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Ask Anthony Bray, MD Your Own Question

Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6662
Experience:  14 years as clinician in the field of Family Practice
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Dr. Bray: I had an echo Monday afternoon to take a look

Customer Question

Dr. Bray:

I had an echo Monday afternoon to take a look at my heart situation. I mentioned my concern to the technician (or whatever her title is) and she and the student in training both commented on my left leg with slight selling, and pointed to markings on the outside, then said it looked like venous insuffieciency to her.
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD :

Hello again,


 


 


 

Anthony Bray MD :

Well I caution you not to put too much reliability on non doctor's offering their opinion but she may be right ...

Anthony Bray MD :

AS we had discussed before venous insufficiency is statistically your more likley cause.

Anthony Bray MD :

Other more serious causes of course must be ruled out.

Anthony Bray MD :

Hopefully you will get the official interpretation back from all of your heart studies and these will prove to be OK!

Anthony Bray MD :

You also have a sleep study scheduled > is that right??

Anthony Bray MD :

Obstructive sleep apnea is another potential cause of lower extremity swelling...

Anthony Bray MD :

Is the left leg worse than the right?

Anthony Bray MD :

Assymetry of the swelling would to me more suggest venous insuffiency as being your cause....

Customer:

She was real good at steering away from my inquiries during the procedure. She knows it's not her place to say anything. The did let me watch the monitor and told me what they were doing and pointed to various things. I learned alot, but obviously not my results. I have a stress test Friday and should know more. Then meet with Doc next Tuesday.

Customer:

Assymtery?

Anthony Bray MD :

Does the swelling go down overnight and get worse during the day?

Anthony Bray MD :

Yes is the left worse than the right?

Customer:

I think the swelling goes done some over night but it it very slight. I wouldn't have noticed it at all except for some very tight socks. Yes, the left leg is worse than the right.

Customer:

I would have to demonstrate to someone to show they are actually swelled.

Anthony Bray MD :

Right, that is what I was getting at. If the cause were sleep apnea, renal, heart, liver then you would expect swelling of right and left side to be equally bad... this CAN be the case with venous insufficiency as well BUT with venous insufficiecny it is more often the case that the condition of the deep vein valves on one side are worse than that of the other side...

Anthony Bray MD :

I see. So it sounds that you really have a mild case of the swelling then to me....

Customer:

The tech also pointed to noticible vericose veins in the left leg, around the knee.

Anthony Bray MD :

Right, vericose veins would be a good clue...

Customer:

Question. Sleep apnea alone can cause swelling?

Anthony Bray MD :

Yes it can because if severe enough then it may deprive the body and heart of oxygen at night >> this can be bad enough to cause CHF but only when you sleep basically!!

Anthony Bray MD :

Obstructive sleep apnea starves the body of oxygen temporarily but this causes much stress to the body...

Customer:

My sister has sleep apnea, uses a CPAP and after the stress test this will be next. I also have thin nostrils and a correct deviated septum.

Customer:

corrected. sorry.

Anthony Bray MD :

I see. Well I hope that all of your studies turn out good for you!

Anthony Bray MD :

They do serve mulitple purpose as these issues are useful to exclude. Maybe a blessing in disguise a little bit...

Anthony Bray MD :

I hope that this helps! Let me know if you have further questions! Let me know how your heart studies do turn out!

Customer:

I don't do heavy exercise but steady. 20-30 on the bike, walking, including hills. I get a little winded going up some of the bigger hills but never have to stop. My B/P seems to be slowly going down. I've have some numbers like 137/88 in the last few days. My OCD drives my worries of course but I actually feel better after just a few weeks on this new programs and have lost 4-5 lbs. I think it has a lot to do with stopping drinking and limiting sodas to once a day and no more Burger King.

Anthony Bray MD :

OK I see >> well I think that your efforst to improve your lifestyle will make a world of difference for you! The exercise and a bit of weight loss are excellent. Your last BP is not bad. All very good signs of a very positive trend for you I think!!

Anthony Bray MD :

The regular exercise will help with your ansiety and sense of well-being psychologically as well!!

Anthony Bray MD :

I hope that you have a great 4th!!

Anthony Bray MD :

Let me know if I may be of further help!

Customer:

Regarding Venous, all I read about is chronic venous. There must be a mild version on some kind with recurring episodes, right. After a good day of exercise and working in the yard my ankles did burn some. In fact I detect a minor burning sensation now.

Anthony Bray MD :

Sure there are all grades of severity of the condition....

Anthony Bray MD :

The burning of the ankles may realte to the swelling as I believe we discussed before but this does make me wonder if you have something else causing the burning sensation... say this is mainly the ankles and not the feet and toes, right??

Customer:

More in the ankles. I have some discoloration on my left foot (been there for years) but my feet do seem to swell nor burn.

Customer:

sorry. soryy

Customer:

My feet DON"T seem to swell or burn.

Customer:

And I do get a mild burning discomfort where the discoloration is on the left leg.

Customer:

at times.

Anthony Bray MD :

I see... then if your feet are not affected by the burning then this relieves me that you are not likley dealing with a peipheral neuropathy as the cause of the burning sensation.. it sounds more a direct association with the swelling in your case...

Anthony Bray MD :

So the pattern does to me at this point sound most consistent with just a mild degree of venous insuficiency >> take care to avoid prolonged standing (walking is not as bad because the leg muscles help to pump venous blood upwards) Also take care to elevate the feet when you sit and this will help.

Customer:

I will do so. So in conclusion, CHF is not high on your list?

Anthony Bray MD :

It does not sound so bad at this point that I suspect that you really need to use the compression stockings (These would be in more severe cases of venous insufficiency)

Anthony Bray MD :

Right > I suspect that you do not have CHF...


 

Anthony Bray MD :

Still we prudently await the results of your studies but evidence seems to be more directed to mild venous insufficiency as being your cause...

Customer:

Thank you. I will let you know the results. Again I appreciate your input. The cardiologist ordered these tests not on the suspicion of such, but because of age and family history (and weight). My GP never mentioned CFH either. Sleep apnea, yes. Hyptertension, yes. I pushed for these to rule out the worse case. Never thought the x-ray, emergency room visit info would be useful. And with the Internet and no clinical experience, the worse case is seemingly the most prevelent.

Customer:

Which is why I come to you.

Anthony Bray MD :

I see. Well I think that you can sigh with relief and hopefully more so soon when you get all of your results back!


 

Customer:

Thank you. Have a pleasant Holiday.

Anthony Bray MD :

Often people can get terrified with health concerns and when it is YOU it turns truly terrifying to consider worst case scearios...

Anthony Bray MD :

Take care and Thank you!

Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6662
Experience: 14 years as clinician in the field of Family Practice
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