Brief Answer:
Anemia & hyperglycemia

Detailed Answer:
Dear XXXXXXX

Thanks for your query.

As per the reports attached, the following observations can be made:

1. Anemia- most probably Iron deficiency anemia, as evident by reduced Hemoglobin concentration & mean corpuscular volume and increased red cell distribution width.

2. Impaired blood glucose status (Hyperglycemia)- Pre-diabetes state, as evident by raised fasting blood sugar, increased HbA1c & increased mean plasma glucose.

In view of the above, the swelling of the legs can be attributed to increased osmotic pressure secondary to the anemic status and hyperglycemia.

Management involves:
1. Treatment of anemia: additional investigations like peripheral blood smear, reticulocyte count & iron studies will be helpful to detect the type of anemia.
Following this, treatment will involve Iron, Folic acid & Vitamin B12 supplements.
Also she should take lots of green vegetables in diet.

2. Control of blood glucose level: proper diabetic diet & exercise will be helpful in controlling the blood sugar level. If it still persists, then oral hypoglycemic medications need to be started.

So, kindly visit your family Physician & discuss regarding this.

There is no need to worry.
All other investigation reports are within normal limits, indicating no target organ damage.
With early initiation of proper treatment, your wife will be fine.

Wishing her a good health.
Take care.

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Brief Answer:
Kindly view the details

Detailed Answer:
Dear XXXXXXX

Thanks for your follow up query.

1. Feet being the most dependent part of the body, there is accumulation of fluid (due to increased osmotic pressure secondary to the anemic status and hyperglycemia) in the feet resulting in swelling.

2. With regards to the Liver & Kidney profile tests, there is mild increase in Alkaline phosphatase, but any pathology in liver can be ruled out in presence of normal level of other liver enzymes.
However, a Vitamin D assay can be done to detect any Vitamin D deficiency.

There are no other symptoms or history of recent illness mentioned in your post.
Kindly let us know about the following:
1. Swelling is present since how many days?
2. It is present in one foot or both the feet?
3. Does the swelling persist throughout the day or more during morning/ evening?
4. Any history of injury/ trauma to the foot?
5. Any history of recent illness?
6. Any associated symptoms like breathlessness, getting tired easily on doing even minor work, irregular periods, etc?
7. History of anemia, diabetes, hypertension, etc in family?

A knowledge of the above mentioned questions will help us in understanding the condition better & help in formulating an appropriate management plan.

Wishing a good health.
Take care.

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Brief Answer:
Kindly view the details

Detailed Answer:
Dear XXXXXXX

Thanks for your follow up query and detailed history.

As the ECG, ECHO and Doppler reports are within normal limits, any Cardiovascular cause for the symptoms can be ruled out.
(If there is any significant finding in other investigations viz 25 hydroxy vitamin D levels, blood sugar PP & Chest X-ray, please let us know).
Also, the Liver & Kidney profiles do not reveal any major abnormality.
Though there is a history of injury to left foot, it will not cause swelling in both the feet.
In view of the above, the swelling can be attributed to anemia & increased blood sugar levels, as explained in my previous answer.
Kindly discuss this with your Doctor and start treatment as advised.

Desk job involving prolonged sitting can be considered as an aggravating factor and can be tackled by periodic movements of feet & avoiding sitting at a place for longer duration.

Wishing a good health.
Take care.

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