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What Causes Swelling In Feet And Ankles?

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Posted on Wed, 27 May 2015
Question: I am having trouble with swelling of my feet and ankles only, two doctors, good ones, internist and rheumatologist both say too much water is bad. Well I only drink 4-5 bottles per day, maybe some days less. They took we off diuretic, salt too low in blood work , 127, with 137, and still no good results. Any comments. I got RA back in 2000, bad, but have been in remission up to now. Fingers that want to freeze, mostly the swelling....?? I am 72, 73 in October, with cholesterol a little high in last blood work. Nothing else.
doctor
Answered by Dr. Anshul Varshney (1 hour later)
Brief Answer:
Dilutional hyponatremia.

Detailed Answer:
Welcome To HCM. I am Dr Anshul Varshney. I understand your concern.
Your sodium is low because of Dilutional Hyponatremia. In this condition, total body water is increased leading to falsely low detection of sodium in blood.
Now, to help you better please share with me the cause detected behind your lower limb swelling. Mention your blood sugar, bloop pressure, Urine report and kidney function tests.
Treatment would be based on the cause.
Revert with the asked details for a better help.
Stay Healthy.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Anshul Varshney (18 minutes later)
I have never had swelling in my feet even when pregnant. Internist put me on Diltiazem 120, twice per day, one did not do what he wanted, increased to two. Since I started that medication,I tend to go sideways, not dizzy, like an equilibruiuum problem. I passed out the other day sitting down which I have not done sin 1995. Only when I have anesthia and they get me up first time. Throw up anesthetic and pass out, last surgery, removal of gall bladder in 1995, husband warned. No way I can ever throw up even when sick of my stomach. Very hard for me to do. My blood work which is taken every3 months, complete, only showed by chlosteral a little high, did not seem to bother the doctor, and had not passed out yet, did report it to his office, "next time go to ER"..well what if 5 minutes ago I was in a car, which I was, pass out and kill someone else or myself? The medications I take are for pain, panic attacks, in remission from a hard hit of RA in 1999-2000, 150 inflammation rate. Last one taken, CRP, was a 1 whole number, always had been in negative. I do not know what to do. I need the diruertic, one doctor says NO, rheumatologist says why not, low sodium per internist. Better than increasing the3 mg predisone I take. I do not know what to do.
doctor
Answered by Dr. Anshul Varshney (7 minutes later)
Brief Answer:
Steroid induced swelling.

Detailed Answer:
Hello.. You mentioned that you are on Pred , so it explains the swelling you have. Steroid is well known to cause swelling and even hyponatremia.
Once you taper and stop steroid if indicated your swelling will disappear completely with in a few weeks time.
You should not consume excessive amount of water and take low salt diet. Don't dehydrate your self. Avoid diuretics as far as possible.
Once your swelling subsides your water retention will be reduce and your sodium concentration will automatically improve.
I hope it helps.
Share my opining with your doctor.
Stay Healthy.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Anshul Varshney (5 hours later)
It is amazing that such a problem can be seen by the "eyes of others" much more quickly than someone with all the charts and tests in the world. Dr., you have made more sense, as of now, than anyone I have consulted.

I have gone back to the 3mg predisone, had increased per rheumatologist to 6 mg. I have RA in remission, taking the Norco which you well know is not Lor-Tab. My three meds for RA have been Predisone, Celebrex (don't take anymore, too clostly, even generic and seemed to make me worse also, and gave the 3-mo supply to my internist, refilled by him while rheumatologist was moving offices, and he looked quite startled that I told him give these to someone who cannot afford to buy them, and, of course the Lor-Tab. Norco and Presisone, Motrin and sometimes acedomeaphin, sorry spelling, are the only things I am taking. Did not mention the XXXXXXX horses, cramping which accompied the swelling.....thank you so much. The dosages are very small compared to what I had to take ever 3-4 hours when my inflammation was 150. The problem is giving up what I take every 12-14 hours now because my fingers and toes want to turn or freeze at times. I do not take a lot of medication compared to where I was early 2000. I just do not want to go back to that. Again, I thank you for your opinion, and would be nice to have someone like you close by in the State of XXXXXXX I do appreciate it Doctor. You have been most kind. Unfortunately, these doctors do NOt like to be told what other doctors can see from the outside looking in. If I had to rate you, you get an A+ from this ole lady.

I did not see the rating for the doctor, but gave it above, excellent to A+. I thank you sincerely.

As soon as I took my 2 mg predisone this afternoon with one Norco and two Motrin, both of my feet swelled. I am going to take your advice and see if I cut the Predisone to 1 or 2 mg per day and then cut off completely, see what happens. Do you agree that Motrin is for inflammation or does it cause it?? One of the doctors told me Motrin was a culprit for inflammation?? I need to find out through the process of elimination without having much pain, which ones I can do without. Bought the Zero water, no sugar or sodium. Going to try that. I have not taken the Triamerene today at all, took one yesterday. Going back on my chicken diet, vegetables, no bread diet. I try not to eat after 4:00 p.m. cst. I also saw Diltiazem for BP had the swelling of ankles and feet? One of many side effects.
doctor
Answered by Dr. Anshul Varshney (10 hours later)
Brief Answer:
Taper and stop Pred

Detailed Answer:
Hello, This proves that the swelling you had was because of Steroids only. In such case you should taper and stop steroid. Motrin is anti inflammatory pain killer and is used in inflammatory conditions, but in many people it can also cause swelling of feet. In such scenario, i would advice you to taper and stop Prednisolone. Take Etoricoxib instead of Motrin for pain. That is a better drug then Motrin.
Yes, Diltiazem can also cause swelling, but your swelling is unlikely to be because of it, the reason being that you have been taking Diltiazem and the swelling appeared as soon as you took Prednisolone.
I hope it helps.
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
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Answered by
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Dr. Anshul Varshney

Internal Medicine Specialist

Practicing since :2009

Answered : 3071 Questions

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What Causes Swelling In Feet And Ankles?

Brief Answer: Dilutional hyponatremia. Detailed Answer: Welcome To HCM. I am Dr Anshul Varshney. I understand your concern. Your sodium is low because of Dilutional Hyponatremia. In this condition, total body water is increased leading to falsely low detection of sodium in blood. Now, to help you better please share with me the cause detected behind your lower limb swelling. Mention your blood sugar, bloop pressure, Urine report and kidney function tests. Treatment would be based on the cause. Revert with the asked details for a better help. Stay Healthy.