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Had a dental abscess, bilateral lower extremity edema and chest pain. Looking for advice

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Practicing since : 1981
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Hi, I wanted to ask about some worrisome symptoms I've been having lately.

About 3 months ago, I had a dental abscess and was taking a lot of alternating ibuprofen and tylenol for the pain until I could get into my dentist's office (not sure if this is relevant, so including it just in case). At that time, I also developed sudden bilateral lower extremity edema, mostly in feet and ankles, but the pitting actually extended up to nearly my knees. I had never had edema before. I should have gotten it checked out, but didn't...mostly because I have a high-deductible health plan and had just been to see the doctor regarding some light galactorrhea that turned out to be nothing. All labs were normal. Anyway, my HSA was empty due to this :(

The edema eventually faded away other than maybe some faint traces of pitting edema around the upper and side of my feet, so I pushed it out of my mind. Until now. A few days ago, it came back. Today, the pitting edema lasts over a minute before disappearing, although it's only in feet and ankles this time. Elevation helps (it's mostly gone in the mornings), and it seems to be very light on days when I'm especially active. It's the days when I'm mostly sitting with my legs down that it's the worst.

Other symptoms I've been having lately that may or may not be related are pleuritic sternal and right chest pain (directly under my breast, especially when lying on my left side), as well as my right upper back. This pain is mild, but more noticeable at nighttime when I lie down to sleep. This pain has been present for about 2 weeks. I have a chronic light cough, especially in the mornings (I was, unfortunately, a smoker for many years), but this has seemed a little worse recently. I've always been pretty overweight, but in the last few months, I've put on an additional 20 lbs and am at my heaviest ever. I don't feel like my diet has changed significantly. I just figured my metabolism had slowed. And, actually, in the last week, I think I'm eating less than usual. But I've noticed that I just feel...heavy...around the middle and in my legs. And like my activity tolerance is down. Also, in the last two days, I've had some mild burning sensations in my feet and my right fingertips. I'm not sure how much this has to do with the heat wave we're having here and how active I've been between moving and unpacking.

About a year and 1/2 ago, I switched from an on-my-feet-all-day job to a very sedentary one. I sit behind a desk all day long during the week, and I'm sure this has affected my health.

I'm only 33 years old. These symptoms are scaring me. I'm a nurse, so I have all these horrible possibilities running through my head, and I don't want it to be any of them. I just moved two weeks ago and don't have a PCP here yet. I'm not sure whether to go to urgent care or try to get a first-time appointment with a new doctor, which could take awhile. I think waiting that long to find out what's going on could drive me nuts with worry. I guess I'm just not sure if this is something that needs checking out NOW now, or if it's okay to wait for a regular PCP visit with a new doctor.
The edema is just slightly worse in the right foot than in the left.

Any advice you can give is much appreciated.
Posted Fri, 27 Jul 2012 in General Health
Answered by Dr. Anil Grover 40 minutes later

Thanks for writing in.

You have two main symptoms PAIN second is EDEMA and you are OVERWEIGHT and you are worried that you are not having a serious illness.
To Take Pain first. One can safely say it is not CARDIAC PAIN
Typical pain related to heart is “retro sterna” (Central) squeezing associated with sweating and increased heart rate and it radiates to neck and left arm. Important is the fact in what setting the pain occurs. At age 33, you have some identified risk factors for coronary artery disease; others you can fill in by personal knowledge and investigations. The idea is if you have a back ground of more known risk factors your chances of pain (even atypical pain) originating as a result of heart are much more. The pain you are describing is more likely to be musculo-skeltal or due to cervical spondylosis.

At any age, following is the list of risk factors for future development of Coronary Artery Disease. Let me enumerate and you can place yourself the risk you are carrying ('*' means you have the risk factor, '+/-' means I do not know and about others you know better):-

Diabetes +/-
Hypertension +/-
Smoking* Have you left it now, not clear from your mail.
Stress* (your mail tells about it may be subconscious level)
Obesity and Sedentary Life Style*
High Bad Cholesterol and Lipid Component +/-
Total Cholesterol above 190 mg%, LDL above 130 mg%, VLDL above 40 mg%,
Triglycerides above 150 mg%, Apolipoprotein B above reference value
Low Good Cholesterol and Lipid Component: +/-
Apolipoprotein a below reference range for the lab and
HDL below 40 mg% for man & and 50 mg% for woman
Family History 0f Coronary Heart Disease +/-
Increasing age*
Being a Man (as opposed to women) till the age 45- (theretically you are protected till menopause) but with more risk factors.
So I do not think your edema is because of heart failure. It is venous stasis with obesity contributing to it.

From the list, above you have some risk factors. Obesity and possible sedentary life style you have identified. Therefore, I will strongly recommend consulting your new, discussing your problem; doctor may complete the list as well do the EKG and cervical spine and or chest x-ray, which may tell us the cause of pain.
Regarding obesity and sedentary life style:
It is never too late to change. With your weight everything you do will have to be under supervision. It need not be cardiologist but your primary doctor can guide your way back to health - I am happy to read that. You may need drugs and he/she (or ask the dietitian) to advise you about diet low in calories and cholesterol, advise you on quantum of exercise. You ought to keep your weight under control for you do not want a heart attack. If you like non vegetarian you cannot take red meat but there is no bar (in taking certainly quantity had to be less) on egg white, roasted chicken and roasted fish.

Are your teeth OK now then dental abscess is past history.
I wish smoking is also past history if you have left it for more than a year after 14 years of smoking. Give yourself a XXXXXXX If you are still smoking then that is harbinger of many a diseases you are a medical professional, but you got to stop it. Use professional help; behavior therapy, nicotine gum or spray. Get out of it. If you are a current smoker chest x-ray is must.

Hope you found something useful in this answer. If you have any follow-up query I shall be happy to answer.

With Best Wishes.
Dr Anil Grover, Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

Above answer was peer-reviewed by
Follow-up: Had a dental abscess, bilateral lower extremity edema and chest pain. Looking for advice 28 minutes later

Thank you so much for your reply!

I didn't think the chest pain was cardiac in nature, either, or I'd have been in the ER regardless of how high my insurance deductible is. It only occurs with XXXXXXX breaths and is very mild. With the increased cough, I was more worried about some type of respiratory infection in my right lung causing pleurisy. And, of course, having worked on a post-surgical floor where pleuritic chest pain plus edema = suspicion of PE and pitting edema usually = CHF, liver, or kidney failure, my mind automatically jumps to these types of very serious illnesses before anything else. I have to admit that my fear of being diagnosed with something that serious is part of the why I've put off seeking medical attention for myself.

I wonder if maybe I have venous insufficiency. I have some varicose veins that started when I used to work 12 hour shifts on a very busy hospital floor, and several months ago, I did mention to my doctor at the time that I was having pains in the backs of my legs when I stood for long periods of time.

Out of curiosity, Dr. XXXXXXX do obese patients with venous insufficiency who make lifestyle changes and lose weight see improvement in their circulation? Is it possible that losing a significant amount of weight would make my feet stop swelling? You said it's never too late to change, but I'm so worried that my diet and sedentary lifestyle and reluctance to seek medical care has caused me permanent harm. I feel like I'm too young to have these issues and am so afraid of finding out they are irreversible.

Thanks again :)
Answered by Dr. Anil Grover 29 minutes later

No I did not think pulmonary embolism, though you are prone to it pulmonary embolism which causes plural rub meaning pulmonary infarct has set in would have made you breathless and more important than that before it caused right sided failure it would have caused cyanosis. You mentioned none of these. So I thought it stands excluded.
Pneumonia or any kind of chest infections causes symptoms of cough and fever, before it produces cor pulmonale. So that stands out. However, a chest x-ray was suggested and it is needed. Kidney and liver failure, with your so comprehensive description, you would have mentioned some pointer to disease of these two organ before pedal edema kidney failure causes puffy face and liver failure causes ascites. You would not have missed either.

Each kilogram of extra weight (we define overweight till 20% of excess weight and obese thereafter) adds 3 kilometers total length by adding capillaries, venules, veins. arterioles and arteries to your circulation tree, extra for heart to pump blood to. So, even if you loose 500 gm weight in a month in 10 years you would have lost a significant bit. That is the time when heart needs some respite. What happens in sedentary obese persons is they do not walk much so veins of the leg loose the extra pumping action of leg muscles and blood goes to get accumulated in extra vascular space hence pitting edema. One need not have propensity of varicose veins.

It has been pleasure interacting with you but I disagree with you, at age 33 there is no permanent harm. Everything is reversible so far but time moves on. Including pedal edema. I sound like preaching my friend, but get the junk food out of your diet and junk thought out of your head. Think positive. You will go a long way. You are in that position in medical profession when your decision can help others. Think about it. Bye.
If you have any follow-up query I shall be happy to answer.

With Best Wishes.
Dr Anil Grover, Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

Above answer was peer-reviewed by
Follow-up: Had a dental abscess, bilateral lower extremity edema and chest pain. Looking for advice 41 minutes later

There's no need to reply to this as you've already answered my questions. I just wanted to say that your replies have inspired me! Also, the recommendation regarding cutting out red meat reminded me that I was at my lowest weight and felt my healthiest during the 4 years I was a vegetarian when I was younger. I would love to feel that way again. I'm going to go back to vegetarianism and take your other advice, as well.

I'm so glad I found this website. I'm one of those patients who doesn't say much and feels a little silly expressing my fears in person with a new doctor, but oddly enough, I felt perfectly comfortable expressing them in written form.

Thank you for the help and reassurance and best wishes to you, as well.
Answered by Dr. Anil Grover 20 minutes later

Thank you for your kind words. May the Almighty bless you.

With Best Wishes.
Dr Anil Grover, Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
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