Hello and thank you for submitting your question.

I will try to provide you with some good information and recommendations regarding what is going on with your wife.

As far as her diagnosis of myelodysplastic syndrome this can be a relatively difficult thing to treat. Often at times patients do end up requiring transfusions on a regular basis. At some point she may be at risk for development of acute leukemia. I am sure her hematologist is following closely to monitor for this type of transformation and that adequate transfusion medicine is being used.

Regarding the swelling in the lower extremities. It appears like her doctors think that this is due to an infection. Generally antibiotics are the mainstay of therapy. Sometimes however certain infections can be resistant and a careful consideration of appropriate antibiotics therapy is indicated. It may be necessary for her to visit with and infectious disease specialist to help select an appropriate antibiotic.

There are other things which could cause the swelling including problems with circulation of lower extremity as well as blood clots. I again am sure that her doctors are following closely for this and looking for certain things to help alleviate her symptoms.

I need to remind you of one thing which is extremely important in the setting of lower extremity swelling and infection. It is absolutely imperative that she keep her legs elevated as much as possible during the day at home. This is as important as any medication which is given to her to help the infection.

It may take quite some time for the infection and the swelling to improve. Please be patient and continue to support her through this challenging time. There are really no other good recommendations which can help to hasten the improvement of her symptoms. Sometimes certain patients may wear supportive stockings at home to help with lower extremity swelling. This can sometimes be uncomfortable and each patient needs to consider this individually. I encourage you to discuss this with her doctors.

Again I thank you for submitting your question. I hope you found my response to be both helpful and informative. If you have any additional concerns I would be happy to address them.

Sincerely,

Dr. Robert.

---

Hi,

Thank you again for your follow-up question.

Myelodysplasia is not directly associated with arthritis. However, it is possible that this process may exacerbate an underlying arthritis.

I would encourage you to discuss these joint pains with her primary care provider as there are a number of excellent medications which can be used for inflammatory arthritis. I would advocate more for antiinflammatory medications rather than short pain medications as pain medications often caused sedation and while they improve symptoms. The underlying cause is not addressed.

Thank you again for submitting your question and follow up. I am always here for you if you have any additional concerns.

Sincerely,

Dr. Galamaga.

---

Hello and thank you for the follow up question.

Regarding anti-inflammatory medications, there are many 'over the counter' preparations that are available.

Today’s research indicates that a move toward individualizing the dosing of prescription agents is warranted and it can happen only after physical consultation.

Your doctor will know about these drugs and their dosages.

I would suggest a simple anti-inflammatory drug like Paracetamol 500mg after food to be taken in case of severe pain.

There are several prescription medications which would be perhaps as effective or maybe more effective. For the time being this over-the-counter preparation is a fine start.

Thank you again for submitting your question. I hope you found my response to be helpful and informative. If you have any additional concerns I would be happy to address them.

Sincerely,

Dr. Robert

---