Dr. Settipalli Saravan Pramod
Internal Medicine
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
Hello doctor,
I am a 39-year-old male with a history of hypertension. My BP medication was changed for the past six months and the doctor put me on Metosartan 50, and Amlodipine 5 mg. For four to five weeks, my ankle joints are swollen. I went to an orthopedic, and he asked for a venous Doppler lower limb. Other results CRP, vitamin B12, ANA, and uric acid, are normal. ESR is 20. There are remarks in venous Doppler, and he suggested a physician's opinion. I am attaching the Doppler report. Please give your opinion.
Hello,
Welcome to icliniq.com.
I have gone through your Doppler report (attachment removed to protect patient identity).
Before making the diagnosis, I want a few things pertaining to your problem, like your complaining of swelling of both ankles joints like on and off.
1. Do you have a fever with regards to swelling?
2. Do you have any history of injury?
3. Whether the swelling is continuous or is there any joint pains?
4. It is better if you can attach your picture of ankle joint. And do you a history of varicose veins?
From the above Doppler, I can make an inconclusive diagnosis. Bilateral inguinal lymph node signifies infection that can be treated with proper antibiotics. And another one with prominent perforators of GSV (great saphenous vein) as it means initial stages of developing varicose veins might eventually lead to swelling of the leg.
Patient's Query
Thank you doctor,
I do not have any fever. Two weeks back I got mouth ulcers, and I was taking Zevit capsule, and it went off last week. The ankle does not swell entirely only in the joints. Swelling is mild in the morning and when I am at home. It occurs when I wear my shoes, and by night it slightly comes down.
There is no pain at any of the joints except pain at joint between the right ankle and lower limb. I do not have any history of injury. The other question is about the normal size of inguinal lymph nodes. My groin area is completely normal, and I do not see any swelling. I have seen some yeast on the end of the penis two to three days back for which I started applying Candid-B cream from today. The ankle swelling came suddenly one day when I worked out high impact aerobics.
Hello,
Welcome back to icliniq.com.
Start using ankle binder most of the time while doing exercises and on daily routine work and can apply Voveran spray (Diclofenac) or gel locally when it finds swelling. It seems to be due to sprain that because of constant pressure. You have to be careful while doing exercises like running and walking for long distance to avoid future complications.
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Internal Medicine
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