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- Sat Dec 28, 2002 7:17 am
I have been seeing my doctor for several months due to swelling in my legs and shortness of breath after limited activity. I am 38, overweight, a diabetic (type 1 for 20 years) with an underactive thyroid, high blood pressure. I have had the ultrasound on my heart, lung/breathing tests, echo stress test and all have come back normal. I am taking Lasiks but the swelling and breathing problems persist. Since my doctor could find nothing "new" wrong with me, she's stopped looking. Can you possibly give me some ideas to bring up at my next appointment? She seems willing to order any and all tests....
| Dr. Yasser Mokhtar
- Sun Feb 09, 2003 11:06 pm
Thank you very much for choosing our website.
Difficulty breathing and swelling of the legs can be caused by several things.
First of all, they both can be caused by the same cause or each one of them can be caused by a different cause on its own.
Your doctor looked for the main reasons that can cause breathing problems and swelling of the legs in the same time which are heart failure and lung problems.
Still there are some reasons that could cause each symptom separately.
Things that could cause the shortness of breath alone could be:
1. Uncontrolled blood pressure. In the begining it will cause shortness of breath alone but later on (if the person develops heart failure) it will cause both. Why uncontrolled blood pressure causes shortness of breath because of something called "diastolic dysfunction of the heart" which is simply abnormality of relaxation of the heart where the heart can not relax enough and thus unable to accomodate the blood coming from the lungs and thus the blood stays for a while more in the lungs and causes shortness of breath.
2. Physical unfitness. Simply if you are physically infit and obese, at some point you will start to have shortness of breath when you exercise.
3. Coronary disease. Being a diabetic for such a long time, although a young female, is a very strong risk factor for developing coronary disease, especially if you smoke or have a history of coronary disease in the family. In some diabetics, they do not have chest pain when they get their coronary disease but their main symptom is shortness of breath and this is called "angina equivalent".
Now for the reasons that could cause swelling of the legs alone:
1. Being a diabetic for such a long time, your kidneys might have been affected and when the kidneys are affected they start to spill proteins in the urine and your legs start to swell up.
2. Having what is knwon as venous insufficiency where your veins are not as strong as they used to be and with putting your legs down most of the time (standing or sitting), you will have fluid accumulating in your legs.
3. Medications. This swelling could be caused by medications that you are taking for control of your blood pressure.
4. Liver disease. If you have a liver disease secondary to any cause this could cause you to have swelling of the legs as well.
5. Sleep apnea. Where the person sometimes stops breathing and has to wake up all the time although does not know that he wakes up. Does not get enough sleep and the next morning feels fatigued, sleepy and may be even doses off when doing anything because litterally he thought that he slept but as a mattter he did not. But you do not get the swelling of the legs until late. This disease affects any body but more the obese people.
What i think should be done in your case in addition to the other things that were done is:
1. A stress test.
2. Check levels of proteins in the urine.
3. Check liver functions.
4. Check a good history for having sleep apnea.
5. Exercise, become fit and loose weight. You will say but i get shortness of breath when i exercise, i know, you will have to do it very gradually after making sure that everthing else is ok and there is nothing wrong with your heart.
6. Make sure that you are taking any medications that could cause swelling of the legs.
7. Very good control of blood pressure.
i hope i have given you some ideas and thank you very much choosing our website http://doctorslounge.com and if you have any comments, please, do not hesitate to post them.
Yasser Mokhtar, M.D.