Dear Doctor: I have neurosarcoidosis and taking steroids bund close monitoring.
Dear Patient: There are numerous causes for your legs to swell; some dangerous and some quite benign. Like any other symptom people experience, it needs to be addressed in context of other signs, symptoms and history. I will discuss several “red flag” scenarios that deem urgent medical attention.
1. Unilateral swelling with or without redness or pain, especially with the following risk factors:
a. Recent travel
b. Recent surgery
d. Use of birth control or hormone replacement therapy
e. Known or suspected history of cancer.
This may be a simple soft tissue/skin infection; however, medical professionals need to rule out a clot in the veins of the lower extremity (DVT – deep venous thrombus) which can lead to a life-threatening condition known as a pulmonary embolus (when the clot dislodges from the leg and travels to the vessels in the lungs preventing oxygenation of blood).
As mentioned, this may look like an infection – which is treated with antibiotics; however, a DVT is not an infection and requires anticoagulation (thinning of the blood) to prevent progression of the clot. Sometimes DVTs are “unprovoked” by medications, surgery or travel and may be due to an underlying condition which would prompt further testing.
2. Bilateral swelling (swollen legs and puffiness in both feet):
a. Pregnancy: water retention in extremities is frequently physiologic and expected; however, it is critical to have routine prenatal care and follow up because conditions such as preeclampsia can present with swelling.
b. Venous stasis: gravity forces blood to pool in people who stand or sit for extended periods of time– this is a benign cause but needs to be evaluated.
c. Malnutrition: blood is more than just red blood cells – there are proteins (namely Albumin) that function by keeping a fluid equilibrium – malnutrition zaps our protein levels and fluid leaks out of our vessels and thanks to gravity pools in the most dependent part of our body (our legs).
d. Liver failure: our liver is responsible for making a lot of proteins (like albumin) and cirrhosis of the liver can lead to increase water retention and swelling.
e. Heart failure: Your heart is designed to pump blood all over the body – if the pump is malfunctioning (or “failing”), fluid backs up upstream from the heart causing swelling in the legs and in the lungs. This needs to be addressed promptly.
George V. Golod, M.D., is a family medicine physician at UT Physicians Health Center – Cinco Ranch. The clinic is located at 713-486-5300. To schedule an appointment, call 713-486-5300.