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Treatment for elevated liver enzymes, cold extremities, diverticulosis?

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Hi, my Mother is 88 y.o., in excellent health except in th last 2 months, she has developed severe lymphedema in Left lower extremety, Moderate RLE, unable to wear shoes to to edema feet, ankles. Her Heart is good, no CHF, diuresis normally with lasix now 80 mg qd. Kindeys good. Slightly elevated liver enzymes. Denies fever.Very active til this happended. Negative for Bil DVTs, good capillary refill, color extremites pale but warm. Denies pain in abd, HX diverticulosis however little problem with it. US abd, pelvis only reveiled poss small area, deep in abd, etioloty unknown. Due to have CT /c contract as soon as available, we live in Longview Washingtom, 50 miles N of Vanc. Washington.Portland Oregon. I wonder about lymphalic hypoplasia? What kind of MD would see her? What further tests needed if CT reveils mass? Any radionuclide or arterial testing needed? Any excellent doctors in our Portland/Vanc avail for this kind of problem? Does it seem like we are in teh right direction? XXXXXXX
Posted Tue, 4 Mar 2014 in Medicines and Side Effects
Answered by Dr. Saumya Mittal 6 hours later
Brief Answer: answering the direct questions Detailed Answer: Hi XXXXXXX I am Dr Saumya Mittal, MD Read your query. You have asked the following specific questions I wonder about lymphalic hypoplasia? What kind of MD would see her? What further tests needed if CT reveils mass? Any radionuclide or arterial testing needed? Any excellent doctors in our Portland/Vanc avail for this kind of problem? Does it seem like we are in the right direction? I will discuss the problem so that you understand more clearly what we may have to do. The edema in the leg can be due to a. heart failure- which you have ruled out, besides she is on diuretics b. kidney disease- where there seems to be a probability, since she is on diuretics c. a vascular disease- like arterial and venous problem, you said the doppler is normal d. an abdominal mass- this may compress the major vessels, causing swelling of the legs by cutting on the flow of blood from legs back to the body- needs a ct scan which she is scheduled for.. So I would answer your last question- yes you are on the right track. As for the question regarding further tests, it will depend on where this mass turns up. Accordingly we will need to do the further tests. We will definitely need a biopsy. A PET may be needed according to the site and possible biopsy diagnosis. So the further tests will vary as per the CT report, as that will guide how we can reach to this mass. if its a mass I would recommend at least one consultation with an oncologist/oncosurgeon/radiotherapist. Usually they work in a team. So you may not have to choose multiple doctors. As for lymphatic hypoplasia, usually its a congenital disease. So I wont worry about that just yet. Let wait for the CT scan. And for the remaining question- a good doctor, the therapy is standard for most of the mass conditions. Whhat you will need to concentrate on is a good hospital with brilliant nursing care. Cause therapy will be similar everywhere. But the nursing care can be crucial in these cases. I hope this has answered your current queries. And doubts, clarifications and further queries are welcome Dr Saumya Mittal, MD
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Follow-up: Treatment for elevated liver enzymes, cold extremities, diverticulosis? 2 hours later
my Mother was doing well, til she sustained a left groin pull mid Dec 2013. While she was barely able to lift her left foot 4 inches off the floor to elevate her foot, even with help, her leg stayed partially dependent for a month to 5 weeks til she could tolerate having her leg elevated at slightly below waist level. By that time her leg, foot and ankle was quite edematous. Cutting back on salt, better elevation, increase from Lasix 40mg to 80mg has not improved the edema but it has not worsened over the 3-4 weeks either since treatment started. This whole edema problem on her BLE, L>R, started right when she was healing from the groin strain. Is it possible this could be associated since this edema happened right after she noticed the pain in her left groin? Could there be bleeding from the groin pull that clotted in the abd, causing an occlusion and not allowing return flow of fluid back to her heart. For years both legs have had insufficient valves in her legs, edema has always been there but not to the extreme amount til the groin pull happened. Could the dependent position of her leg at first while she was first healing been enough to swell her legs and not have the valve integrity to allow fluid to be pushed back toward her heart? Could a clot just stay there til dissolved or removed, causing this edematous condition? Is so, is she at risk of having a huge CVA if part or all of it broke off? Is this an emergent situation considering that? Thanks, XXXX
Answered by Dr. Saumya Mittal 2 hours later
Brief Answer: Answering further queries Detailed Answer: Recieved your return query XXXXXXX First I would want you to calm down. Yes, there is a possibility that the mass was in her stomach for a long time. And has gradually grown to cause symptoms of pain, as in groin, and pressure on the nerves and also the inferior vena cava. The pressure on the last causes the blood to be retained in the lower legs. Now while leg valve insufficiency can cause the problems you talked about, you have already said that the Doppler study was normal. There is a possibility that the clot may have been small, and dissolved, but usually a clot extends it self first and then later starts resolving. So if the Doppler was done while she was developing the edema, the condition would probably have been caught before. Just to answer your question, though the chances are slim and unlikely, the clot in the lower legs usually travel to the heart and thereafter lungs where most of the clots are filtered. So it is a very rare possibility that a clot from the legs reaches the brain. I would say you wait for the ct abdomen to happen and then we can make a better statement about what might be happening. So till then please do calm down yourself too. If you are calm, you can help your mother better. Your anxiety may make her more anxious. I hope this answers your current query. Any further queries are welcome. Dr Saumya Mittal MD
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