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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
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Experience:  14 years as clinician in the field of Family Practice
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Ive had mild ankle and leg swelling for a few months. Live

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I've had mild ankle and leg swelling for a few months. Live and Kidney issues have been ruled out. Having an echo Monday for heart. Home doc not concerned as I had an ekg and xray of heart in Jan.

After 30 minute walk, yard work and 20 minutes on exercise bike, both ankles are experiencing a mild burning sensation. Comments as to the cause?
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD :

Hello!

Anthony Bray MD :

There are as you know several possible causes of this....

Anthony Bray MD :

The most probable cause would be venous insufficiency as the cause....

Anthony Bray MD :

In this cause there would tend to be improvement at night with your legs up and worse with standing especially...

Anthony Bray MD :

Does the swelling tend to worsen with prolonged standing??

Anthony Bray MD :

Sitting with legs dependant tends to aggravate swelling from venous insifficiency as well..

Anthony Bray MD :

If your swelling is due to venous insufficiency (leaky valves in the deep veins of the legs) then you may benefit from compression stockings up to the level of the knees...

Anthony Bray MD :

This type is the LEAST responsive to using a diuretic though...

Customer:

I suppose it does to some extent. My swelling has been quite mild, comes and goes. I had been concerned about CHF but never noticed the burning sensation as a symptom.

Anthony Bray MD :

Well hopefull CHF is not your cause... that would be the most serious cause of course... it sounds from your history to not be expected to have a high probability of heart problems but rather a low probability....

Customer:

Is that because of the x ray and ekg?

Anthony Bray MD :

CHF would be more treated medically>> reduction of blood pressure and use of a strong diuretic and low salt diet...

Anthony Bray MD :

WEll a resting EKG is limited in its usefulness... it is better predictir when positive in showing a problem than in guranteeing than none exists when it is normal...

Anthony Bray MD :

Your history of exercise and normal results so far in this regard do not sound as suspicious for heart related issues however but a stress test and echocardiogram may need to be combined to give a more definitive answer to the question....

Customer:

I was in the emergency because I was having a chest pain. Did xray, ekg, all kinds of blood work. Turned out to be a pulled muscle.

Anthony Bray MD :

Well it sounds reassuring that this was diagnosed as a puled muscle but I would be comforted I suppose by full clearance as per a cardiologist on this matter....

Customer:

I am overweight, mild hypertension but putting plenty of focus on exercise, diet and talking with doc about medications needed to get BP down.

Anthony Bray MD :

I feel that some form of CHF definitely needs to be firmly ruled out as posssible but I suspect that it will be in your case from what I know...

Customer:

I'm having an echo Monday and a Nuclear Stress test Friday.

Anthony Bray MD :

What is your BP running??

Anthony Bray MD :

How about your pulse rate?? (If you know)

Customer:

143/90 pulse around 80.

Anthony Bray MD :

OK those are the tests that I would expect that you should have to fully check the health of your heart. Those will help to determine if any heart dysfuction could be part of the problem...

Customer:

on average over the last three days

Customer:

May I ask a clarification?

Anthony Bray MD :

I see>> want to get your BP down below 135/85 and prefer less tahn 130/80 ON AVERAGE...

Customer:

You said;

Anthony Bray MD :

Low salt may help with BP issues and with swelling...

Customer:

"I feel that some form of CHF definitely needs to be firmly ruled out as posssible but I suspect that it will be in your case from what I know..."

Customer:

"it will be in my case?" Ruled out is that what you menat?

Customer:

You suspect it will be ruled out?

Anthony Bray MD :

Oh OK I guess I messed up a bit on my typing >> sorry about that >> Yes I think that CHF must be ruled out as a possible cause but I have more reason to NOT suspect this in your case than to expect it... the normal EKG would be in your favor and lack of suspicious findings on chest xray such as enlarged heart or vascular congestion in the chest...

Anthony Bray MD :

It is possible that you could have hypertension and diastolic dysfucntion as a cause.... the heart muscle is too thick in this condition and with high heart rate it may cause increase in back pressure and lead to lower extremity swelling...

Anthony Bray MD :

Obstructive sleep apnea is another potential cause... you said that you were a bit overweight didn't you??

Anthony Bray MD :

A sleeep study could be of help in ruling out that cause....

Customer:

Sleep study is in the works.

Customer:

Hypertension and diastolic dysfunction is not CHF?

Anthony Bray MD :

I see... it sounds that your doctors are doing a good and thorough job for you to evaluate this problem then....

Anthony Bray MD :

Not one in the same no >> but the wrong conditions of diastolic dysfucntion and hypertension can indeed lead to CHF,,,,

Customer:

Ok. Something to work on. I'm doing it all. Eating better, no salt, exercise. no more alcohol, and never smoked.

Anthony Bray MD :

If you had diastolic dysfucntion then 90% plus of the time you might do fine but the wrong circumstances of heart rate, heart workload adn BP could lead to CHF....

Anthony Bray MD :

That is great with your efforts to improve your lifestyle!!

Customer:

So hopefully we all these tests (being good of course), and lifestyle changes I have a good chance of keeping CHF at bay?

Anthony Bray MD :

If you should have diastolic dysfunction and the high BP then a combination of a beta blocker plus a diuretic would be likley choices for treatment...

Anthony Bray MD :

Yes

Anthony Bray MD :

The most serious cause of heart failure would be a damaged heart muscle from prior heart attacks...

Anthony Bray MD :

This would be the most potentially difficult to treat...

Anthony Bray MD :

This sceanrio would have been ruled out by normal EKG and chest xray though...

Anthony Bray MD :

It is still posible that you could have some coronary artery disease lurking that may need treatment. The stress test will help to determine if this might be the case...

Customer:

The nurse at the emergency said my lungs were remarkably clear and that my blood work (whatever they did) was great. I stayed four-five hours. Wouldn't let me eat, doc said no evidence of heart attack, ekg normal, xray clear. He suggested followup with cardiologist which is whatI'm doing now, albeit a few months later.

Anthony Bray MD :

I see... well that makes sense....

Anthony Bray MD :

The blood tests would have beeen CK-MB and troponin = enzymes that get into blood with heart muscle damage....

Customer:

Good. You've eased my OCD a bit. I thank you for that. I've never had a heart attack, the only symptom I have now is the swelling that has the burning sensation (didn't always) comes and goes. I can walk a mile or two with hills and not get very winded and will continue that as my regimen. I'm determined to pay close attention as I head into my 25th anniversary with a very understanding wife (as you can imagine).

Anthony Bray MD :

The burning sensation may relate to the swelling as you imagine if nerves become fluid overloaded then they may not work properly. If the burning should continue then further evaluation of this specific symptom may be needed as that could be a symptom of perpipheral neuropathy... diabetes is the most common cause but there are many possible medical reasons that may cause that (Thyroid , B-12, heavy metal exposure, autoimmune disases, electrolyte abnormalities >> these and other things may need to be checked...)

Anthony Bray MD :

I hope that this has been helpful for you! Let me know if you have further questions! I will be happy to get back with you if so!

Anthony Bray MD :

If my answers have been helpful and to your satisfaction then please remember to leave positive feedback. That would be very much appreciated! Thank You and Best Regards,

Anthony Bray MD :

Anthony Bray MD

Customer:

Thank you, XXXXX XXXXX Our conversation helped me wade through all the info on the Internet that I couldn't make sense of and what kept my OCD going only to the worse case.

Anthony Bray MD :

PS If you fear diabetes as a possibility this is best evaluated for by a combination of a fasting glocose plus a test known as a hemoglobin A1C which reflects what your blood sugar has been doing for the past three months...

Customer:

I will have my GP look into that. Thank you again.

Anthony Bray MD :

Well try to relax as best that you can. I can at least tell you that you do not have the worst case scenario as your EKG and chest xray being normal are still positive aspects of your evaluation !!

Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 7162
Experience: 14 years as clinician in the field of Family Practice
Anthony Bray, MD and other Health Specialists are ready to help you
Customer: replied 1 year ago.

Dr. Bray:


 


I've had three LFT tests in the normal range since 7/2012. Today I got results from an Ammonia Plasma test reading 101 ug/dl. The lab reference range is 27-102 so they list it as a normal result. The lab doing the work is LabCorp.


 


I've seen much lower references ranges mentioned for this test. I'm not experiencing any symptoms associated with abnormal levels of Ammonia. With the normal LFT should I be concerned?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I have as my reference for serum ammonia level as normal from 11 to 79 mcg/ dL so I understand your concern. Since Labcorp lists this within normal range for the test I think that you need not worry. Lab tests are done by various technologies and these will cause differences in the normal range that is found( generally corresponding to the 5th to 95th percentile of normal healthy subjects. So even though your value would be high by many common published reference ranges it has been determined to fall in the normal range for the specific technology and method used to run your blood sample. This plus other normal liver function tests would add up to mean no liver disease. I presume that you do not have a history of liver disease - right?? It is usually in the setting of long standing known liver disease that high ammonia levels become a concern. So if you have no such history and your other liver tests are normal then I think you should be reassured that you do NOT have a liver problem. The normal brackets for ammonia just happen to be set higher according to Labcorp 's latest test for this. That is all that is going on! You have nothing to worry about with this!!

I hope this helps! Let me know if you have further questions.best regards!!

Anthony Bray MD
Customer: replied 1 year ago.

I've had the following LFT done over the span of a year(2 by me and one in general bloodwork):


 


Total Protein, Albumin, Globulin, A/G ratio, Billirubin (direct and indirect), ALP, LDH, AST, ALT, GGT. Last LFT was 06/13.


 


All tests came back normal except for a mild elevation in LDH, which was 242 (lab range 0-225).


 


My GP has all these results (though we haven't met about the Ammonia and others he ordered one yet). My GP is satisfied that I do not need an ultrasound, except if my OCD mandates it.


 


I am no longer drinking and if I return a glass or two of wine will suffice, but only in company. So I'd say I have no history of liver problems, thankfully.

Expert:  Anthony Bray, MD replied 1 year ago.
Hi again,

Your overall picture sounds reassuring and more than sufficient to prove that your liver is healthy!! You should have no need to worry in this regard!

I hope this helps! Let me know if you have further questions! Best regards,

Anthony Bray MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 7162
Experience: 14 years as clinician in the field of Family Practice
Anthony Bray, MD and other Health Specialists are ready to help you

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Anthony Bray, MD
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14 years as clinician in the field of Family Practice