Swelling in the Lower Legs
Greetings everyone. I'm a 22-year-old female weighing approximately 260 pounds, and I’ve been experiencing some swelling in my feet. I brought this issue up during my annual check-up with my physician, but neither of us were particularly worried. I mentioned it just to keep her informed in case it turned into a larger concern, especially as my lab results showed some irregularities. This evening, however, I noticed my legs appear to be more swollen than before; the swelling now extends up to my calves, though it’s not causing me significant discomfort—I’ve certainly seen worse cases. Still, when I press down on my leg (I had to double-check to reassure myself!), it does leave an impression. So, it’s clear that there is indeed swelling present. Here's a bit of background that might be pertinent: - I began taking medroxyprogesterone around July 12. - My most recent lab results from a comprehensive metabolic panel (CMP) on July 2 showed creatinine at 0.48 and BUN/creatinine at 23. All other CMP results were within normal limits; while these values aren't drastically elevated, I thought they might be worth mentioning. - Lately, I've experienced some chest discomfort and shortness of breath, which I have linked to my asthma. Additionally, I’ve been feeling dizzy occasionally. These symptoms aren't severe and are intermittent. Earlier today, I used my inhaler during one of these episodes, but it didn’t seem effective. The discomfort manifests as a sharp sensation just above my left breast; it comes and goes in waves. - The last EKG was performed in 2024 and showed normal results, which was done following reports of a “double heartbeat.” This was later attributed to anemia. - Following an appointment with my primary care provider, I was cleared of anemia, with a hemoglobin level of 12.4. However, since my iron studies hadn’t been conducted in two years, I requested them as my last iron saturation was just 6%. All results came back normal, except for the saturation now at 14%. - I’ve been dealing with chronic fatigue for about 15 years, which I’ve hesitated to discuss, suspecting it might be linked to undiagnosed depression. - I also have been diagnosed with PCOS, menorrhagia, and insulin resistance. Could any of this information be significant for my situation?
Answers (1)
7/26/2025, 6:20:41 AM
OpenHealth AI
It sounds like you're experiencing significant swelling in your lower legs, which can be concerning, especially with the other symptoms you've mentioned. The swelling could be due to several factors, including fluid retention, hormonal changes from the medication you're taking, or other underlying conditions related to your health history. Let's address this step by step.
Main Points:
- Swelling in your lower legs may indicate fluid retention or other underlying issues.
- Your previous symptoms of chest discomfort and shortness of breath need careful consideration.
- You should monitor your symptoms closely and take some immediate actionable steps.
Explanation:
Swelling, especially when it moves up to your calves, can be caused by various factors:
- Medications: Medroxyprogesterone may contribute to fluid retention in some individuals.
- Hormonal and metabolic issues: Given your history of PCOS and insulin resistance, these conditions can affect fluid balance.
- Heart and lung considerations: Since you’re experiencing chest discomfort and shortness of breath, it's essential to consider cardiovascular or respiratory reasons. Even though your EKG was normal, persistent symptoms warrant monitoring.
Next Steps:
-
Monitor Symptoms:
- Keep a daily record of the swelling, noting any other symptoms (e.g., chest pain, breathlessness, dizziness). Look for patterns or triggers.
-
Lifestyle Modifications:
- Hydration: Ensure you're drinking enough water, which can help manage fluid levels. However, reduce salt intake to minimize further swelling.
- Movement: Engage in mild activities like walking or leg elevation when sitting, which may help reduce swelling.
-
Asthma Management:
- Since your inhaler hasn’t been effective recently, evaluate your asthma management plan. If symptoms persist, consider discussing an asthma action plan with your provider.
-
Follow-Up:
- Schedule a follow-up appointment with your healthcare provider to discuss your worsening symptoms, particularly the leg swelling and the chest discomfort. You may need additional evaluation, such as an ultrasound of the legs to rule out deep vein thrombosis (DVT) or cardiac evaluation if symptoms change.
-
General Self-Care:
- Prioritize resting and managing stress, as chronic fatigue can exacerbate other symptoms. Consider discussing mental health resources, given your longstanding fatigue and potential underlying depression.
Overall, while your symptoms may not feel severe, they are worth monitoring closely, especially given the changes you've observed. Taking these steps can help you stay proactive about your health. Let me know if you need further clarification on any aspect!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.