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Dr. Hasan
Dr. Hasan, Doctor
Category: Health
Satisfied Customers: 7198
Experience:  MBBS, FCPS, with experience in all fields of medicine and surgery
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Hello, I am writing this question on behalf of my father

Customer Question

Hello,
I am writing this question on behalf of my father. He is 88 years old and has no major diseases or ailments. He is 5' 6" tall, about 130 lbs. He walks with a cane to steady himself but gets around fine, still drives, still very active and healthy.

Over the past several months he has developed extremely swollen feet (from the ankles down) and extremely swollen hands (from the wrists down). The rest of his joints are completely normal (elbows, knees, etc.). He has had a blood test for Rheumatoid Arthritis which came back negative. He has no pain whatsover in the swollen areas. They just look awful and it concerns him because no doctor so far can tell him what's causing it. So far he's just been told to take Advil which only very slight reduction in swelling. By the way, the swelling doesn't vary from morning to night. It always looks the same (so having his feet elevated at night does not improve the situation).

Hope you can give me some ideas on what could be causing this and what can be done to reduce the swelling. He has an appointment with a geriatrician in 2 weeks and can't get in any sooner. Hopefully you have an idea or two in the meantime. Thank you.

Denise
Submitted: 3 years ago.
Category: Health
Expert:  Dr. Hasan replied 3 years ago.
HI,

thanks for your question.

Which specialist he has seen so far?
what about the liver & kidney function tests?
What about his heart status?
any urinary complaints, breathlessness on exertion, face swelling etc?
Any diagnosed medical problem?
Any medications he is on ?

Regards
Customer: replied 3 years ago.

Okay, I've been on the phone with my mother getting all the details for you.

 

The swelling started with his hands/wrists close to a year ago. It later moved on to his feet/ankles a few months later.

 

He had been to a vascular surgeon in July about the swelling. My dad has had PAD, peripheral artery disorder, for a few years. That doctor thinks my father should see a cardiologist re: hardening of the arteries (and a possible relation to the swelling)??

 

He had hernia surgery in August but the hand/feet swelling preceeded the hernia and hernia surgery. He healed up from the surgery well and no problems there.

 

He saw his general doctor at the VA on Oct 1 who did blood tests. They came back as follows:

low on RBC (4.46)

high on RDW (14.6)

low on MPV (6.1)

low on lymphocytes % (17.8)

high on mononuclear (0.8)

high on B12 (1023) - geriatrician had put him on B12

high on folate (serum) >24.00

high on urea nitrogen (23)

low in chloride (99)

high cholesterol (226) went off simvastatin in Sept due to violent nighmares

cholesterol/HDL together (4.52 - within normal range)

low iron (52)

high anion gap (12)

 

This doctor thought it looked like arthritis (even though there was no pain) and sent him to someone else to test for arthritis. As mentioned earlier, that came out negative and he was just told to take advil.

 

As for medications, here's what he's on:

Triam/HCTZ 37.5/25 mg once a day

atenolol 25 mg

felodipine 5 mg (that used to be 10 but was reduced in July to 5 and it seemed to reduce the swelling immediately from extreme to bad and has remained at the same bad level since)

Proscar (for reduction of prostate) 5 mg

Cilostazil 100 mg twice a day (for PAD)

3 inhalers, one puff each AM and PM for breathing and sleep apnea (spiriva, asmanax, foradil)

Polyethylene glycol (Miralax) for bowel movements 15 grams every other day

Zoloft 50 mg

1 aspirin 325 mg

 

Vitamins:

D 1000 iu

B12 1000 mcg

one-a-day multi vitamin

 

I think that's it. Thanks!

 

Customer: replied 3 years ago.

one last thing....

one of the blood tests came back with 3x the normal C-Reactive Protein. The doctor said that this means there is an inflammation process going on in his body. Of course we already knew that without a blood test, so it didn't really tell us anything new. Just forgot to mention it to you.

Expert:  Dr. Hasan replied 3 years ago.

Thanks for your reply.

 

Well i have few things to suggest. First that he has high urea levels so his kidney evaluation should be done , moreover heart needs to be assessed because such swellings can be due to the these disorders, although less likely with these disorders. same is about liver function tests.

 

Family doctor might not be able to help you with this, so the first thing you need to do is to visit an internal medicine specialist. He will do a detailed examination and investigations as per suspicion. And after that he will be able to point out the problem and to treat himself or to refer for consultation. Arthritis yes is a possibility but other things needs to be ruled out and if its arthritis even , your father should be seeing a rheumatologist. I know this is not something exactly i am diagnosing as you can understand that without examination , its difficult to do this on website but i am hopeful that my suggestions will help you.

 

I wish him good luck and good health.

 

Please click ACCEPT if you think i have tried to help you, for clarifications you can ask more.

 

Regards

 

Dr Hasan

Customer: replied 3 years ago.

Can you tell me more specifically what types of issues/disorders could be going on with liver or kidneys to cause swelling of feet and hands? Thank you.

Expert:  Dr. Hasan replied 3 years ago.
Well decrease in function of the liver and kidneys can result in accumulation of fluid in the hand or feet and sometime as whole body swelling(depends on extent). This decrease in function can be due to any disease affecting these organs like for kidney it can be one of the various types of glomerulonephritis and for liver it can be due to any chronic liver disease such as hepatitis etc. Same is for heart, if it is not pumping blood effectively then the fluids can accumulate in the peripheries. You said extremely swollen so thats why i suggested that rule these things out instead of just thinking about arthritis. These are more common causes of swelling in peripheries rather than what is been looked for but definitely examining doctor is at more benefit because of being in direct contact with patient.

i hope this helps.

Regards
Dr. Hasan, Doctor
Category: Health
Satisfied Customers: 7198
Experience: MBBS, FCPS, with experience in all fields of medicine and surgery
Dr. Hasan and 4 other Health Specialists are ready to help you
Customer: replied 3 years ago.
Okay, I have sent your responses to my mother. They have an appointment already set with the cardiologist on Wednesday so they will start with the heart examination and then proceed from there with kidney and liver examination. Thank you.
Expert:  Dr. Hasan replied 3 years ago.
Thanks much,

I wish that your dad GET WELL SOON.

Regards

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