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What Causes Painless Edema On Ankles?

Posted on Fri, 5 Dec 2014

Question: Hello doctor

I was on 10 mg lipitor for long time.

Last 2 years after a L3-L4 Disk ops, in a time scale for last 2 years.

The following conditions were treated. (Depression, Cholestrol and BP)
Morning
Norvasac 10 mg
WellButrin 300 mg XL

Night
Approvel 150 mg
Rivotril 1/4 of .5 mg
Lipitor 10 mg
cipralex 1 mg

Overall all well, functional manageable.
Recently, Wellbutrim was hiked to 450 mg.

I dont want to correlate but at the same time.

I had a painless edema in both of my ankles. (one month before)
Then pain started. (I can climb steps but cannot climb down as much easily as I climb up)
I had tremors only in pincer like movements. (specific movements)

I did a xray and blood work.

beginning of arthritis in knees (slight).

Only abnormal was SGPT (79) and CPK (243).

I am 168 cm and 91 Kg. (climbed from 78 to 91 in 2 years)

I need opinion and guidance.

Thanks doctor

Answered by Dr. Anshul Varshney (22 minutes later)

Brief Answer:
Lipitor and Norvosc can be the culprits.

Detailed Answer:
Welcome To HCM. I am Dr Anshul Varshney.
I understand your concern.
Pedal edema that is swelling in legs can occur due to 2 reasons in your case:
1. Use of Norvosc that is Amlodipine.
2. As a complication of Osteoarthritis.

Now most important problem that is troublesome is rise in your liver enzymes and CPK levels. In your scenario Lipitor can be the culprit as long term use of Lipitor can cause proximal myopathy, rise in CPK as well as deranged liver enzymes.
Wellbutrim is Unlikely to cause this. However the tremor like problem can occur with this
I would advise you to discuss with your doctor to stop Lipitor as your Lipid profile is within normal limits.
I am also considering that you have not been taking any pain killers for Osteoarthritis. They can cause deranged liver enzymes.
I will also advise you to get your cardiac evaluation done.
Also get a Urine routine and microscy done.
Persistent rise in CPK levels will harm your kidneys .
CPK has many subtypes. If subtyping is done, we can reach a conclusion that it' coming from heart, muscles or liver.
In nut shell I advise you following investigations:
1. Hemogram
2. LDH.
3. Total CPK, CPK-MB, MM
4. Urine routine and microscopy.
5. ECG and ECHO.
I hope this information helps you.
If you have any further query please ask me.
Stay Healthy.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anshul Varshney (21 minutes later)

Dear Doctor

Thanks for your quick reply.

I do not use pain killers.
Suspecting, Vitamin D deficiency, without checking I took Vitamin D (high dose).
One time.

I had a improvement in my energy and health. (This happened in a day)
It might be a placebo effect.

Does my uric acid of 5.8 does not rule out my kidney issues ?
Does my other biochemistry rule out liver ?

Kindly provide a scale of CPK which can occur ?

What is serious or highly serious ?
What is fluid replacement ?

Is there any supplements which can improve my health ?
(I understand the causality principle)

My pressure is normal and I have no noticeable problem with heart.
I have a slight bronchitis which I never used to have.

Sorry for extreme details but I thought more info will help you to help me.

Thanks doctor

Answered by Dr. Anshul Varshney (55 minutes later)

Brief Answer:
Detail Follows.

Detailed Answer:
Dear Friend.
You can take Vitamin D supplements. No issues with them.
No, Uric acid doesn't rule out normal kidneys.
We need kidneys function tests. However, you have them, they are normal. At present your kidneys are working fine, but in case this CPK continues to increase, it can start damaging your kidneys.
The reference range of CPK varies from laboratory to laboratory.
You can consume a lot of water orally. Drink as much as possible.
Your liver functions are normal except rise in liver enzymes that can be due to Lipitor.
Normal BP doesn't rule out heart Diseases.
Eventually, you would require these testing.
It's always better to be sure.
So get these tests and write back to me with your reports.
If you have any further query , please ask me.
Stay Healthy.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anshul Varshney (8 hours later)

Brief Reply
I will do all the tests you mentioned and get back.

Detailed Reply

Thanks doctor

Still I need a reference range for CPK.
Can it become maximum 100000 ?
At what stage of damage we have diagnosed our CPK ?
A month, is reversible or not.

Which branch of medicine I should consult about supplements |

Answered by Dr. Anshul Varshney (5 hours later)

Brief Answer:
Internal Medicine.

Detailed Answer:
Dear Friend.
CPK can go up to in thousands. I have never seen in lakhs.
Try to understand. Even a slight rise means you are at risk. Kidney Damage can occur specially if it goes in thousands.
You need to consult a doctor who is MD in Internal Medicine or MD Medicine.
Get the advised investigations.
If you have any further query please ask me.
Stay Healthy.

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar