
What Causes Progressive Swelling From Knee To Waist?

1. Her right Leg is swelled up from knee to hip/waist since two years. Started the swelling from knee and gradually moved to up to hip/waist in past 2 years.
2. When she stands for more one than an hour or so she feels cramping inside her leg, like warm liquid flowing.. something like that.
3. She feels same as above when she does long walk also.
4. It's quite visible when we see her legs.
We have done a lot of tests in Apollo XXXXXXX and USA.
You can find all the reports & few images of her legs in below link
https://onedrive.live.com/YYYY
In CT Scan doctor saw some atrophy on her left leg, However they are still unable to conclude the treatment & reason behind that.
Three below blood tests are pending to come
1. Anti-nuclear Anti body panel(14 antibody panel)
2. Anti-nuclear Anti body - ANA(Immunofluorescenc)
3. CA(CPK)..CREATINI KINASE - SYRUM
Her Medicine Reconciliation are as follows
Vitamine D November - 2013
Vitamine Iron November - 2013
Diovan 160 November - 2013
Diovan 80 May - 2014
Telsite May - 2015
D-Rise May - 2015
Nurvup OD Caps May - 2015
ShelcalHD May - 2015
Given By current doctor 2 weeks back. This doctor is from Apollo XXXXXXX
Telday-40 XXXXXXX - 2015
Gabaneuron 100 XXXXXXX - 2015
D-Rise 60K XXXXXXX - 2015
We will really appreciate your help..
It is important to exclude myopathy.
Detailed Answer:
Hello
I have gone through findings in detail.
Your wife's major problem is swollen lower limbs and exertional pain.Swollen legs may be due to many reasons like hypertension,anemia,altered thyroid profile,cardiac problem,positional etc.
Pain may be due to arterial pathology.
She has underwent almost all investigations and all are almost normal.
Major concern like deep vein thrombosis,arterial pathology etc are excluded.
I am sure that routine investigations and thyroid profile must had been done.
Only investigations related to autoimmune disease like myopathy are pending.
This is also an important reason related to these symptoms and it must be excluded.
She may need measurement of serum muscle enzymes,electromyography (EMG),muscle biopsy.
Presently your doctor has empirically prescribed vitamin D and Gabapentin.Gabapentin is prescribed for neuropathic pain.
Telday-40 is an anti-hypertensive.
There is a fibroid in her uterus.Its treatment choice (surgery or conservative )depend upon many things like symptoms,age,family is completed or not.It need evaluation.
Get well soon.
Hope I have answered your question.
Further queries are most welcome
Take Care
Dr.Indu XXXXXXX


What is the laboratory test name for 'autoimmune disease like myopath'.
"This is also an important reason related to these symptoms and it must be excluded."
Did you meant "This is also an important reason related to these symptoms and it must NOT be excluded."
2013 She had undergone thru D&C and Hysteroscopy for her fibroid. We are planning to have baby in coming year. Hope before that we will consult with gynecologist.
Thanks
ANA and CPK tests are related to autoimmune causes.
Detailed Answer:
Hello
Tests related to autoimmune conditions are already done and results are pending.
ANA and CPK tests are related to autoimmune causes.
Autoimmune causes is also an important reason related to these symptoms and it must be excluded,I mean that it should be ruled out.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr.Indu XXXXXXX


I will share the report of the below tests soon and wait for you response on that.
1. Anti-nuclear Anti body panel(14 antibody panel)
2. Anti-nuclear Anti body - ANA(Immunofluorescenc)
3. CK(CPK)..CREATINI KINASE - SYRUM
Yes,we should wait for reports.
Detailed Answer:
Hello
Yes,we should wait for reports.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr.Indu XXXXXXX


We got the reports and uploaded in below link. Please have a look and let us know your Opinion.
These reports were requested by a General Medicine + Rheumatologist doctor.
After seeing these result he referred to an Orthopedics.
Please share your opinion.
Thanks
Forgot to mention the link
https://onedrive.live.com/YYYY
Only finding is atrophied muscles in left lower limb.
Detailed Answer:
Hello
Sorry for replying late
I have gone through all reports in detail.
Only finding is atrophied muscles in left lower limb.It may be due to nerve involvement.This need proper clinical evaluation by a neurologist.It is important to rule out any neurological disorder.She may need further tests related to nerve like nerve conduction study,muscle biopsy etc.
Uploaded files still doesn't include ANA factors,CPK report.We should wait for these reports.
It is better to consult neurologist for further treatment.
Get well soon.
Hope I have answered your question.
Further queries are most welcome
Take Care
Dr.Indu XXXXXXX


Can you please review ANA & CK Reports in below link
https://onedrive.live.com/redir?resid=55213c1d4317f4ad!157&authkey=!APMWV72ppHX-yeE&ithint=folder%2cpdf
Reports related to autoimmune causes are negative.
Detailed Answer:
Hello
Reports related to autoimmune causes are negative.
Then nerve disorder should be ruled out as suspected also in reports.
Get well soon.
Hope I have answered your question.
Further queries are most welcome
Take Care
Dr.Indu XXXXXXX


She is going to Apollo XXXXXXX to Dr. Syamasis Bandyopadhyay. He suggested those last 3 reports. Doctor referred to Amitabha XXXXXXX (Orthopedic, I may not correct exactly about doctor name). And we have the appointment on 10th of this month.
I saw you passed out from RGKar Medical College, and I am from XXXXXXX
What is your recommendation. What would be next step.
Thanks
I think your wife also need proper examination by a neurologist.
Detailed Answer:
Hello
Sorry for replying late
You can consult orthopedician,but I think your wife also need proper examination by a neurologist.
Rheumatologist opinion may also be needed.
Get well soon.
Hope I have answered your question.
Further queries are most welcome
Take Care
Dr.Indu XXXXXXX


He asked to do GEP test. Can you please give some idea what is that for.
Hi Doctor,
Please ignore my previous reply.
Dr.Amitabha XXXXXXX (Neurology doctor) asked to test VEP & MR Dasal Spine.
Could you please help us what are those for.
Thanks
VEP is an evoked potential due to visual stimulus.
Detailed Answer:
Hello
Sorry for replying late
Visual Evoked Potential(VEP) is an evoked potential due to visual stimulus(it can be alternating checkerboard pattern on a computer screen).It is a neurological test.VEP measures time taken by a visual stimulus to travel from eye to occipital cortex.Electrodes are placed in back of head.
This test is useful in detecting optic nerve pathology and it is helpful in detecting diseases like MS(multiple sclerosis) etc.
Your doctor has also prescribed MRI of dorsal spine.I think it has been done previously also.
Get well soon.
Hope I have answered your question.
Further queries are most welcome
Take Care
Dr.Indu XXXXXXX

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