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Really need help. my husband is a 42 year old juvenile

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really need help. my...
really need help. my husband is a 42 year old juvenile diabetic with an insulin pump. he has had two strokes, the first they say was caused by him having a pfo in his heart. The second happened on the table while doing a cardiac cath to close the hole an air embolus went to his brain and caused a stroke on the right side of his brain which left him with left sided weakness he can walk his leg is just slightly weak but his hand he has no functional use of it he can open and close it but thats all. Ok here is our problem, for the past 49 days his left foot and ankle has been swollen. he was admitted to the hospital for four days and they could not find a reason why, his primary doctor can not figure out why. while in the hospital they checked all of his organ function, they went into the joint and took fluid to sample which all they could get was two drops, all tests come back normal.his foot is twice the size it normally is and its painful. I am really starting to get worried about this there has got to be a reason why this is happening that they are missing. Now as of yesterday his other foot is starting to slightly swell as well. and sodium levels were a little low so its definitely not that. We also found out yesterday that he is right on the verge of having osteoporosis. his T score is a -2.4
Submitted: 4 years ago.Category: Health
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Answered in 10 minutes by:
5/3/2013
Health Professional: 911Doctor, Doctor replied 4 years ago
911Doctor
911Doctor, Doctor
Category: Health
Satisfied Customers: 5,094
Experience: Board Certified Emergency Physician
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911Doctor :

Welcome, My answers are for educational purposes only. Remember please, that we do not get paid if you do not click 'accept' / give positive ratings!

911Doctor :

Heave they done ultrasound exams of the swollen leg to look for bllod clots?

911Doctor :

Have they done a CT or MRI exam of the upper leg and pelvis to rule out a blood clot in that area or anything that might obstrucy lymph flow (a mass of some sort)?

911Doctor :

standing by

JACUSTOMER-wsd5n9m0- :

they have done ultrasound of the foot and legs and they found nothing.

JACUSTOMER-wsd5n9m0- :

no they have not done a ct or mri. they said they he had a strong pulse in his foot so they were not concerned about circulation

911Doctor :

That doesn't satisfy me, then again, I'm not seeing him and do not have the benefit of looking at his chart.

911Doctor :

A high blood clot would not affect pulses in the foot

911Doctor :

So I think a pelvic CT with contrast to rule out a clot in the proximal femoral vein or illiac vein is indicated.

911Doctor :

Unilateral (one sided) leg swelling is theoretically due to poor heart function, but the odds are that the problem is on the same side, and they have only looked low in the leg.

911Doctor :

an ultrasound can miss a high, deep-thigh clot and can miss pelvic clot.

911Doctor :

also, they have not looked to see if there is something else (a mass) interfering with blood and lymph return from the leg.

911Doctor :

That's what I would want next.

JACUSTOMER-wsd5n9m0- :

ok. and the same stands for the fact that its mainly his foot swollen not really the leg well maybe slightly

911Doctor :

yes, still the same answer.

911Doctor :

looks like they ruled out gout with the fluid from the joint

911Doctor :

that's good and appropriate

911Doctor :

and the ultrasound was the proper first study to order

JACUSTOMER-wsd5n9m0- :

yes they did rule out gout and any kind of infection also

911Doctor :

an MRI or CT would add lots of info

911Doctor :

good

911Doctor :

so so far they have proceeded appropriately, but you are right that something is wrong and they need to run this down.

JACUSTOMER-wsd5n9m0- :

thank you so much, I am so worried about this because the doctors dont seem to be but somethings just not right this is not normal

911Doctor :

I agree with you.

JACUSTOMER-wsd5n9m0- :

one last question

911Doctor :

If a vascular surgeon has not been added to the consulting team I might suggest this.

911Doctor :

standing by

JACUSTOMER-wsd5n9m0- :

do you think it is just a side effect of his stroke? Thats was one doctors opinion

JACUSTOMER-wsd5n9m0- :

and the stroke was march 29 2010

911Doctor :

doubtful, though possible, and I would not hang my hat on this until more testing, and, perhaps, a vascular surgeon, rules out other possible causes.

JACUSTOMER-wsd5n9m0- :

ok. thank you.

911Doctor :

It's a long and complicated list, but notice that diseases in the pelvis can cause this, and they haven't looked there.

911Doctor :

you are welcome

911Doctor :

do you have anything further for me?

JACUSTOMER-wsd5n9m0- :

no we are going to his primary doctor today hopefully he will order these tests for him

JACUSTOMER-wsd5n9m0- :

thank you

911Doctor :

Great. I wouldn't be shy about asking about problems higher up in the thigh or pelvis and would not be shy about asking for a vascular surgery consult.

Thank you so much for your question. It was a pleasure talking with you. Should you need my assistance in the future simply start your question with ‘for 911doc only’.

Positive feedback is always appreciated.

Be Well

911Doc

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