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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31641
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I had lap band removed may 15, 2013, had a golf ball hematoma

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I had lap band removed may 15, 2013, had a golf ball hematoma that dissolved on its own after a couple weeks. I feel like my body is just hoding onto to fluid. My right knee was bugging me last week then in get home tonight it's 100 degrees outside haven't been outside long walk in my apartment and my legs hurt, ankles hurt and are swollen to where i have no ankles. My weight just keeps going up no matter what I eat. I do know I am hydrated and drinking enough. What could this be?

Hello Stephanie ,
I am Dr. Arun and will be helping you today.

How much weight has increased since May 2013?
Is there pain, redness, tenderness in calves?
Were any investigations done for the fluid accumulation in lower limbs?

Thank you.

Customer: replied 3 years ago.
June follow up I was around 260-270, which was same as at home scale. My weight today is 280-285. When I get up to walk yes it's tenderness in calves then moves up leg. No real redness. Feels swollen in knees. My boyfriend was rubbing my legs and said they feel a lot like tight skin/doesn't sink in like normal larger legs do. Today /a little yesterday was first time I noticed tightness in calves & legs right after started to walk after getting up.
Thanks Stephanie, for the further information.

The pain, tenderness and swelling in calves would need ruling out of blood clot in the veins (deep vein thrombosis) for the cautionary reasons. Though this is not the common cause for swelling in both the lower limbs. Idiopathic (cause not ascertainable) edema is the commonest cause for it. Swelling of feet, ankle and knees on both the sides can be associated because of the following reasons (apart from idiopathic edema);


1) Venous valvular incompetence

2) Obstruction of the lymphatic outflow

3) Dependent edema which can occur because of the prolonged standing or sitting.

4) Congestive heart failure

5) Kidney diseases

6) Protein deficiency

7) Hypothyroidism

8) Anemia

9) Medications

Following would be advised:

1) Avoid prolonged standing or walking for long distances in a single stretch.

2) Whenever you sit; keep your legs elevated on a chair or a sofa or stool.Do not hang the legs, otherwise gravity will increase the swelling.

3) Exercises / physical therapy

a) Lie down straight and raise your leg and feet for 10-20 seconds. Repeat this for ten times (twice a day whole set).

b) When you sit; pull the feet towards you for 10-20 seconds. Repeat it for ten times twice a day.

4) Raise leg end of your bed by 6 inches.

Pain can be helped by;

1) Analgesics

2) Acupuncture

3) A very mild massage; keeping the massage direction towards heart.

4) Electrical stimulation; this is a small device which physical therapy centers would give your for the home use.

But before all this blood clot should be ruled out by an ultrasound and blood test (D-dimer).


Idiopathic edema may be a multifactorial disorder that has not been completely delineated. The postulated causes are;

1) secondary hyperaldosteronism,
2) primary abnormalities of the hypothalamus,
3) Abnormalities of thyroid,
4) dopaminergic release

The underlying cause seems to be due to fluid leaking out of the small blood vessels called capillaries into the tissues. Why this occurs in some people is not clear. It is usually worse after standing for long periods, as there is increased pressure in veins when standing compared to lying down. Long periods sitting can also worsen the swelling. One other possible explanation is the retention of salt. When the body retains salt it also holds on to fluid and thereby may cause some edema. Idiopathic edema is characterized by impaired water excretion also, particularly in the upright posture. Indirect evidence has shown that antidiuretic hormone is involved in this disease.


Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

 

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Customer: replied 3 years ago.
I had lab work done Sunday and they said CBC, regular blood work they run looked all normal. Would soaking my legs in warm/hot bath help the swelling? I have Addison's disease but have had since 2009 and never had anything like this. Can this just be a reaction to having surgery, then hematoma form, I also had bronchitis two weeks ago. I have water pills that I took two but doesn't seem like it is helping all that much.
Is this blood clot test something that can wait tell tomorrow, insta care is closed and I have a 200.00 er copay. I don't mind going in just don't want to go in if not urgent. I do feel like the swelling has just gotten worse and worse little by little.
Hello Stephanie,

If there is mild pain; you may wait till tomorrow. If there is moderate to severe pain and is accompanied by redness and tenderness; this will warrant an evaluation today. Soaking in warm water can help, so you may go ahead with it. Surgery is not likely to be responsible for the edema.

It is privilege assisting you.

Dr. Arun
Customer: replied 3 years ago.
I apologize one more question, and I appreciate all your help. The discomfort is hard to explain, when i stand up and start to walk three steps I feel the tightness in my legs/knees/ankles right away. Is that something that warrants being seen tonight or waiting tell tomorrow?
This is not a significant sign for the immediate evaluation.

Your questions are welcome.
Customer: replied 3 years ago.
I just soaked my legs, didnt really help. The one thing I forgot was after walking even short distance it also causes me to feel really worn out / tired like I have been walking for awhile. There is no way I could walk even five minutes without to much tightness / tired feeling.
A tired feeling point to more of an hormonal issue or a mild grade infection. But the increasing tightness in the calves on walking would be considered as a significant sign which would warrant an evaluation by the ultrasound. I am sorry, but since I can't examine you, I cannot say anything in a very certain term. But we need to work on the cautionary side for these problems.
Customer: replied 3 years ago.
Your totally fine, u have been a huge help and I appreciate it very much. I will go get it checked out to be safe. Thanks again u were/are great.
You are very welcome.

Good luck
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