I Have Been Having Severe Ankle, Foot And Leg Swelling

Posted on Wed, 12 Dec 2018

Question: I have been having severe ankle, foot and leg swelling for about a month. I have also had a cough with clear phlegm for the last few weeks. I also have a wet wheeze when lying down. I also cough and have trouble breathing after any exertion.

I have been to the doctor multiple times. They put me on water pills and potassium. This doesn't seem to be doing anything for the swelling. Though it had been going down at night, they are now extremely swollen and stay that way.

I've had chest x-rays that do not show anything. My doctor wants to do an echo, but I haven't been able to have that done yet.

I went to the ER last night, because I had chest pressure and pain. They did EKGs, which they said were normal. They also did an ultrasound on my heart, and said there was nothing obvious.

My troponin level was:
Troponin I     <0.04 ng/mL     0.00 - 0.03 ng/mL

Some of my blood levels were high. They follow, with the normal ranges following.

Neutrophils Absolute     8,856 /uL     1,500 - 7,800 /uL
Lymphocytes Absolute     5,247 /uL     850 - 3,900 /uL
Additional review to follow.
Monocytes Absolute     1,049 /uL     200 - 950 /uL
Eosinophils Absolute     747 /uL     15 - 500 /uL

These have been rising over time, I've noticed, when I compare to past tests.

My WBC is also high:

WBC     15.9 10E3/uL     3.8 - 10.8 10E3/uL

My doctors don't seem too sure about what to do, other than an echo. I also have doctors switching because my old one is done and the new doctor is coming in, complicating getting things done for me.

I generally feel ill and extremely fatigued.My appetite has gone in the last few days, I am just not hungry. I sweat at night and during the day, when others are comfortable. And again, my legs/feet/ankles are severely swollen. Any thoughts on what could be going on?

Thanks!

Answered by Dr. Dr. Yogesh D (1 hour later)

Brief Answer:
Elevated WBCs indicate acute infection, likely bacterial, heart failure.

Detailed Answer:
Hello,

Welcome to Ask a Doctor service.

I have read your query carefully and have understood your problem.

There are at least two major issues of concern here.

1. Acute infection. It could be a bacterial infection, your total wbc counts are significantly high, (it is reflected also as an increase in all types of white blood cells - lymphocytes, neutrophils, monocytes and eosinophils.

The site of infection can be lungs, or it could be generalized bacteremia.

You need to be admitted in a hospital and blood culture and sensitivity is a must to find the exact pathogen responsible.

An emperical antibiotic combination must be started.

Disseminated Pulmonary tuberculosis must also be ruled out considering you have night sweats, and your symptoms are not responding to the diuretics.

2. Your other set of symptoms of difficulty breathing, leg swelling indicate either heart failure, or low albumin levels in the blood.

Low proteins in the blood can also cause swelling in the legs, so does kidney disease.

If you have been suffering from hypertension or diabetes since long, both of them can cause heart failure or chronic kidney failure which can cause swelling in the legs.

Your problems are quite serious and need to be managed in a hospital.

I urge you to kindly get yourself admitted in a good teaching hospital (Hospital attached to a Medical College/school).

Unfortunately I can not help you in relieving your symptoms online, you need expert medical care and I hope you get that soon and get well soon.

Wishing you speedy recovery.

Best regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dr. Yogesh D (2 days later)

I just wanted to let you know that I went to the ER after I got your reply, very concerned. They blew me off, didn't test for anything and after pumping me full of liquids because I was dehydrated, sent me home. They did re-test my blood, and things were still high, and others were high from having been normal. I saw my new doctor today, who also blew it off. She said I just needed to loose weight. Quite an insult, I have gained 25 lbs in a few months, and I know it's not from food, it's from water weight, as I haven't been eating well.

I believe I have an infection like you said, and I believe it's from my gums. I have very few teeth left, with broken and exposed roots and abscesses. I believe it's causing the infection you mentioned. I know this can turn to sepsis, and I don't know why the hospital and doctor aren't taking me seriously.

I will be going to a different hospital and doctor, as I am feeling sicker and my whole body has become puffy, especially my face. Thank you for the reply, I know I am ill and someone will listen!!

Answered by Dr. Dr. Yogesh D (7 hours later)

Brief Answer:
It is very unfortunate that ER doctors did not think you need admission.

Detailed Answer:
Hello Ms Kimmiekins,

I am sorry to hear about your ordeal and blunt dismissal by your new doctor.

Such high total counts and severe leg and facial edema should never be dismissed off as insignificant.

Since you have multiple dental abscesses you must consult a dentist/oral surgeon along with medical doctors.

Since you had had such a bad experience with the ER doctors, as I suggested earlier, I think you should visit a teaching hospital (the belief here is, teaching hospitals tend to make less mistakes in diagnosis and treatment).

I wish I could do more for you, but I am sorry again.

I do sincerely hope you will get good doctors to take care of you and look into the problem with more genuine care.

I wish you a speedy and complete recovery.

Warm regards

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Yogesh D