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My question is about my mother. She is 77 and just had

squamous cell skin cancer removed...
My question is about my mother. She is 77 and just had squamous cell skin cancer removed from her flank 12/21/17. A couple of weeks after the surgery, she developed swelling across her shin in one leg and then it moved to bilateral legs. She went for her checkup and did not mention this to the surgeon. The margins were positive and he did not get it all, so she is scheduled to go back for either another excision or radiation. In the meantime, she still has the bilateral leg swelling across both lower legs (hourglass look). She has frequent urination, and now has developed a productive cough. She was taken to the ER 2 weeks ago for the cough because she has an anxiety disorder and she got short of breath from panicking over the cough. They ran a chest x-ray (portable and then 2 view) and the portable showed elevated right diaphragm and the 2-view showed right pleural effusion. They referred her to a pulmonologist and that was all. In obtaining the records, I have looked at all of her labs and other tests, and am suspecting these symptoms may be heart related (I work in the medical field). I did notice that her MCV, MCH and MCHC are very low, so that points to iron deficiency anemia. The EKG showed possible atrial enlargement and an anterior infarct, age undetermined of which we have known nothing of an infarct. Her BNP was elevated to 508. All of her preop work was great before the surgery and they even told her that her heart and lungs were in excellent shape. So, I am wondering could the surgery have triggered a cardiac event, could her low iron be causing the cardiac symptoms and could these be congestive heart failure signs, and if so, how could all of it happened so quickly from the surgery? She is doing better in terms of being up and around, she is not short of breath and can talk quite a bit without even being out of breath but the cough is constant and it's a cough where you can hear the production in her throat not in her lungs. I do have all of the records I can upload from the ER visit if that would help. I have gotten her iron, vitamin C and B12 for her to take as of today. She is very small, 82 pounds, and wasn't but a few pounds more than this prior to the surgery. She had gotten up to 87 in a couple of weeks of the surgery but I believe that was fluid retention. She hasb't been back to the surgeon due to the leg swelling and now the cough, and thinks she needs to get better from it before she goes back to the surgeon. Just trying to figure out a direction to go in.
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Answered in 19 minutes by:
3/23/2018
Dr. David
Dr. David, Doctor
Category: Cardiology
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Experience: Experienced physician with cardiology experience
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Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

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Customer reply replied 4 months ago
I did upload all of the labs but am not seeing them now, did they upload correctly?

fluid retention, too much salt intake can cause edema in the legs and fluid back up in the lungs

she needs a heart echocardiogram to check for heart weakness and decreased ejection fraction

she can get blood tests for CKMB and troponin levels to see if they are elevated which can be a sign of heart attack or heart muscle damage.

no, I don't see files uploaded.

you need to upload files where it says "add files" do you see that?

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Customer reply replied 4 months ago
They did do the troponin and CKMB levels, let me attach the labs again.
Customer reply replied 4 months ago
All cardiac profile was normal.
Customer reply replied 4 months ago
My main concern was the elevated BNP to 508 along with the cough even though the cough doesn't seem suggestive of the "dry" cough that is normally associated with a pleural effusion.
Customer reply replied 4 months ago
if troponin and CK, CKMB were normal what would the elevated BNP suggest? Previous cardiac injury? I was under the impression that the troponin and CKMB were only if it was an "active" myocardial infarction presently going on, which it wasn't.

she may need to cut down on salt intake which can cause fluid retention.

https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/84291

her BNP has to be above 1200 for congestive heart failure.

she should get a heart echo, but most likely her heart is fine.

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Customer reply replied 4 months ago
Ohhh, okay, I didn't know that about the BNP. She does eat a lot of chicken salad that has high sodium, so if she cut that out, that should help? I will make sure to do the echo. So, would the iron not be needed then?
Customer reply replied 4 months ago
Everyone around has had the cough and we do have very high pollen, but I was thinking with the elevated BNP and the x-ray showing pleural effusion, that it might be heart related. Sounds like I was wrong, thankfully!

she should be eating low sodium chicken salad.

and this will help her swelling and fluid in her lungs get better.

she could take an allergy pill like allegra and a steroid nasal spray which could help the mucus and post nasal drip

this doesn't sound like heart issues.

Let me know if you have other questions.
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Customer reply replied 4 months ago
You helped me out tremendously! I thank you so much for your time and help! Have a wonderful evening! 5 star!!

thanks for that

do you see the ratings area?

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thanks.

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