[69F] With moderate, continuous bilateral leg swelling and calf pain

Patient Description

A 69-year-old female presents with moderate, continuous bilateral leg swelling from the calf to the ankle, persisting for several months, and associated calf pain rated 8/10 in severity. The pain is described as cramp-like, with occasional nocturnal 'Charlie horses.' The patient is elderly, homebound, and experiences increased discomfort and pain with walking. She has a history of asthma, diagnosed a few years before the pandemic, and is currently using an inhaler. The patient is overweight with a BMI indicating obesity and has suspected diabetes, pending evaluation at an upcoming primary care appointment. She has a couple of sores on her legs that have been slow to heal but no discoloration, redness, or warmth over the swollen areas. The patient experiences shortness of breath when walking, which she attributes to her asthma. She is currently taking Tylenol for pain relief, which provides limited benefit, and is on estrogen. No known drug allergies have been reported.

Arora's Assessment

What might be happening

Based on the information you've provided, the swelling and pain in your legs could be due to several possible conditions:

Chronic Venous Insufficiency (CVI): This condition occurs when your leg veins don't allow blood to flow back up to your heart. Symptoms can include swelling in the legs and ankles, pain that gets worse when you stand and gets better when you raise your legs, and leg cramps.
Lymphedema: This is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system. It can cause swelling in the legs and may result in discomfort or pain.
Deep Vein Thrombosis (DVT): This is a blood clot in a deep vein, usually in the leg. However, DVT usually affects one leg and not both. It can cause pain and swelling in the leg, but many people have no symptoms.
Peripheral Edema: This is swelling caused by the buildup of fluid in the tissues of your legs. It can be a symptom of a systemic disease such as heart disease or kidney disease, or it can be due to local factors such as venous insufficiency or lymphedema.
Peripheral Artery Disease (PAD): This condition is caused by a buildup of plaque in the walls of the arteries that supply your legs and feet with blood. It can cause pain and swelling in your legs.

What you can do

Given your symptoms, it's important to seek medical attention. Here are some steps you can take:

Schedule an appointment with your primary care provider as soon as possible. They can evaluate your symptoms and may refer you to a specialist if necessary.
Try to keep your legs elevated when you're sitting or lying down.
Try to avoid standing or sitting for long periods of time. If you must stand for long periods, shift your weight from one foot to the other every few minutes.
If you're overweight, try to lose weight. This can reduce pressure on your legs and help alleviate your symptoms.
Wear loose clothing. Tight clothing can restrict blood flow.

What you should look out for

You should seek immediate medical attention if:

The swelling in your legs suddenly increases.
You have chest pain, shortness of breath, or both. These could be signs of a serious heart or lung condition.
You have a fever, chills, or other signs of infection. These could be signs of cellulitis, a skin infection that can cause swelling and redness in your legs.
You notice a sudden change in your ability to walk or move your legs.

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, diagnosis, and treatment.

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11 mo ago

Top picked over-the-counter products for Venous Insufficiency and Varicose Veins Management