Suddenly swollen ankles

[Felt 35]

In the last 2-3 weeks both my ankles have swollen up and as of today I can barely fit my feet into a pair of trainers. I have taken various blood tests and an ultrasound of both legs (negative) Now the hospital will do a CT scan with contrast of the abdomen + CTV extremities as the doctor believes the swollen legs are due to what he think is a problem in the abdominal region which may be linked to cancer. (For the record, I rarely if ever have a stomachache) I have never had swollen ankles before in my life and with an active lifestyle of road cycling, jogging and swimming as well as a smoke/alcohol free existence, I have some issues with sharing the doctor's view. Anyway, If there is anyone on the forum who has experienced something similar, I hope they will share their experience.

Thanks

Felt

[Sheryl]

There are many different things which can cause ankle swelling so pointless to compare notes on it with others whose swelling may be -- indeed probably will be -- from a completely unrelated cause.

 

When the swelling is limited to just one leg, a blood clot or orthopedic issue is often to blame., but for  bilateral swelling (both legs):

 

In some people the cause is cardiac, presumably this has already been ruled out in your cause.

 

in others, cause is related to kidney function -- ditto.

 

In still others it is due to a mass in the abdomen, especially the liver, or sclerotic changes to the liver which impede blood return from the lower part of the body. Sounds like this is what your doctor suspects. The CT will determine whether or not his suspicion is correct.

 

Wait and see what the tests show, is all I can advise at this point. If they did not as far as you can tell do any sort of cardiac workup you can ask about that.

 

Addendum: are you by any chance on blood pressure medication? As some of those can cause this, especially amlodopine. Or any other regular meds?

 

 

 

 

[Felt 35]

Thank you for replying. They tested hTSH T3 free T4. (Negative) / Troponin I (Negative) and then the thing which of all the test I think the doctor put most weight on the FDP D-Dimer (Sysmex) 2.540 ug/ml (H) / Glucose (Random) 88L mg/dl /

Total Protein, Albumin, Globulin (L) / Sodium L, Anion gap (L) / Pro Brain Natriuretic Peptide 340 pg/ml / Red Bloodcells 3.83 (L), Hemoglobin 12.0 (L), Hematocrit 35.0 (L). Remark H = above reference, L= Below reference range.

They did a chest x-ray and this electro thing with a a lot of cables to chest /legs and got no negative comments about that so probably normal. I have been quoted 25K for a CT whole abdomen with contrast and 20K for CTV extremities is that more or less the price in a private hospital? Btw, my blood pressure was in hospital yesterday 98/64 and have recently been lower than expected and admittedly I've been a bit low on energy lately. Lastly Iron, can I get good Iron supplement over the counter in Thailand or is Iherb best option?

Thanks, 

Felt

[Sheryl]

25k for an abdominal CT with contrast is pretty normal for private hospital. While it can be done for less at a stand-alone imaging center it is not safe to receive contrast injection outside of a hospital.

 

I honestly don't know usual cost of CTV. While it is an excellent way to see what is going on with the blood flow from your legs, the fact that ultrasound was negative and both legs are involved make an abdominal cause more likely so if you are concerned about expense you might ask to do the abdominal CT first and reserve the CTV for if the abdominal film fails to show a cause. Though to do both would be the most throrough approach.

 

For that matter could do a less expensive abdominal ultrasound first, but there is good chance you'd still need to progress to CT.

 

You can get a good iron supplement on Lazada or Shoppee.  eg https://www.lazada.co.th/products/exp032026nature-made-iron-65-mg-365-tablets-i4603746759-s18867340247.html?c=&channelLpJumpArgs=&clickTrackInfo=query%3Airon%2Bsupplement%3Bnid%3A4603746759%3Bsrc%3ALazadaMainSrp%3Brn%3A61474271fd2f497c20f06abd0590e7c8%3Bregion%3Ath%3Bsku%3A4603746759_TH%3Bprice%3A630%3Bclient%3Adesktop%3Bsupplier_id%3A100199451277%3Bbiz_source%3Ah5_hp%3Bslot%3A5%3Butlog_bucket_id%3A470687%3Basc_category_id%3A6966%3Bitem_id%3A4603746759%3Bsku_id%3A18867340247%3Bshop_id%3A2899879&fastshipping=0&freeshipping=1&fs_ab=2&fuse_fs=&lang=en&location=Bangkok&price=6.3E 2&priceCompare=skuId%3A18867340247%3Bsource%3Alazada-search-voucher%3Bsn%3A61474271fd2f497c20f06abd0590e7c8%3BunionTrace%3A2102fc1a17096951609447239eb714%3BoriginPrice%3A63000%3BvoucherPrice%3A63000%3BdisplayPrice%3A63000%3BsinglePromotionId%3A-1%3BsingleToolCode%3A-1%3BvoucherPricePlugin%3A1%3BbuyerId%3A0%3Btimestamp%3A1709695161466&ratingscore=5.0&request_id=61474271fd2f497c20f06abd0590e7c8&review=11&sale=42&search=1&source=search&spm=a2o4m.searchlist.list.5&stock=1

[Ralf001]

1 hour ago, Felt 35 said:

Btw, my blood pressure was in hospital yesterday 98/64 and have recently been lower than expected and admittedly I've been a bit low on energy lately. Lastly Iron, can I get good Iron supplement over the counter in Thailand or is Iherb best option?

Thanks, 

Felt

 

Did they check Ankle Brachial Index ?

[Felt 35]

1 hour ago, Ralf001 said:

 

Did they check Ankle Brachial Index ?

No and I did not even know what it was until I just now google it.

Felt 

[Ralf001]

19 minutes ago, Felt 35 said:

No and I did not even know what it was until I just now google it.

Felt 

Yeah I only found out when I was being tested for PAD.

[Nemises]

Gout?

[Sheryl]

Neither PAD nor gout would explain this and he has symptoms of neither.

 

From the information provided, either heart failure, an abdominal mass of some type or fibrotic  changes in the liver  seem most likely.

 

The anemia and elevated d-dimer (with negative LE ultrasound) further add to suspicion of an abdominal tumor. But cannot be sure without scans.

 

The cardiac workup described (treponin levels and EKG) would rule out only acute heart attack, not heart failure. Hopefully he also had a chest xray and they listened to his heart and lungs and checked his oxygenation.

 

 

[paddyfield7]

The same happened to me after my doctor at the Bangkok Chiang Mai Hospital decided I should replace my usual medication against hypertension with Zanidip. It just took a few days until I got heavily swollen ankles. After just a few weeks we decided to stop taking Zanidip and return to the previous mediation. My ankles got back to normal almost immediately.

[Will B Good]

Mine did the same....but I found out why.....I mixed up my amlodipine and atorvastatin tablets.

 

I was taking no atorvastatin and 60mg of amlodipine instead of 20mg......how stupid can you get?

[Felt 35]

4 hours ago, Sheryl said:

25k for an abdominal CT with contrast is pretty normal for private hospital. While it can be done for less at a stand-alone imaging center it is not safe to receive contrast injection outside of a hospital.

 

I honestly don't know usual cost of CTV. While it is an excellent way to see what is going on with the blood flow from your legs, the fact that ultrasound was negative and both legs are involved make an abdominal cause more likely so if you are concerned about expense you might ask to do the abdominal CT first and reserve the CTV for if the abdominal film fails to show a cause. Though to do both would be the most throrough approach.

 

For that matter could do a less expensive abdominal ultrasound first, but there is good chance you'd still need to progress to CT.

 

You can get a good iron supplement on Lazada or Shoppee.  eg https://www.lazada.co.th/products/exp032026nature-made-iron-65-mg-365-tablets-i4603746759-s18867340247.html?c=&channelLpJumpArgs=&clickTrackInfo=query%3Airon%2Bsupplement%3Bnid%3A4603746759%3Bsrc%3ALazadaMainSrp%3Brn%3A61474271fd2f497c20f06abd0590e7c8%3Bregion%3Ath%3Bsku%3A4603746759_TH%3Bprice%3A630%3Bclient%3Adesktop%3Bsupplier_id%3A100199451277%3Bbiz_source%3Ah5_hp%3Bslot%3A5%3Butlog_bucket_id%3A470687%3Basc_category_id%3A6966%3Bitem_id%3A4603746759%3Bsku_id%3A18867340247%3Bshop_id%3A2899879&fastshipping=0&freeshipping=1&fs_ab=2&fuse_fs=&lang=en&location=Bangkok&price=6.3E 2&priceCompare=skuId%3A18867340247%3Bsource%3Alazada-search-voucher%3Bsn%3A61474271fd2f497c20f06abd0590e7c8%3BunionTrace%3A2102fc1a17096951609447239eb714%3BoriginPrice%3A63000%3BvoucherPrice%3A63000%3BdisplayPrice%3A63000%3BsinglePromotionId%3A-1%3BsingleToolCode%3A-1%3BvoucherPricePlugin%3A1%3BbuyerId%3A0%3Btimestamp%3A1709695161466&ratingscore=5.0&request_id=61474271fd2f497c20f06abd0590e7c8&review=11&sale=42&search=1&source=search&spm=a2o4m.searchlist.list.5&stock=1

 

Thank you for the recommended Iron supplement. (Is this on the gentle or harsh side of constipation)

Btw, and as mentioned they did a chest x-ray, but no heart, lungs or oxygenation 😕check as far as I know test procedures.

Felt

[My Paradice Lost]

I am too old for travel health insurance.

I arrived Thailand early December having had my latest covid jab just a few days before.  

3 or 4 days after arrival, my lower legs and feet swelled a lot (Endema). 

After another 2 or 3 days I had great difficulty breathing, especially lying down and spent 3 nights awake in a chair just hyperventilating. 

For 40 years I've take medicine for hyprentension and my blood pressure was generally around 140/90 with 60bpm.  On 3rd night I took my bp with my portable machine and found my bp was down to around 98/52 with 95bpm. 

Next morning I went to the local public hospital emergency department.  I was administered oxygen and subjected to several tests including ECG, xray, blood tests etc.  Next thing I knew, was 2 days later when I started to come around and was choking on something hard in my mouth and a large white tube down my throat and found my wrists firmly tied firmly to the side of the bed. After great struggle, I managed to free my wrist and pulled the tube out together with aquantity of water.  Staff came running and a doctor told me I have a lot of water on my lungs and I had heart failure.  I remained there for 5 days with innumerable test including many xrays.  The hospital was my biggest ever nightmare and I eventually said "no more" and went to a teaching hospital some 32 km away where very good cardiologist performed a catheterisation through my wrist up to my heart with the strong probability of requiring stents to open my clogged veins.  When finished the cardiologist told me it's good news as my veins were nowhere near as bad as expected and did not require stents .  He prescribed numerous medicines (7) which I need to take for life together with a letter to my UK doctor for folow up.   After nearly 2 months, I'm now very much on the mend and wanting to get home away from the hot Thai summer to the UK Spring where the air will be very much cleaner and cooler, thereby carrying increased oxygen.

It's impossible to say but your symptoms sound quite similar to my own and although I wouldn't wish it on anyone, I hope that my experience may prove useful to you.  Good luck

[charleskerins]

18 hours ago, Sheryl said:

There are many different things which can cause ankle swelling so pointless to compare notes on it with others whose swelling may be -- indeed probably will be -- from a completely unrelated cause.

 

When the swelling is limited to just one leg, a blood clot or orthopedic issue is often to blame., but for  bilateral swelling (both legs):

 

In some people the cause is cardiac, presumably this has already been ruled out in your cause.

 

in others, cause is related to kidney function -- ditto.

 

In still others it is due to a mass in the abdomen, especially the liver, or sclerotic changes to the liver which impede blood return from the lower part of the body. Sounds like this is what your doctor suspects. The CT will determine whether or not his suspicion is correct.

 

Wait and see what the tests show, is all I can advise at this point. If they did not as far as you can tell do any sort of cardiac workup you can ask about that.

 

Addendum: are you by any chance on blood pressure medication? As some of those can cause this, especially amlodopine. Or any other regular meds?

 

 

 

 

amlodopine    did not know that

[charleskerins]

5 hours ago, Felt 35 said:

No and I did not even know what it was until I just now google it.

Felt 

there might be a much simpler explanation    sent you a pm

[The Old Bull]

I was taking Amlodipine 10mg a day for high blood pressure for a couple of years till my feet swelled up , I dropped it to 5mg and they went down, That was two years ago and they are still good.

[newbee2022]

20 hours ago, Sheryl said:

There are many different things which can cause ankle swelling so pointless to compare notes on it with others whose swelling may be -- indeed probably will be -- from a completely unrelated cause.

 

When the swelling is limited to just one leg, a blood clot or orthopedic issue is often to blame., but for  bilateral swelling (both legs):

 

In some people the cause is cardiac, presumably this has already been ruled out in your cause.

 

in others, cause is related to kidney function -- ditto.

 

In still others it is due to a mass in the abdomen, especially the liver, or sclerotic changes to the liver which impede blood return from the lower part of the body. Sounds like this is what your doctor suspects. The CT will determine whether or not his suspicion is correct.

 

Wait and see what the tests show, is all I can advise at this point. If they did not as far as you can tell do any sort of cardiac workup you can ask about that.

 

Addendum: are you by any chance on blood pressure medication? As some of those can cause this, especially amlodopine. Or any other regular meds?

 

 

 

 

You forgot to mention the salt intake. Don't eat too much salt! Also important to raise your legs, a bit higher than your heart. And last give some soft massage from the bottom up.

Only if this will have no effect you might consider to see a hospital.!!

[Sheryl]

3 hours ago, Felt 35 said:

 

Thank you for the recommended Iron supplement. (Is this on the gentle or harsh side of constipation)

Btw, and as mentioned they did a chest x-ray, but no heart, lungs or oxygenation 😕check as far as I know test procedures.

Felt

Heart lung check would be just listening to your chest with a stethoscope. Did they not do that?

 

Heart failure bad enough to cause ankle swelling would usually show up on chest Xray.

[Sheryl]

6 minutes ago, newbee2022 said:

You forgot to mention the salt intake. Don't eat too much salt! Also important to raise your legs, a bit higher than your heart. And last give some soft massage from the bottom up.

Only if this will have no effect you might consider to see a hospital.!!

Given all the other findings, (including anemia, elevated d-dimer) and the severity of the swelling, I very strongly disagree.

 

Unless there is already a known cause, foot swelling severe enough to prevent putting on of shoes should always be referred to a doctor in any case.

 

Of course, there are people with known chronic conditions (heart, kidney) whose feet may swell a bit from time to time and this can be managed more conservatively as they are already, presumably, on treatment for the known underlying conditions.

 

Sudden severe foot swelling such as he reports, of no obvious cause, needs thorough workup.  And  there are now other worrisome findings as well.

 

Excessive salt intake is a bad idea but will not cause such marked foot swelling in a healthy person.

[Sheryl]

1 hour ago, charleskerins said:

there might be a much simpler explanation    sent you a pm

Yes, amlodopine and related drugs are notorious for this. But does not sound like he is on any BP meds let along those.

[newbee2022]

1 hour ago, Sheryl said:

Given all the other findings, (including anemia, elevated d-dimer) and the severity of the swelling, I very strongly disagree.

 

Unless there is already a known cause, foot swelling severe enough to prevent putting on of shoes should always be referred to a doctor in any case.

 

Of course, there are people with known chronic conditions (heart, kidney) whose feet may swell a bit from time to time and this can be managed more conservatively as they are already, presumably, on treatment for the known underlying conditions.

 

Sudden severe foot swelling such as he reports, of no obvious cause, needs thorough workup.  And  there are now other worrisome findings as well.

 

Excessive salt intake is a bad idea but will not cause such marked foot swelling in a healthy person.

I don't agree and would not recommend your advice for intervention.

[Furioso]

There are a lot of different causes, hopefully for you it isn't very serious. Best of luck to you!

[charleskerins]

12 hours ago, Sheryl said:

Yes, amlodopine and related drugs are notorious for this. But does not sound like he is on any BP meds let along those.

I am on amlodopine   and was never told by my Dr it could cause swollen ankles. Important to know -thanks.  If I wear my sandals when I walk  instead of my sneakers with orthotics  my ankles swell up.( more than a hour)

Edited March 7 by charleskerins
nm

[charleskerins]

12 hours ago, The Old Bull said:

I was taking Amlodipine 10mg a day for high blood pressure for a couple of years till my feet swelled up , I dropped it to 5mg and they went down, That was two years ago and they are still good.

Get better medical info on here than in the states  ,I just went from 10 to 5 also.

[Felt 35]

16 hours ago, Sheryl said:

Heart lung check would be just listening to your chest with a stethoscope. Did they not do that?

 

Heart failure bad enough to cause ankle swelling would usually show up on chest Xray.

No stethoscope listening. 😕

Felt

[Felt 35]

22 hours ago, Sheryl said:

Neither PAD nor gout would explain this and he has symptoms of neither.

 

From the information provided, either heart failure, an abdominal mass of some type or fibrotic  changes in the liver  seem most likely.

 

The anemia and elevated d-dimer (with negative LE ultrasound) further add to suspicion of an abdominal tumor. But cannot be sure without scans.

 

The cardiac workup described (treponin levels and EKG) would rule out only acute heart attack, not heart failure. Hopefully he also had a chest xray and they listened to his heart and lungs and checked his oxygenation.

 

 

 

Will a CT/ and or CTV for sure show a tumor? I can do this here with or without insurance and it will not ruin me. However, I also have the option to get it done in home country where any sign of tumor / cancer will be treated quickly and no question about price, our taxes cover that. I have always been skeptic about health and especially "care" when the system is business oriented so I can see for me a long row with test and a nurse standing behind the doctor listing up prices for tests but no secure result for the correct treatment whatever they find. 

Thanks

Felt

[GarryP]

4 hours ago, charleskerins said:

Get better medical info on here than in the states  ,I just went from 10 to 5 also.

You'd also need to monitor that the reduction did not result in a rise in BP. If it doesn't, that would be good. I've been on 5mg for about 10 years now and luckily no serious swelling at all.  

[Sheryl]

3 minutes ago, Felt 35 said:

 

Will a CT/ and or CTV for sure show a tumor? I can do this here with or without insurance and it will not ruin me. However, I also have the option to get it done in home country where any sign of tumor / cancer will be treated quickly and no question about price, our taxes cover that. I have always been skeptic about health and especially "care" when the system is business oriented so I can see for me a long row with test and a nurse standing behind the doctor listing up prices for tests but no secure result for the correct treatment whatever they find. 

Thanks

Felt

Yes, a CT woukd show an abdominal tumor.

 

CTV on the other hand visualizes the blood vessels in the leg. Since the problem is bilateral and ultrasound was negative, as previously mentioned  you might defer this,  but the abdominal scan should be done as soon as possible. 

 

From the information you provide the doctor has solid reason to suspect (not know, suspect)  an abdominal mass or fibrosis  impeding  return of blood to the heart.  I can appreciate that this idea is frightening to you but he is making a sound recommendation.

 

As for returning to your home country, if it were me I'd have the CT here then go home if it shows anything significant. Because going home at this stage woukd likely mean starting ftom scratch and led to inadvisable delays  whereas if you return with CT resukt in hand that shows a mass you will be fast tracked.

[georgegeorgia]

Are you on any blood pressure meds , Amlodipine?

[Sheryl]

23 minutes ago, georgegeorgia said:

Are you on any blood pressure meds , Amlodipine?

Already asked and it seems not.