Dr. Basuki Nath Bhagat
Family Physician
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My mother, who is 79 years old, broke her right knee, and the doctor put her in a brace for ten days and then put her in a cast.
She leans only on her left leg while performing her personal needs. But her left foot was swollen for a few days, and later her right leg appeared swollen. At first, she was on Pamprin for blood thinning, and currently, she is on Xarelto 10 mg once a day. She is diabetic, and she takes Cilostazol 100 mg twice daily and Insulin injections once daily.
Please can you tell me what I should do?
Hi,
Welcome to icliniq.com.
I understand your concern.
You mentioned your mother has bilateral lower limb edema, especially leg and foot swelling. And she has type 2 diabetes mellitus, is on Insulin injections, and is currently on Cilostazol (Quinolinone) and Xarelto (Rivaroxaban) medication. However, I have a few questions based on this,
1. Can you specify for how long she has had diabetes?
2. Does she have a recent renal function test report?
3. I want to know her serum creatinine level.
4. How is the swelling? Is it mild or severe? Can you attach an image of it?
5. For what medical condition is she taking the above medication?
6. How is the urine output?
Based on your medical history, one of the reasons I can think of is that it could be dependent on edema over both leg and foot (due to prolonged bed rest because of a cast over the knee). The second reason could be alteration in the renal function (it manifests in the long-term diabetic patient, especially whose blood glucose level is not well controlled). So I suggest you to follow the instructions mentioned below:
1. Based on the severity of edema, a low dose of diuretic can be given only if the renal function test is normal.
2. If the edema is mild, foot elevation while sleeping (keep two to three pillows at the leg end of the bed and rest her foot over it) could help reduce swelling.
3. Adequately mobilizing her (if permissible by a concerned orthopedic doctor) could also reduce lower limb swelling.
4. You may need to do a few tests like LFT (liver function test), RFT (renal function test), and USG (ultrasonography) kidney to know the underlying cause (I am suggesting these investigations to know her medical history).
I hope you find my reply helpful.
Patient's Query
Hi doctor,
Thank you for your reply.
She has been diabetic for the past 30 years. She is on insulin which she takes three times a day, and tablet Levemir once daily.
Thank you.
Hi,
Welcome back to icliniq.com.
How is she doing now? Is there any improvement in the leg swelling?
In the laboratory report, there is an elevation in the D-dimer values (attachment removed to protect the patient's identity). So, I suggest you to do a doppler ultrasound of both lower limbs at the earliest to rule out any clot. Her renal function test is normal. Her CBC (complete blood count) is also normal, and her ESR (erythrocyte sedimentation rate) is increased. Therefore, it is important to do a doppler ultrasound of the lower limbs.
Kindly follow up with the ultrasound report.
I hope this has helped you.
Patient's Query
Hi doctor,
My mother, after removing the plaster from her knee, has been walking for almost two weeks. Today, she did a blood test. We see an increased ESR.
Hi,
Welcome back to icliniq.com.
How is your mother now? How is her knee? I hope she is doing well and there is no or very little pain while walking I have downloaded the files you have attached let me go through them properly and reply to your query.
Patient's Query
Hi doctor,
She is not taking any other medicine except Furosemide, Bisoprolol, Atorvastatin, and insulin apart. During the day, she has a dry cough, when she lies down to sleep, the cough goes away. During the night, there is almost no cough. What must she use for cough?
Hi,
Welcome back to icliniq.com
I hope your mother is recovering from the knee problem after the removal of the cast. You have asked for dry cough medication.
The following combination of medicine Phenylephrine, Chlorpheniramine, and Dextromethorphan cough syrup would be good for her to treat dry cough. You can buy any brand containing all three combinations or at least two combinations of the above-suggested medicine and should be sugar-free. Take cough syrup 10 ml three times a day for 5 days.
I hope this has helped you. Thank you.
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