you soon.

Erik
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Avatar_n_tn
Eight beers and McDonalds!~!  HELLO!~! No wonder your were swollen. Do you realize how much sodium you were taking in?  

When I swell...I look at what I ate the day before and if any meds I were taken state a side effect of edema.  Advil does this to me and so does Amoxicillan.
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Avatar_n_tn
You are probably right. Thanks for the reality check. I needed that!

Erik
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Avatar_n_tn
5'9" 210 lbs eating MacDonalds and getting drunk? Are you kidding me?

I do everything right and still have CAD.
I don't drink, I'm not 40 lbs over weight and I would never eat at MacDonalds.

Consider yourself lucky.....for now. This is a wake up call.
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Avatar_n_tn
When I fell apart in 1992, the first thing the docs did was take away ALL alcohol and sharply curtailed fast food (once a year?).

Alcohol is a poison. You are already overweight, so the carbs and calories in beer are bad, along with the sodium and saturated fat in fast food slop.

Please get smart, for your own sake.

Be well.
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Avatar_n_tn
Thank you all for your support, words of wisdom and constructive criticism. In what you have said, you have become a part of me that is going to turn my life around. Thanks again!


Erik
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Avatar_m_tn
Not to nag you but swelling in the limbs is common in overweight people and can happen a day or two after minimal exertion and also from wearing tighht fitting clothes. If you would drop even 20-30 pounds you would see a huge change in the way you feel and lower your risk of having serious problems later on in life. It seems you had a normal cardiac workup so exercise should not be an issue.
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Avatar_n_tn
I also have problems with swollen feet and ankles. My Dr. has switched my medications several times in the last 8 months. Maybe its time for me, and you, to switch doctors? Maybe its time to see a specialist?
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Avatar_m_tn
Do a little Google search on Cardizem SR and Edema.  Peripheral Edema was 8.3% in their studies for approval.  It's only 2.5% in the not time release.

This is similar to Norvasc.  I think that once your get up in the high dosages you are going to have this problem, especially if you drink and are overweight.  I know that I was fine until I exceded the maximum daily recommended dosage.

Well spring is here and I am getting out of my funk, cleaning house, eating better, and hope to get out and do more exercise and lose a little weight.

That HDL is a problem.  That's where mine typically was - guaranteed M.I. by the time your 50 if you also have high LDL, but I guess that you don't.  It's been in the 50's for the last three years with Niaspan.  That new Phizer drug should be better.  If you live near Ohio you could probably get in the study.  I think that I remember you saying you were from NY State.  

Why do they want to take you off Zocor?  Liver problems?  With those numbers you probalby could just take Niaspan for HDL. Have you considered Welchol or Zetia?  I've been taking Welchol since it came out -- haven't noticed any side effects.

It is pretty amazing to me that I have three vessel CAD with a totally occluded RCA and live a pretty normal life.  It's also amazing that when I started feeling so good that I really started abusing myself with food and drink and still feel reasonably well physically.  But I guess it's like a large ship, that takes a couple of years to turn - by the time you see the iceberg, it's too late!

Take care


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Avatar_n_tn
I had swollen ankles for several years with no identifiable cause (had stress test, ekg, blood work, everything).  This continued until I was diagnosed with obstructive sleep apnea.  I stopped breathing about 300 times a night and had hypoxia.  Since going on a CPAP machine, I have not had any swelling whatsoever.  Sleep disorders were the last place I would have thought about looking for a cause, but there it was.  just my 2 cents!
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Avatar_n_tn
well i am 37 years old. i have to say up front i have spent my life using a large amount of meth. approx 22 years. recently i have gained some weight about 40 50 pounds more than my usuall wieght. today i decided to take a walk in the middle of the afternoon the temp was im guessing about 80 degrees. i was walking and my right arm started to really get a che deep inside like by the done deep all up and down my arm, at the same time my arm also did fall asleep and tingly also i experienced a feeling of extreme dizzyness like i may faint this lasted approx half hour fourty min. after i sat down and rested i felt better but now its bed time and my ankles are extremly swollen . are these reasons to be alarmned or is it simple heat exastion or whatever? i was alarmed  becouse i have heard your right arm gets -pain and turns numb in such cases as a heart attac.also i had a aunt  age 41 wake up one morning and drop dead of heart attac she had minor clues but all in all she was blindsided by the sudden attack. i dont want that to happen to me also. thanks for you reading my concerns  i look forward to reading your responces.
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Avatar_n_tn
Hi Donname:

Your honesty about your chemical use is appreciated but that is apparently behind you and the good news is you have your whole life ahead to enjoy.  Right now, I would concentrate on getting an appointment with a doctor at your earliest, perhaps you havent had a physical exam in a while. That should really be a priority, as only a doctor has the expertise to determine the cause of your concern. The arm pain/tingling in your arm could be one of several issues but it is best not to self-diagnose and ask a doctor to take a look, sooner rather than later..

However, if, in the days until you can see a doctor and you have the same signs of weakness and symptoms of arm pain or tingling, (or sluring of speech/blurry vision) you should immediately dial 911 to the local EMS unit to bring you to an ER. Then, take a single aspirin with water and rest while waiting for the unit to arrive. Make sure you tell the medic that you took an aspirin (so he can alert the ER doctor.)

Sometimes we feel strange about calling for a medic, but they and the ER doctor and nursing staff are there to help.. See a doctor... get your questions answered and live a good life!!!
regards,
Tom/7deuceman
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Avatar_n_tn
my dad aged 64, underwent bypass surgery on Aplril 7th 2006. He is recovering but there is a fluid which comes out from left knee. He goes to the hospital every second day. They remove the liquid through syerenge. Minimum 50ml comes out. They even powered the medicine and try to arrest. But there is no sign of improvement. I realy wanted to know the cause of limb liquid and the treatment.This is this 22nd sitting with the doctor to remove the liquid from the limb. Please help. MY EMAIL ID IS anjana.***@****

thanks
nanu
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140719_tn?1217470652
Re Reply: "...and the amount of proteins in the bloodstream."
My ankles swelled suddenly 3 weeks ago; have Dr. appt., but an concerned about the "protein level in bloodstream", as my mother had that problem and needed transfusions.  I do not remember if her ankles were swollen.  I do have several problems: smaller lung capacity due to Scoliosis, minor leakage, rear of heart sac, Sleep Apnea (recently diagnosed, but present for many years), GERD, Bruxism (clenching), high cholesterol (heriditary), PLMD (at witt's end) but low blood pressure.  Recent weight gain 5 lbs. Non-drinker.
I have appt. w/movement-disorder neuro, and my internist, but am worried about the PROTEIN level remark, and how it can be tested, etc., and any other help and advice you can provide.
Thank you so much for your information and time.
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140719_tn?1217470652
p.s.  I am not overweight  5'6 1/2" 140; usually 132-135. NOT a leakage in heart, but small amount of fluid; told to monitor it.
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Avatar_n_tn
Do yourself a huge favor and read books on nutrition.  "Let food be your medicine and medicine be your food", said Hippocrates a long time ago.  And it is still true!  Eating more fresh fruits and vegetables, and more grains and high fiber foods, and drinking LOTS of water will keep you healthier than the presription drugs you get from the doctor. My mother has a shopping bag full of prescription drugs...one ailment, then a side effect, would lead to another drug and another.  Doctors do not talk about nutrition...only drugs and surgery. I got her eating more fruits and vegetables, took away the Sweet n Low, took away the foods with preservatives and artificial flavors, and anything with "partially hydrogenated oil", and she is feeling a lot better!  Read "Natural Cures They Don't Want YOu To Know About", "Fast Food Nation", "Beating the Food Giants", or watch a 15-minute video at www.NaturalOvens.com (and then click on "Schools") to see what effect healthier foods had on an alternative school of violent and failing students.  The food industry and the drug companies are killing Americans...look at the number of people with cancer, heart disease, diabetes, etc....and our youth are following in these deadly footsteps!
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Avatar_f_tn
I am on lasix for swelling on legs and a  potassium supplement. I am not voiding much at all, the knee is still swollen and I am exhausted.....wondering if my body is hanging on to the potassium? The edema is due to my osteoporosis they say. I have healthy heaart, although bad pvc's...........take inderal for that.
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