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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35710
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I am a musician on the road with a Broadway show. I tripped

Customer Question

I am a musician on the road with a Broadway show. I tripped and fell on the street in San Francisco Tuesday night. I fell on my face, broke my nose, and my glasses put a 1" gash across the top of my nose. I was so busy trying to staunch the blood that I didn't notice at first that my right knee was puffy and had swollen quickly to almost twice it's size. My face is healing and I'll have the stitches out on Monday. Since I can walk, I have been going back and forth from Oakland where the company is housing us to the Orpheum Theatre in San Francisco. I walked quite a lot today. I am a cardiac patient who suffered a major heart attack 7 years ago, requiring me to take blood thinners. My age is 63. My right leg is badly bruised, from halfway down my shin to halfway up my thigh, virtually all the way around. Strangely it doesn't hurt that much to walk. It hurts more when I don't walk. But tonight when I got home from the show, I noticed that my entire shin all the way to the ankle has turned purple. I'm icing it, but I'm a little freaked out and I don't know what to do. Urgent care faciilities in Oakland are not open on Sundays. I don't think I can go until 8am Monday morning, and I don't know how dangerous it might be to wait that long. Can you adivse me?
Submitted: 4 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 4 years ago.

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

Let me at the outset tell you that it may not be anything serious. This may be just the stagnated blood (bruising and small leaking of blood in soft tissue, called as hematoma formation), which changes color with the time and can discolor the skin. The decrease in the pain during activity or walking is due to better venous drainage as the muscle act as pump and push the blood from the area. While rest or sitting cause further stagnated or pooling of blood which increases the pressure in the tissues of the legs, thus increasing the discomfort.

Having said that, getting an evaluation would be advised at ER (as urgent care clinics are closed and waiting till 8 AM of Monday morning is not recommended). You are taking blood thinners which may cause fresh bleeding in the area (termed secondary hemorrhage) or continuous leak in the area. You may require blood work like bleeding time and clotting time and a colored Doppler study (specialized ultrasound) for the evaluation of the veins. The other thing need to be ruled out would be compartment syndrome which is increase in the pressure in fascial compartments of the lower limbs which may jeopardize the venous circulation. Increased walking can be contributory factor for the compartment syndrome. Both of these possibilities have very small chance, but we need to work on highly cautionary side for;

1) your present symptoms,

2) in your age group,

3) with your medications and

4) with the past medical history.

Any increasing swelling, pain, darkening also would point to immediate evaluation.

Please feel free for your follow up questions.

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

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