Swollen, red leg calls for immediate treatment


DEAR DR. DONOHUE: Recently my left leg has swollen from below the knee down to the ankle and foot. There also is some redness of the skin. Did I get a spider bite, or what? What is the remedy? — D.Z.

ANSWER: I suppose it could be a spider bite, but the first thought that comes to mind is cellulitis, an infection of the skin and the tissues beneath the skin. The leg is one of the prime sites where this happens. It’s a condition that calls for prompt antibiotic treatment. I hope you have seen a doctor before waiting for this to appear in the paper.

Another possibility is a blood clot in one of the leg veins, thrombophlebitis (THROM-boh-flea-BITE-us). It, too, is an emergency situation.

A third cause is obstruction or inflammation of lymph vessels. Lymph is fluid that circulates between cells and tissues. Lymph vessels, also called lymphatics, vacuum up the fluid and return it to the circulation.

The rupture of a Baker’s cyst, a behind-the-knee bulge, causes similar signs. It’s very painful, and I am sure you wouldn’t hesitate to see a doctor if this happened.

I’m not suggesting any treatment because all of these diagnoses are serious and need quick attention. I hope you have gotten it.

DEAR DR. DONOHUE: Will you write about chronic fatigue syndrome? I have been diagnosed with it after years of a worsening “mystery” illness and many doctor appointments with several misdiagnoses. My family doctor told me, grudgingly, that there is nothing to be done for it. Well, there might not be a cure, but there are treatments. When presented with a list of classic symptoms, my rheumatologist had no idea what I was talking about and sent me away after a pneumonia vaccination.

I am now under the care of a doctor who is a leading clinician in the field. I was stunned to learn the seriousness of the illness, including brain and nervous system inflammation, cognitive difficulties (I was a college professor), streaks of muscle pain, nausea and grinding exhaustion. I was shocked to learn that I am 100 percent disabled. My goal is to pass to others information on this illness. It might help them. — B.D.

ANSWER: Chronic fatigue syndrome is an illness that’s difficult to have and difficult to treat because it’s one of those illnesses whose cause remains unknown. By definition, it’s fatigue that lasts longer than six months. The fatigue does not improve with rest. In addition to exhaustion, memory impairment, joint pain, diffuse muscle pain, new headaches, tender neck nodes, sore throat and sleep that doesn’t refresh can be part of the syndrome.

It sounds ridiculous to suggest exercise to people with chronic fatigue. However, a graded exercise program often can improve many symptoms. Exercise should be both aerobic exercise and anerobic exercise. Aerobic exercise is exercise that involves the continuous movement of large muscles, like leg muscles, for a somewhat prolonged period of time. Initially, the time is short, whatever the person is able to do. Five minutes is enough; if that’s too much, take it down to a couple of minutes. Walking is aerobic exercise. The goal is to slowly but persistently increase both the exercise time and intensity. Anerobic exercise is weightlifting. Don’t start with heavy weights; three pounds is enough. Again, the goal is to increase the time spent lifting and the amount lifted.

Refreshing sleep often can be restored with short-term use of sleeping pills. Don’t drink caffeinated beverages after 6 p.m., and don’t exercise within four hours of bedtime.

I’m sure your doctor ran through a battery of tests to exclude illnesses that rob a person of energy: low thyroid hormone output, sleep apnea, anemia and adrenal glands that are not functioning.

The pamphlet on chronic fatigue explains this unappreciated illness in greater detail. Readers can obtain a copy by writing: Dr. Donohue — No. 304, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.